Care Teaching Hospital In India Research Articles

Study of Gaming Disorder and Its Association with Depressive Disorder and Anxiety among Medical Students in India

Abstract Context: Internet gaming disorder (IGD) was included in the 5th edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Addiction to Internet gaming is prevalent among Indian medical students. This study aims to measure the severity and pattern of gaming behavior along with the impact and association of IGD on different psychological conditions such as depression and anxiety. Methods: A cross-sectional study was conducted through an online survey among 845 medical students at a tertiary care teaching hospital in India. The Internet GD Scale-Short Form (IGDS9-SF) was used to assess the intensity of gaming disorders, while patient health questionnaire-9 (PHQ-9) and generalized anxiety disorder assessment (GAD-7) were used to assess the severity of depression and anxiety, respectively. Results: A total of 194 students were identified as current gamers, out of which 36 had gaming disorders based on DSM-5 diagnostic criteria for IGD from the current study sample. Multiple regression was calculated for the following age (B = 0.85, P = 0.002), weight (B = 0.07, P = 0.02), average time spent on gaming/day in hours (B = 1.01, P < 0.0001), PHQ-9 scores (B = 0.35, P ≤ 0.0001), GAD-7 scores (B = −0.24, P = 0.01) - Model R 2 = 0.35, F = 19.41, P < 0.0001. Conclusions: Potentially problematic gaming was found to be associated with psychological symptoms, negative affectivity, and a preference for solitude. There is a need for other studies that can help in creating awareness about the prevalence of gaming disorders in medical students.

Impact of Educational Intervention on Knowledge, Attitude & Practice About Pharmacovigilance in Nursing Students in A Tertiary Care Teaching Hospital in India: A Cross-Sectional Study

Background: It is crucial for healthcare professionals to know how to report adverse drug reactions (ADRs). To improve reporting rates, it is essential to improve knowledge, attitude and practice (KAP) of healthcare professionals regarding Pharmacovigilance (PV) and adverse drug reactions (ADR) reporting. According to previous studies, there has been a lack of knowledge in nursing students regarding Pharmacovigilance (PV) and reporting of adverse drug reactions (ADR). Hence, this study was planned to assess the impact of educational intervention on nursing students' knowledge, attitude, and practice of pharmacovigilance at a tertiary care teaching hospital in India. Materials and Methods: This was an interventional study conducted among 93 BSc nursing students at a tertiary care teaching hospital, India. Each participant was explained the purpose of study and asked to fill in a questionnaire about their knowledge, attitude and practice of pharmacovigilance. The post-KAP questionnaire was re-circulated among participants at the end of the intervention and data was analyzed using Chi square test. Results: The study involved 93 BSc nursing students aged 21.52 ± 1.11 years, with a male to female ratio of 1:2. All statistical calculations were performed using Graph Pad prism v10.1.0. Results showed significant differences in understanding pharmacovigilance between pre-intervention and post-intervention, and a significant change in attitudes towards pharmacovigilance due to the educational intervention. A statistically greater proportion of students learned about Pharmacovigilance and ADR reporting forms. Conclusion: The Continuing Medical Education (CME) and group discussions significantly enhanced the knowledge and attitude of nursing students regarding pharmacovigilance.

The Combined Effect of Robot-assisted Therapy and Activities of Daily Living Training on Upper Limb Recovery in Persons With Subacute Stroke: A Randomized Controlled Trial

ObjectivesTo evaluate the effectiveness of robot-assisted therapy (RAT) followed by activities of daily living (ADL) training in comparison with conventional rehabilitation therapy (CRT) and ADL training in individuals with subacute stroke. DesignA single-blind, 2-arm, parallel-group, open-level, randomized controlled trial. SettingA tertiary care teaching hospital in India. ParticipantsForty-four persons (n=44) with first-ever stroke (in subacute stage) were enrolled from August 2021 to July 2023. InterventionParticipants in the RAT group (n=22) received RAT for 30 minutes, followed by ADL training for 30 minutes. In contrast, participants in the CRT group (n=22) received CRT (30 minutes) followed by ADL training (30 minutes). Both groups received allocated interventions for 15 days over 3 weeks (5 days/week, 3 weeks). Main Outcome MeasuresPrimary outcome: Motor domain score of the Fugl-Meyer Assessment scale for upper extremity (FMA-UE). Secondary outcomes: the other domains scores of FMA-UE (UL -sensation, -joint motions, -joint pain); Modified Ashworth Scale (MAS) (spasticity); hand-function (HF) and ADL-domain scores of the stroke impact scale (SIS); WHOQQL-BREF questionnaires (QOL). Participants were assessed at enrolment and follow-up at 3, 6, and 12 weeks. ResultsPersons who received RAT and ADL training reported significant improvement (P<.05) in UL motor function (mean difference [MD]=3.54;(95% confidence interval [CI]: 1.28 to 5.79]), UL passive joint motions (MD=2.54; [95% CI: 1.56 to 3.52]), SIS-HF (MD=6.37;[95% CI: 4.75 to 7.99]), SIS-ADL (MD=7.13 [95% CI: 3.52 to 8.74]), and in all domains of WHOQOL-BREF (except environmental domain) compared with persons who received CRT and ADL training at 12 weeks. ConclusionsThe findings indicate that RAT followed by ADL training is more effective than CRT followed by ADL training in motor improvement, SIS-HF, SIS-ADL, and QOL at 12 weeks.

