Care Hospital In North-East India Research Articles

Genital dermatoses in children in a tertiary care hospital in Northeast India

Genital dermatoses in children in a tertiary care hospital in Northeast India

Clinicopathological features and risk stratification by the sokal score of patients with chronic myeloid leukemia at a tertiary care hospital in North-East India: A prospective study

Clinicopathological features and risk stratification by the sokal score of patients with chronic myeloid leukemia at a tertiary care hospital in North-East India: A prospective study

Frailty and Associated Factors in the Elderly: A Cross-sectional Study from a Tertiary Care Hospital of Northeast India

Abstract Background: Despite the unfavorable impact of frailty on the health of the elderly, research on frailty in Northeast India remains scarce. This study aimed to assess the prevalence of frailty among elderly inpatients and identify associated factors. Subjects and Methods: This cross-sectional study was conducted among 200 elderly (above 60 years of age) inpatients at a tertiary care hospital. A semistructured pro forma was used to collect data on sociodemographic details and other laboratory parameters. The Fried frailty phenotype was used to assess frailty. Quantitative data were presented as means ± standard deviation, whereas qualitative data were presented as frequency and percentages. The Chi-square/Fisher’s exact test was applied to determine the association, and P < 0.05 was considered statistically significant. Results: The majority of the study participants were male, <70 years, and had a caretaker at home. The proportion of frail among the hospitalized elderly was 50% (95% confidence interval = 42.87%–57.13%). The rest 49.5% were categorized as robust and 0.5% were categorized as prefrail. Frailty was significantly associated with increased age, status of presence of caretaker, addiction, and higher body mass index. Comorbidities such as hypertension, chronic kidney disease, stroke, anemia, diabetes, chronic pulmonary disease, ischemic heart disease, and malignancy were also significantly associated. Conclusions: Frailty is a significant concern among hospitalized elderly individuals. Further research is needed to identify effective interventions to alleviate its impact. Community-level studies should elucidate the relationship between modifiable risk factors and frailty, aiming to enhance the quality of life for our aging population.

Complications of thyroidectomy: Insights from a single-centre study in northeast India

To study and compare the frequency of post-operative complications associated with thyroid surgeries indicated for various benign and malignant pathologies and assess the outcome of management of such complications in a tertiary care hospital in Northeast India. An analytical study was done at a tertiary care hospital in Assam over a period of 1 year from May 2022 to June 2023. Data was collected from 53 patients who underwent surgery at this hospital. Hemithyroidectomy, subtotal, near-total, and total thyroidectomies were performed in 31(58.4%), 2 (3.7%), 6 (11.3%) and 14 (26.4%) cases respectively. The overall rate of complications was 39.6%. Permanent hypocalcaemia was observed to be the most common complication, followed by transient hypocalcaemia and transient recurrent laryngeal nerve palsy. The complications were found to be more frequent in surgery for malignant thyroid disease. There was no mortality in our study. A better understanding of thyroid gland anatomy, meticulous haemostasis and Identification of Recurrent laryngeal nerve and parathyroid glands lead to favourable post-operative outcomes. Appropriate post-operative care with early identification and management of complications plays an essential role in reducing the duration of postoperative hospital stay and limiting patient morbidity.

Importance of 1H-MR spectroscopy of the brain to identify the minimal hepatic encephalopathy in different patients with liver cirrhosis: A prospective study.

Liver cirrhosis patients commonly progress to minimal hepatic encephalopathy (MHE) with cognitive impairment and raised blood ammonia and proinflammatory cytokines levels. This study aims to identify the subjects of MHE in patients with liver cirrhosis by hydrogen 1 magnetic resonance (1H-MR) spectroscopy of the brain, serum proinflammatory cytokines, and neuropsychiatric tests. This prospective was carried out on 100 patients of liver cirrhosis without overt hepatic encephalopathy (HE) and compared with 100 healthy controls in a tertiary care hospital in Northeast India between September 2017 and October 2019. The psychometric hepatic encephalopathy score (PHES) neuropsychological tests, cranial MRIwith 1H-MR spectroscopy, and estimation of serum interleukin 6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were done. The PHES scores and serum proinflammatory markers levels were correlated with the conventional and 1H-MR spectroscopy findings of the brain. The mean PHES score in the case group was -7.58±3.43 (standard deviation [SD]) and the control group was -3.41 ± 3.87 (SD). Patients with Child-Pugh class A (n = 8) had a PHES score of -8.7 ± 2.5 (SD), class B (n = 42) -7.62 ± 3.7 (SD), and class C (n = 50) had a score of -7.36 ± 3.3 (SD). The mean value of IL-6 and TNF-α in the case group was 219 ± 180 (SD) pg/mL and 99 ± 118 (SD) pg/mL and the control group was 67.4 ± 77 (SD) pg/mL and 57.5 ± 76 (SD) pg/mL. Globus pallidus T1-weighted hyperintensities on the visibility scale with a visibility score of 0 were observed in 39 cases, a score of 1 in 38 cases, and a score of 2 in 23 cases. Increased glutamate/glutamine/creatine (Glx/Cr) ratio was identified in the case group on MR spectroscopy as compared to the control (0.95 ± 0.24 vs. 0.31 ± 0.19, P < 0.0005), a decrease of myoinositol/creatine (mI/Cr) ratio (0.11 ± 0.13 vs. 0.30 ± 0.12, P < 0.0005), and increase choline/creatine (Cho/Cr) ratio (0.69 ± 0.26 vs. 0.61 ± 0.20, P < 0.0005). There was a statistically significant difference in Glx/Cr, mI/Cr and Cho/Cr ratio between the case and control groups with P < 0.0005. Predicting the development of MHE in established cases of liver cirrhosis using non-invasive modalities like PHES, IL-6, TNF-α levels, and 1H-MR spectroscopy plays an important role in further progression to overt HE and coma.

Profile of Acute Poisoning and Its Outcome in Children Admitted to a Tertiary Care Hospital in Northeast India: A Cohort Study

Introduction: Acute poisoning in children is an important public health problem. It is a significant paediatric emergency in both developing and developed countries, leading to preventable morbidity and mortality. While there is substantial research literature on acute childhood poisoning from developed countries, there is a lack of data from developing countries like India due to inadequate and poor surveillance of poisoning-related data. Aim: To investigate the clinical and epidemiological profile, as well as the outcome, of acute poisoning in children admitted to the paediatric emergency department of a tertiary care hospital in Northeast India. Materials and Methods: This prospective cohort study was conducted in the Paediatrics department of Assam Medical College and Hospital, Dibrugarh, Assam, India, from April 1, 2021, to March 31, 2022. All children under the age of 12 years who presented to the paediatric department with a history of exposure to toxic substances were included in the study. The admitted children were assessed in terms of demographic variables, type of poison, route of poisoning, time of presentation, circumstances of poisoning, storage place of poison, clinical presentation, and interventions provided. Data were presented as mean and frequency. Results: A total of 78 children under 12 years of age were enrolled in the study, with a mean age of three years and three months at presentation. The majority of cases (96.2%) involved accidental poisoning, while a small proportion (3.8%) was due to suicidal poisoning. Of the two reported cases of suicidal poisoning, one involved a male child and the other involved a female child. Both children were above six years of age. The most common causes of poisoning were kerosene (34.6%), organophosphorus compounds (10.3%), and liquid mosquito repellents (9.1%). Conclusion: This study revealed both unintentional and intentional poisoning cases, with a high prevalence of accidental poisoning observed in children below three years of age. Kerosene was identified as the most common cause of childhood poisoning.

Risk factors and etiology of early-onset neonatal sepsis in Northeastern part of India: Case-control study.