Predictors of biomedical waste management practices among staff nurses of a tertiary care teaching hospital in India.

Inappropriate handling of biomedical waste (BMW) may pose serious threats to the health of patients and hospital personnel. Among all healthcare workers, staff nurses play a vital role in BMW management (BMWM). Thus, the present study aimed to determine the predictors of BMWM practices among staff nurses of a tertiary care teaching hospital in India. A prospective cross-sectional study was conducted among 150 staff nurses, working at a tertiary care teaching hospital in South India, from July to August 2018. Data were collected using a pretested, semi-structured, and self-administered questionnaire after taking their written informed consent. Regression analysis was carried out to identify the predictors of satisfactory BMWM practice status. Of the total 150 staff nurses, most of them were young females with a work experience of ≤ 5 years. Concerning knowledge scores, most staff nurses (63.3%) belonged to the moderate category, whereas a few (24%) were in the high category. Also, most of them (62.7%) were in the high category of attitude scores. For practice scores, half of the participants were in moderate and high categories, each. Female gender, attended training status, and moderate and high knowledge scores were significantly associated with satisfactory BMWM scores in unadjusted analysis. After adjusting for other independent variables, all these three factors were found significantly associated with satisfactory BMWM practice scores. The present study shows that the female gender, attending training in BMWM, and having a moderate and high knowledge of BMWM were significant predictors of satisfactory BMWM practice among staff nurses. Thus, all hospitals must periodically train their staff nurses to strengthen their BMWM practices. Safe BMWM leads to environmental protection and safeguards the health of patients, hospital personnel, and the public.

Treatment Cost Along With Pattern of Disease and Therapy in the Intensive Care Unit of a Tertiary Care Teaching Hospital in India.

Background The intensive care unit (ICU) represents an important platform for conducting drug utilization analysis using defined daily dose (DDD)/100 bed-days and the financial burden of treatment as patients are seriously ill and are often suffering from chronic critical illnesses. Therefore, in this study, we evaluated the drug utilization patterns and cost of treatment in the ICU. Methods A retrospective observational analysis of the medical records obtained for the medical ICU of an apex tertiary care teaching hospital in central India was conducted for a period of three years from 2017 to 2019. All the patients admitted to the medical ICUduring the study tenure were included in the study. Patients hospitalized in neonatal intensive care unit (NICU), pediatric intensive care unit (PICU), and surgical ICU were excluded from the study. The socio-demographic and clinical data, utilization of different classes of drugs, WHO-Anatomic Therapeutic Chemical(WHO-ATC) classification, DDD/100 bed days, hospital stay, etc. were analyzed.A partial pharmaco-economic analysis of the average cost of admission to patients was done. Results Data from 280 patients was assessed. The mean age was 47 ± 19.18 years and 58% were males. Antibiotics and injections were prescribed to 96% and 97.5% of the patients, respectively, during their ICU stay (median: seven days). Antimicrobial drugs were most frequently prescribed (n=1096, 68%); the most common were beta-lactams and carbapenems, followed by drugs acting on the central nervous system (5%) and cardiovascular system (4.3%). Cefoperazone/sulbactum, ceftriaxone, and piperacillin/tazobactam were the most utilized antibiotics with 8, 16, and 6 DDD/100 bed-days, respectively, while proton pump inhibitors, analgesics, and anti-epileptics were the most frequently prescribed non-antimicrobial drug class. The median cost of treatment per ICU admission was Indian Rupees (INR) 23,347 (IQR 12,552- 65,524). Conclusion Drug utilization assessment provides crucial information for understanding the usage of drugs in the settings of the ICU, and should be conducted regularly to help in the proper planning and implementation of rational drug use. Treatment costs reflect the high economic burden seen in ICU admissions.