Sepsis, the second most common cause of neonatal mortality, causes more than one million deaths annually. India has the highest incidence of clinical sepsis (17000/100000 live birth). This study aimed to determine the risk factors and organisms of early-onset neonatal sepsis (EONS) in a tertiary care hospital in Northeast India. It was a case-control study conducted in the neonatal unit of MGM Medical College, Kishanganj, Bihar, from January 2022 to April 2023. All neonates admitted to the neonatal intensive care unit (NICU) within 72 hours of life constituted the study population. Neonates diagnosed as EONS by clinical and laboratory parameters were considered as cases and those not diagnosed for EONS as controls. Maternal and newborn information and laboratory parameters were collected and analyzed. For risk factor identification, the bivariate logistic regression was used. An equal number of cases (78) and control (78) were enrolled in the study. Maternal age >30 years (adjusted odds ratio [aOR] = 3.017, confidence interval [CI]: 1.238 to 7.352; P < 0.015), maternal urinary tract infection (UTI) in the third trimester (aOR = 5.435, CI: 2.647 to 11.158; P < 0.0001), and premature rupture of membranes (PROM) (aOR = 2.918, CI: 4.61 to 33.73, P < 0.004) were significant predictors of EONS. Pseudomonas (41.02%), Klebsiella (16.66%), and coagulase-negative Staphylococcus aureus (20.51%) were commonly isolated organisms, which were highly resistant to cephalosporin, meropenem, aminoglycosides, and quinolones. Proper and adequate antenatal screening for diagnosis and treatment of maternal infection and high-risk pregnancies for perinatal management of newborn is recommended to prevent neonatal sepsis-related morbidity and mortality. Rational use of antibiotics may minimize the hazard of antibiotic resistance.

A Cross-sectional Study on the Pattern of Skull Fractures in Fatal Two-wheeler Road Traffic Accidents at a Tertiary Care Hospital in Northeastern India

Introduction: Death due to Road Traffic Accidents (RTA) is one of the leading causes of mortality and morbidity in a developing country like India. As there is a paucity of literature on the nature and type of injuries in RTAs in the locality of Upper Assam, a retrospective study on postmortem cases of fatal two-wheeler accidents was conducted to address the magnitude of the problem. Aim: To analyse different types of skull fractures and causes of death among two-wheeler RTAs at tertiary care Hospital in Northeast India. Materials and Methods: The present cross-sectional study was conducted in the mortuary of Assam Medical College, Dibrugarh, Assam, India, for a period of one year from August 2020 to July 2021. The records of all RTA cases involving twowheeler motorcycles brought for postmortem examination during this period were studied for parameters including age, gender distribution, cause of death, type of skull fracture, intracranial haemorrhage, and time of occurrence, and analysed using descriptive statistics. Results: There were 532 fatal RTA cases recorded, out of which 292 involved two-wheelers (54.89%). Males (87.67%) outnumbered females (12.33%). The most affected age group was between 21-30 years with a total of 98 cases (33.56%), followed by 31-40 years with 68 cases (23.29%). Skull fracture was present in 103 cases (35.27%). Fissured fracture was the most common type seen in 64 cases (62.14%) followed by depressed fracture in 19 (18.45%). The most common single bone fracture was of the Temporal bone in 44 cases (42.72%), followed by frontal bone in 18 (17.48%). Coma was the most common cause of death, seen in 214 cases (73.29%), followed by haemorrhagic shock in 42 (14.38%). Subdural Haemorrhage (SDH) alone was the most common intracranial haemorrhage found in 159 cases (74.30%), followed by Extradural Haemorrhage (EDH) alone in 7 cases (3.27%). Conclusion: Injuries to the skull and brain are the leading cause of death in RTAs. Adequate measures should be taken to prevent mortality and morbidity, achievable through strict enforcement of road safety measures, awareness among the people, and improving road infrastructure along with emergency medical services.

The Spectrum of Deletion Pattern in the Dystrophin Gene in Duchenne Muscular Dystrophy Patients: A Cross-sectional Study from Northeast India

Introduction: Duchenne Muscular Dystrophy (DMD) is an X-linked recessive neuromuscular disorder characterised by progressive, irreversible muscle weakness. It is caused by a mutation in the dystrophin or DMD gene, leading to the absence of the essential muscle protein Dystrophin in DMD. Muscle strength continually diminishes, and death usually occurs from chronic respiratory insufficiency and/or cardiac failure. Due to the high mortality rate, early diagnosis is crucial to allow appropriate planning for patient care and treatment. In India, the traditional multiplex Polymerase Chain Reaction (PCR) assay is the most common method to detect Dystrophin gene deletion mutations. Aim: To describe the spectrum of deletion patterns in the dystrophin gene in muscular dystrophy patients attending a tertiary care hospital in Northeast India. Materials and Methods: A hospital-based cross-sectional study was conducted on a total of 53 suspected DMD patients attending the Department of Neurology and Department of Paediatrics at Assam Medical College, Dibrugarh, Assam, India from January 2016 to December 2022. Multiplex PCR was performed to study the deletion patterns for the 25 most common exons of the DMD gene for all patients at the Genetic lab, Department of Anatomy. Deletion mutations at different multiple exons were found, and the results were statistically analysed using Statistical Package for Social Sciences (SPSS) to calculate the mean and standard deviation. The results were presented in tabular form as percentages. Results: Out of the 53 cases suspected to have DMD on the basis of clinical presentation and high serum Creatine Kinase (CK) levels, 34 patients (64.2%) showing deletion mutations in the 25 most common exons of the DMD gene were included in the study. Deletions were most common in 15 (44.1%) patients in the distal hotspot region of exons 44-55. The most common gene deleted was exon 50 in 11 (32.4%) patients. The age at which symptoms were noticed was 4.7±2.01 years. The mean age at diagnosis was 8.4±2.4 years. Conclusion: In the present study, most patients suspected of DMD based on clinical and laboratory findings had deletions in the DMD gene, with the most common region for deletion in the dystrophin gene being the distal hotspot region, and exon 50 being the most commonly deleted.

Clinicopathological profile and survival analysis of esophageal carcinoma: A retrospective study in a tertiary care hospital in Northeast India

ABSTRACT Background: Esophageal cancer (EC) is an extremely aggressive tumor with one of the highest geographic, ethnic, and gender variations. Various factors including tobacco consumption, unhealthy diet, and socioeconomic status have been implicated in the etiology of EC. Despite the advent of modern treatments, the prognosis of EC is dismal. This study has been undertaken to review the clinical and pathologic profiles, treatment approach, and survival pattern in patients with EC in a tertiary care hospital in northeast India. Materials and Methods: A retrospective descriptive study was done with 179 EC patients presented to our department between January 2013 and December 2020. Statistical analysis was done by using IBM Statistical Package for the Social Sciences version 21. P- value &lt;0.05 was considered significant. Results: The majority of the patients presented in the sixth decade of life from rural areas with male to female ratio of 3.7:1. Dysphagia was the most common presenting feature. High incidence of tobacco and alcohol use was found. Mid-esophagus is the most common site and squamous cell carcinoma is the most common type. Fifty-two (29.1%) and 71 (39.6%) patients presented in stages III and IV, respectively. Twenty-four (13.4%) patients presented with metastatic disease, the lung being the most common site. Patients were treated with surgery, chemotherapy, radiotherapy, or combination of any of these. Overall median survival for the EC patients was 6 months. Patients treated with concurrent chemoradiation had better survival. Conclusion: EC is a serious malignancy with a dismal prognosis due to the advanced stage at presentation. Larger clinical trials using new therapeutic strategies are the need of the hour.

External Beam Radiotherapy for Dysphagia Palliation in Advanced Esophageal Cancer: A Prospective Study

Background: Esophageal cancer is a highly aggressive malignancy often associated with a poor prognosis because of locoregional failure and distant metastases. About 60–70 percent of the patients present at an advanced stage, have a median survival in the range of 6-10 months, and are not amenable to definitive treatment. Dysphagia is the most common complaint, seen in 80%–90% of patients. The priority for managing patients with advanced disease is dysphagia control, which in turn can improve nutritional intake and quality of life. External-beam radiotherapy (EBRT) is one of the major means of palliation. Objective: The primary goal of our study was to assess the efficacy of external beam radiotherapy in alleviating dysphagia in patients with esophageal cancer.Materials and method: This was a single arm prospective clinical study conducted in a tertiary care hospital in northeast India. The study comprised of 57 esophageal cancer patients, ineligible for definitive treatment. The patients received EBRT of 30 Gy in 10 fractions over two weeks. Dysphagia was graded using Modified Takita’s grading system. Patients were followed up at one-month intervals after treatment to assess dysphagia and acute toxicity. Results: Out of 57 patients in the study, subjective dysphagia relief was seen in 82.45%. The median dysphagia score decreased from 3 to 2 at the end of the 3-month post treatment period. (p &lt; .001). In terms of treatment-related toxicity, treatment was well tolerated. No grade 4-5 toxicity was encountered. The most commonly encountered toxicity was radiation esophagitis, which affected 15 patients (26.31%).Conclusion: Radiation significantly improves dysphagia in esophageal cancer patients. It is an effective, non-invasive, and well-tolerated way to treat dysphagia in selected individuals with incurable esophageal cancer.