High-dose versus low-dose intravenous nitroglycerine for sympathetic crashing acute pulmonary edema: a randomised controlled trial

ObjectivesSympathetic crashing acute pulmonary edema (SCAPE) is a subset of heart failure with a dramatic presentation. The unique physiology of this condition requires a different management strategy from the conventional...

Acquaintance of medical students with the National List of Essential Medicines

Background: Undergraduate medical students are future prescribers of medicines, and they must understand the concept of essential medicines and their importance in healthcare. Regulations on Graduate Medical Education Amendment 2019, has revolutionized Indian medical education by introducing competency-based medical education which states that the major goals for an Indian medical graduate are to acquire the competency of a “clinician who understands and provides preventive, promotive, curative, palliative, and holistic care with compassion.” The National List of Essential Medicines (NLEM) has been included as a core topic in the curriculum of undergraduate medical students. This research attempted to understand the level of knowledge regarding the NLEM among undergraduate medical students. Aim and Objective: To assess the baseline level of knowledge regarding the NLEM among undergraduate medical students. Materials and Methods: A questionnaire-based study was done among medical students of a government tertiary care teaching hospital in India. 1st year students were excluded as they were not taught about Essential Medicines and NLEM. A pre-validated multiple-choice questionnaire was distributed to medical students and information was collected related to knowledge regarding NLEM significance, criteria for inclusion in NLEM, terminologies, and drugs in NLEM that are used for common conditions. Results: Out of 600 students 237 (39.50%) students responded. 98 (41.35%) students were aware of recent NLEM-2022, 91 (38.40%) students were aware of terminologies used in NLEM, and 71 (29.96%) students were aware of the criteria for inclusion of any drug in NLEM. 175 (73.84%) students were unaware of updates in NLEM-2022. 165 (69.62%) students were unaware of the number of medicines added and deleted in NLEM-2022.155 (65.40%) students were not able to answer the questions regarding drugs for anaphylaxis and new antihypertensive drugs included in recent NLEM-2022. Conclusion: Knowledge regarding NLEM is limited among undergraduate medical students. To sensitize medical students to rational drug therapy, there is an urgent need to improve their knowledge related to NLEM via educational interventions.

Unit Cost of Magnetic Resonance Imaging Scan at a Tertiary Care Teaching Hospital in India

Unit Cost of Magnetic Resonance Imaging Scan at a Tertiary Care Teaching Hospital in India

Surgical Site Infections in Elective and Emergency Abdominal Surgeries: A Prospective Observational Study About Incidence, Risk Factors, Pathogens, and Antibiotic Sensitivity at a Government Tertiary Care Teaching Hospital in India.

Background Surgical site infections (SSIs), the third most common nosocomial infection, endanger hospitals and patients. SSIs must be monitored continuously. This present study examined SSI incidence, risk factors, pathogens, and antibiotic sensitivity in emergency and elective or planned abdominal surgeries. Methods The Dr. S.N. Medical College General Surgery Department in Jodhpur, India, operated on 100 patients. The sample was divided into two 50-person groups. Group A includes emergency surgery patients, while Group B includes elective surgery patients. The samples were aseptically collected and processed according to microbiological methods. Data were processed with IBM SPSS Statistics for Windows, version 20 (released 2011; IBM Corp., Armonk, New York, United States). Results Out of a sample size of 100 patients, 17 individuals experienced SSIs. SSIincidence was 16.66% in male patients and 18.18% in female patients. In addition, the rate of SSIs was 26% in the emergency group and 8% in the planned group. The association was stronger among elderly individuals, diabetics (33.33% in Group A and 12.5% in Group B), and anemics with a history of smoking. The association was higher in those who underwent surgery for more than 60 minutes (34.37% in Group A and 18.8% in Group B). The incidence of SSIs was higher in emergency cases compared to elective surgeries, with rates of 26% and 8%, respectively, but was statistically insignificant. The infection rate in clean cases during planned surgery was 3.70%, while clean contaminated cases during planned surgery had a wound infection rate of approximately 13.04%. In emergency surgery, no clean case was operated on, but the SSI rate in the emergency group was 9.09%, 22.22%, and 47.36% in the clean-contaminated, contaminated, and dirty cases, respectively.In Group A, Escherichia coli was the predominant organism found in SSI wounds, while in Group B, Staphylococcus aureus was the predominant organism, accounting for 46.15% and 50% of infections, respectively. Amikacin and metronidazole exhibited the highest efficacy against E. coli, with amikacin demonstrating the highest sensitivity. Conclusion SSIs are more common in emergencies than planned procedures. Age, gender, diabetes, hypertension, smoking, and prolonged surgery are risk factors for SSIs. Effective antibiotic policy and infection control can greatly prevent SSIs.