Road traffic accidents presenting to the emergency department of a tertiary care hospital in North-East India: A cross-sectional study

Road traffic accidents (RTA) are one of the most common cases brought to a hospital daily. The severity of the situation is not known to most of the masses. It has a high chance of mortality and high disabling capacity due to injuries to the main vital parts of the body.: A cross-sectional study was conducted to analyse the pattern of road traffic accidents as regards the type of victims, offending vehicle, place &amp; time of occurrence, type of injuries sustained, fatality among the RTA victims admitted in the emergency department of a tertiary care hospital in North-East India during January 2021-June 2022.A total of 1002 RTA cases were reviewed, and it was found that most of the RTA (76.3%) were males and 32.7% of the cases belonged to the age group of 21-30 years, followed by the age group of 31-40 years (20.5%). RTAs commonly occurred between 12:01 p.m-6 p.m.; the offending vehicles were 4-wheelers (38%) followed by 2-wheelers (36.4%). Most of the victims were 2-wheeler riders (62.2%) followed by pedestrians (16.8%); the head &amp; face were most affected body parts (42.2%) followed by lower limbs (30.6%) and Imphal West was the most common place of occurrence (48.8%).With the increasing use of motor vehicles, the number of road traffic accidents is rising. It is important to find a pattern of these cases in this part of the country so that we can prevent such unfortunate and unnatural deaths.

Clinical profile of COVID-19 infection among persons with spinal cord injury: a case series.

Retrospective case series. To report the clinical features and outcomes of spinal cord injury (SCI) patients with COVID-19 and to see if they are any different from COVID-19 in the general population. A tertiary care hospital in North-East India. Data of already diagnosed traumatic SCI patients with COVID-19 infection reporting to the COVID-19 management team (from June 2021 to November 2021) were collected. The source of data was hospital records (admitted patients) and home visits and teleconsultation logs (home isolation patients). There were eight traumatic SCI patients (five admitted, three in home isolation) with COVID-19 infection. Four patients had complete injury with American Spinal Injury Association Impairment Scale (AIS) Grade A, two with AIS Grade C, and one each of Grade B and D respectively. Five patients were cervical level injuries, and others were T10 level and below. Six patients were categorized as mild clinical illness and one each as moderate and severe illness. Cough was the most common symptom which was seen in seven patients. Only two patients needed oxygen therapy. All eight traumatic SCI patients recovered eventually from COVID-19 symptoms and regained their pre-COVID-19 functional status, 1 month after being free from COVID-19 symptoms. The COVID-19 infection did not result in a worsening of functional ability among SCI people after 1-month post-recovery. It also did not affect the SCI patients in doing activities such as rehabilitation exercises at 6 months follow up.

Cytopathological Spectrum of Salivary Gland Lesions According to Milan Reporting System: A Retrospective Study

Background: The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) was developed in 2015 to standardize reporting of salivary gland cytology, promote better communication between clinicians and institutions, and ultimately improve patient outcomes care. The current study aims to determine the cytopathological spectrum of salivary gland lesions using the Milan System for reporting in a tertiary care hospital of northeast India. Methods: Clinical data and cytology smears of salivary gland lesions diagnosed from January 2016 to May 2021 were retrieved. All the cytology smears were reviewed again and reclassified to one of the six categories after applying strict criteria given by MSRSGC. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of FNAC to detect malignant lesions were calculated considering HPE as the gold standard. Results: A total of 57 salivary gland lesions were examined, 31 (54.38%) were males, and 26 (45.6%) were females with a median age of 34 years (range 6-70 years). Statistical analysis showed the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy as 75%, 100%, 100%, 95%, and 95.65%, respectively. MSRSGC Category IVa was the commonest with 29 cases of pleomorphic adenoma. Conclusion: The overall diagnostic accuracy of cytologic reporting of salivary gland lesions based on Milan nomenclature in our institution was 95.65%. Our findings reflect the positive contribution of the MSRSGC towards accurately identifying the malignant lesions and thus further helping the clinicians regarding the specific management decisions.