A study to evaluate the significance of Mantoux test investigated for tuberculosis in a tertiary care teaching hospital of India

A study to evaluate the significance of Mantoux test investigated for tuberculosis in a tertiary care teaching hospital of India

A Two-Year Surveillance of Central Line-Associated Bloodstream Infections in the Trauma ICU of a Tertiary Care Hospital in India.

Aim The aim of the study is to identify therisk factors and mortality associated with central line-associated bloodstream infection (CLABSI) and to investigate the incidence and associated etiology in trauma patients admitted to the trauma ICU (TICU) of a tertiary care teaching hospital in Northern India. Materials and methods The study was a prospective study conducted in the trauma ICU of a tertiary care teaching hospital in India from November 2020 to October 2022. Adult patients >18 years of age who were on central line for >48 hours were included in the study. The automated blood culture system BacT/ALERT 3D (bioMérieux, Durham, NC) was used for microbial detection from blood samples. We recorded patients' daily progress, and catheter-related data was collected and used as variables. All the data was analyzed using the Statistical Package for Social Sciences (SPSS)version 22.0 (IBM SPSS Statistics, Armonk, NY)to evaluate the risk factors associated with CLABSI. Result A total of516 admissions occurred during the surveillance period, out of which352 patients fulfilled the inclusion criteria and were enrolled in the study. Out of these 352 patients, a total of 74 patients developed central line-associated bloodstream infection (CLABSI). Thus, the incidence of CLABSI was 16.4 per 1000 central line days and 13.2 per 1000 inpatient days with a 0.8 device utilization ratio (DUR). The most common organisms isolated from these CLABSI cases were Acinetobacter species (23%), followed by Escherichia coli(16.5%) and Staphylococcus aureus(15.6%). The independent healthcare-associated risk factors for CLABSI were longer length of ICU stay and prolonged duration of central venous catheterization. The most common comorbidity associated withCLABSI was diabetes mellitus (20.3%), followed by hypertension (14.8%), and the mortality rate was 41.9%. Conclusion The healthcare-associated risk factors such as longer length of ICU stay and prolonged duration of central venous catheterization are the risk factors for developing central line-associated bloodstream infections (BSI).

Developmental outcomes of very low birth weight infants in a tertiary care teaching hospital in India

Developmental outcomes of very low birth weight infants in a tertiary care teaching hospital in India

Appropriateness of Surgical Antibiotic Prophylaxis in a Tertiary Care Teaching Hospital in Central India: A Retrospective Analysis.

Surgical antibiotic prophylaxis (SAP) has been a boon in the prevention of surgical site infections (SSIs). This study was conducted to assess and evaluate the selection, timing, and duration of administration of SAP and their compliance withnational and international guidelines in a tertiary care teaching hospital in India. This retrospective study included the data collected from the central records department in a tertiary care teaching hospital on major surgeries conducted between January 1, 2018, and December 31, 2018, from the departments of ENT, general surgery, orthopedic surgery, and obstetrics and gynecology. The data was analyzed for the appropriateness of their indication for SAP administration, choice, timing, and duration of antibiotics, and compliance with the American Society of Health-System Pharmacists (ASHP) and Indian Council of Medical Research (ICMR) guidelines. Results and interpretation Out of the total 394 case records included, only 2.53% (n = 10) of the cases were given an appropriate antibiotic. The duration of SAP was appropriate only in 6.53% (n = 24), and the timing of SAP administration was appropriate only in 50.76% (n = 204). The most commonly used antibiotic was ceftriaxone (pre-operative 58.12% (n = 229) and post-operative 43.14% (n = 170)). Major inappropriateness was observed in the selection of antibiotics which may be attributed to the non-availability of cefazolin in the institute. The inappropriateness of the duration of the SAP may be attributed to the extra precautions taken by the treating physicians to prevent SSIs. The overall compliance of the surgical cases with respect to the ASHP and ICMR guidelines was less than 1%. Conclusion This study identified the lacuna between the guidelines for SAP and the clinical application of the same. It also identified the areas where quality improvement was needed which can be improved by implementing antimicrobial stewardship, especially the choiceand the duration of SAP administration.