Spectrum of lower urinary tract symptoms in the women attending gynecological OPD in a tertiary care hospital in Northeast India

&lt;b&gt;Aim:&lt;/b&gt; Lower Urinary Tract Symptoms (LUTS) are common conditions seen in women of all ages and by clinicians of nearly all specialties. The prevalence of LUTS has been measured by numerous epidemiological studies around the globe. However, there are insufficient data from India, particularly among women consulting gynecology clinics. This observational study was conducted to determine the proportion of LUTS among women attending the Gynecology OPD.&lt;br /&gt; &lt;b&gt;Material and methods:&lt;/b&gt; For the evaluation, a standardized, pretested, structured, and scored Bristol LUTS questionnaire containing sociodemographic information and a clinical history of LUTS symptoms has been utilized. The symptoms of LUTS were classified as storage, voiding, and stress symptoms. Each response received a score between 0 and 4. Patients were categorized into no/minimal LUTS (score1–7), moderate LUTS (score8–19), and severe LUTS (score&amp;gt;20). In our study, 48% of women attending the Gynecological OPD had LUTS. Age and vaginal delivery had a significant influence on the incidence of LUTS.&lt;br /&gt; &lt;b&gt;Results:&lt;/b&gt; Despite the high prevalence of LUTS, few patients in our study spontaneously reported symptoms of LUTS. This underreporting may be due to a lack of awareness as well as social stigma. Many consider these symptoms to be a normal part of the ageing process, especially in postmenopausal women.&lt;br /&gt; &lt;b&gt;Conclusion:&lt;/b&gt; Although all of the patients we have identified are based on the evaluation of a symptomatic questionnaire, a urodynamic study should be conducted to determine whether or not these women have different types of LUTS.

Neutrophil-to-Lymphocyte Ratio (NLR) Useful as a Cost-Effective Preliminary Prognostic Marker in ST-Elevation Myocardial Infarction (STEMI): An Observational Study From a Tertiary Care Hospital in Northeast India.

Introduction Myocardial infarction, a major consequence of coronary artery disease, is an important cause of in-hospital mortality and morbidity worldwide. Blood neutrophil-to-lymphocyte ratio (NLR) is a novel laboratory marker of systemic inflammation that can predict the severity and mortality in various non-cardiovascular illnesses, including malignancy and infective pathology. We sought to evaluate its potential in predicting the outcome in hospitalized patients with myocardial infarction. Material and methods The index study was conducted at Silchar Medical College and Hospital from June 1, 2021 to May 31, 2022, with the aim of evaluating the role of NLR in determining the outcomes of ST-elevation myocardial infarction (STEMI). A total of 110 patients fulfilling the requisite criteria and admitted to the cardiology and medicine departments of the hospital with evidence of STEMI were included in the study and evaluated for the relationship of NLR with various outcome variables in STEMI. Results Out of 110 patients, 69.1% were males. The mean age of the study population was 58.2±15.3 years. The baseline characteristics and risk factors of patients who survived the acute attack of STEMI and those who died from complications of STEMI were similar. Laboratory parameters which correlated with worse outcomes included a higher fasting triglyceride level (173.4 mg vs. 215.6 mg, p < 0.001), a higher blood neutrophil count at baseline, 24 hours and 72 hours (70.1% vs. 69.04%, 66.3% vs. 75.2%, 81.6% vs. 73.8%, p<0.05), a higher NLR value at baseline, 24 hours and 72 hours (2.91 ± 1.13 vs. 3.19 ± 2.32, 2.39 ± 0.74 vs. 5.56 ± 4.11, 5.1 ± 4.38 vs. 3.01 ± 1.02, p < 0.05). Among patients hospitalized with STEMI who had high NLR, had significantly elevated incidence of complications, including a higher acute, left ventricular failure (42.8% vs. 35.9%; p < 0.05) as well as increased risk of mortality (66.7% vs. 33.3%; p < 0.05) compared to low NLR group. Conclusion NLR can predict the outcome among STEMI patients in terms of morbidity and mortality and correlates with poor left ventricular function. NLR can serve as a potential tool for early identification and efficient triage of STEMI patients during initial presentation to the ED. Its utility is more so in resource-constrained developing countries with limited access to health care. The significant advantage of NLR is its easy accessibility, rapid turnaround time, and inexpensiveness.

Analysis of twin pregnancy based on obstetrics and perinatal outcome in a tertiary care hospital in North-East India

Background and Objective: Over the last decade, the incidence of twin pregnancies has been enormously increased. Preterm births and neonatal deaths are associated with twin pregnancies which might be due to prematurity, fetal growth restriction and low birth weight. In the present study, the consequences of twin pregnancy have been analyzed. Methods: This descriptive observational study has been conducted in Silchar Medical College and Hospital in between June 1st 2020 to May 31st 2021.A total of 120 twin pregnant women admitted in maternity ward in labour during the study period. Maternal and perinatal outcome has been analyzed. Result: The result showed that pregnancy complications were remarkably higher. Preterm labour 65.4%, hypertensive disorder of pregnancy 35.2%, premature rupture of membrane 30.2%, anaemia 44.1%, antepartum haemorrhage 7.5%, liquor abnormalities 11.6%, cesarean section 46.7%, postpartum haemorrhage 18.3%, gestational diabetes mellitus 5.8% are the complications encountered. About 10.1% of first twins and 17% of second twins were asphyxiated (APGAR score <7) at 5 minutes of birth. The perinatal mortality rate was 10.2% for first twin and 16.2% for second twin. Very low birth weight (<1500 g) were 18.3% of 1st twins and 24.2% of 2nd twins. Low birth weight (1500 to 2000g) 41.7% of 1st twins and 38.3% of 2nd twins. Presentations during delivery of twin babies were vertex-vertex 50.8%, vertex-non vertex in 29.1%, non-vertex 1st twins 19.8%. Conclusion: Institutional deliveries are essential in twin pregnancies because twin pregnancies are considered as high-risk pregnancies. Early diagnosis, adequate ante-natal, intra-natal and postnatal care are important to boost the outcome.

Understanding the Demographic, Clinical, and Real-Time Polymerase Chain Reaction Profiles of COVID-19 Patients in a Tertiary Care Hospital in Northeast India.

Introduction and aims The demographic and clinical profile and dynamics of real-time polymerase chain reaction (RT-PCR) in coronavirus disease 2019 (COVID-19) patients are not well understood. The study aimed to analyze the demographic, clinical, and RT-PCR profiles of COVID-19 patients. Methodology The study was a retrospective, observational study conducted at a COVID-19 care facility, and the study period was from April 2020 to March 2021. Patients with laboratory-confirmed COVID-19 by real-time polymerase chain reaction (RT-PCR) were enrolled in the study. Patients with incomplete detailsor with only single PCR tests were excluded. Demographic and clinical details and the results of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RT-PCRcollected at different time points were retrieved from the records. The statistical software Minitab version 17.1.0 package (Minitab, LLC, State College, PA, USA) and Rstudio version 1.3.959 (Rstudio, Boston, MA, USA) were used for the statistical analysis. Results The mean duration from symptom onset to the last positive RT-PCR was 14.2 ± 4.2 days. The proportions of positive RT-PCR tests were 100%, 40.6%, 7.5%, and 0% at the end of the first, second, third, and fourthweeks of illness. The median duration of days to first negative RT-PCR in the asymptomatic patients was 8 ± 4 days, and 88.2% of asymptomatic patients were RT-PCR-negative within 14 days. A total of 16 symptomatic patients had prolonged positive test results even after three weeks of symptom onset. Older patients were associated with prolonged RT-PCR positivity. Conclusion This study revealed that the average period of RT-PCR positivity from the onset of symptoms is >2 weeks in symptomatic COVID-19 patients. Prolonged observation in the elderly population and repeat RT-PCR before discharge or discontinuation of quarantine is required.

Perception and Attitude towards Passive Euthanasia among Doctors in a Tertiary Care Hospital in Northeast India: A Cross-sectional Study

Introduction: The medical fraternity now has more control over the processes of life and death due to advances in medical technology and equipment. Euthanasia has been debated around the world for more than half a century and it continues to raise important questions in medical ethics, moral theology, civil rights and liberty. Physicians’ attitudes to life and death emerge to relate their end-of-life decision-making, although usually carried out at the request of ailing person. Physicians’ contemplation on euthanasia is a vital building block in the path towards any change, in the euthanasia situation in a country. Aim: To determine perception and attitude towards passive euthanasia among doctors in Regional Institute of Medical Sciences, Manipur, India and to evaluate the association between attitude and variables favourable to passive euthanasia. Materials and Methods: A cross-sectional survey in the Regional Institute of Medical Sciences (tertiary care hospital), Manipur, India, between October 2018 and September 2020, in Northeast was carried out among 673 doctors. A selfadministered questionnaire was designed and approved by three specialists with expertise in palliative care and medical ethics. The questionnaire had a total of 46 questions in English language, of which 15 questions were on socio-demographic profile, 13 were attitude questions and 18 were questions on perception towards passive euthanasia. Attitude questions were scored using 5-point Likert scale from strongly disagree (-2) to strongly agree (+2). Total attitude score ranges from -26 to +26. Score above zero was considered to have positive attitude and vice-versa. There was no scoring to determine perception towards euthanasia. The questionnaires were given to the doctors and postgraduate trainees of clinical and non clinical specialities in a tertiary care hospital in North Eastern India during their work hours. Data were summarised using descriptive statistics. Chi-square test was used to assess factors favouring attitudes toward passive euthanasia. Results: Age of the respondents ranged from 24 years to 63 years, with a mean age of 37.1±10.7 years and mean duration of experience was eight years. Out of 577 respondents, 368 (63.8%) were postgraduate trainees and 209 (36.2%) were doctors. Majority (463, 80.2%) of the respondents had positive attitude, 97 (16.9%) had negative attitude and 17 (2.9%) had neutral attitude. Total 543 (94.1%) respondents agreed that declaration from patient/family members must be obtained before the act of passive euthanasia. Also, the quality of life as viewed by the patient himself (452, 78.3%) and humanitarian basis (372, 64.4%) were the important factors in influencing decision making regarding passive euthanasia on a terminally ill patient. There was no significant association between sex, religion, specialisation, Intensive Care Unit (ICU) experience and attitude towards passive euthanasia. Conclusion: Majority of the respondents had positive attitude towards passive euthanasia in the face of intractable suffering and terminal illness. Hastened death looks easier to the patients and family because of physical suffering and financial burdens they are subjected to. The doctors got request for euthanasia by the patients and relatives which reflects the public awareness on euthanasia.

A single-center retrospective study of Vitamin D status and acute left ventricular heart failure from a super specialty tertiary care hospital in Northeast India

Introduction: Heart failure (HF) is a progressive clinical condition and is a major cause of mortality and morbidity. Various studies have shown the association of Vitamin D deficiency with HF. The present study aimed to investigate the Vitamin D status among acute left ventricular failure (LVF) patients admitted to our hospital. Materials and Methods: Medical records of 55 acute LVF patients were retrospectively assessed. Patients were categorized according to their Vitamin D status. Demographics, risk factors, clinical presentations, and biochemical data of the patients were analyzed and documented. Results: Patients were grouped based on their Vitamin D status as deficient (40%; n = 22), insufficient (32.7%; n = 18), optimal (23.6%; n = 13), and toxic (3.6%; n = 2). The overall cohort included 67.3% (n = 37) of males with a male/female ratio of 2.1:1. Ages ranged from 22 to 86 years with a mean age of 64.8 years ± 2.3. Rural/Urban was 1:0.9. Hypertension (63.6%; n = 35) was the predominant risk factor across all groups. Mortality was the highest in the Vitamin D deficient group (36.4%; n = 8). The most common symptom observed was dyspnea (76.4%; n = 42). A high incidence of HF with reduced ejection fraction (58.1%; n = 32) was seen in the entire cohort with the highest prevalence in the Vitamin D-deficient group (27.3%; n = 15). Conclusions: Our study revealed a high occurrence of Vitamin D deficiency and insufficiency among HF patients. Routine screening of Vitamin D levels should be done in patients with unexplained cardiac problems. Serious adverse events, including HF, can be prevented and/or reduced on early diagnosis and treatment of Vitamin D deficiency/insufficiency.