COMPARATIVE ANALYSIS OF MRI AND ARTHROSCOPIC FINDINGS FOR KNEE ACLAND MENISCAL INJURIES

Background and Aim: Common knee injuries include meniscal or ligamentous tears, which can cause discomfort, instability, and movement restrictions. The knee is evaluated using a variety of imaging techniques, such as radiography, CT scans for fractures, and MRIs for soft tissue damage to the knee joint. Our study's objective was to compare the results of the aforementioned two methods and assess the radiological and arthroscopic ndings of anterior cruciate and meniscal injuries. Find out which of the two is more effective at accurately diagnosing ACL and meniscal injury. Material and Methods: This is a prospective study that was done on at least 200 patients who met the inclusion criteria and were being treated for knee injuries at a Tertiary Care Teaching Hospital in India. Among of them, 200 knee injury patients had an MRI, clinical examination, and arthroscopy. Many statistical tests were used to compare and assess the outcomes. These arthroscopy and MRI data were used to compute the accuracy, sensitivity, and specicity. Results: In our investigation, the sensitivity, positive predictive value, and accuracy of an MRI scan in identifying ACL injury were 91.10%, 93.10%, and 87.5%, respectively. In our investigation, the sensitivity, positive predictive value, and accuracy of MRI scan in diagnosing medial meniscus damage were, respectively, 86.8%, 90.12%, and 87.2%. In our study, lateral meniscus injury was detected by MRI scan with 74.15% sensitivity, 71.25% PPV, and 84% accuracy, respectively. Conclusion: Our research demonstrated good sensitivity, specicity, and accuracy for knee joint ACLand meniscal injuries. Meniscus and ACLdamage can be accurately diagnosed by MRI. For therapeutic arthroscopy, MRI is a suitable screening tool, negating the need for diagnostic arthroscopy in the majority of patients. For the assessment of ligamentous and meniscus injuries, magnetic resonance imaging is a reliable and noninvasive method.

Impact of Virtual Interprofessional COVID-19 disaster simulation Tabletop Exercise (VICTEr) workshop on Disaster Preparedness among interprofessional trainees in a tertiary care teaching hospital in India

INTRODUCTION: Disaster planning is of significant importance for the healthcare professional and the healthcare setting. Hospital-based disaster protocols form the cornerstone of disaster response. There is a paucity of data on disaster preparedness training using the virtual tabletop exercise (VTTX) module for interprofessional education from in-hospital and prehospital settings. With the coronavirus disease 2019 (COVID-19) pandemic, we have seen a paradigm shift of education strategies to the virtual realm. Here we attempt to study the impact of an online tabletop exercise workshop on the knowledge and confidence of disaster preparedness among Interprofessional trainees. MATERIAL AND METHODS: Interprofessional trainees from medical, dental, nursing, respiratory therapy, and paramedic domains who consented were included in this study. Institutional ethics committee approval was received and the study was registered with the clinical trials registry India (CTRI), before initiation. The VTTX module has been adapted from the World Health Organization (WHO) COVID-19 training resources. Three international experts from the disaster medicine domain validated the module, questionnaire, and feedback. Wilcoxon signed-rank test was used to compare the parameters (Knowledge and confidence level) pre and post-workshop. RESULTS: A total of 76 candidates with a mean age was 21.67 ± 2.5 (range:19–36) were part of the workshop. Comparison of the median scores and interquartile range of confidence level and knowledge respectively before [38 (29.25–45.75), 9 (7–11)] and after [51.50 (45–60), 11 (10–12)] the workshop showed vital significance (p-value &lt; 0.001). All participants gave positive feedback on the workshop meeting the objectives. The majority agreed that the workshop improved their self-preparedness (90%) and felt that the online platform was appropriate (97.5%). CONCLUSIONS: This study sheds light on the positive impact of the online VTTX based workshop on disaster preparedness training among interprofessional trainees. Disaster preparedness training using available online platforms may be effectively executed with the VICTEr workshop even during the COVID-19 pandemic. The VICTEr workshop serves as a primer for developing online modules for effective pandemic preparedness training in interprofessional education.

Assessment of medication adherence among hypertensive patients in a tertiary care teaching hospital in India

Background: Hypertension is a chronic disorder and a prevalent non-communicable disease in India. With the increasing burden of hypertension, adherence to antihypertensive therapy plays a vital role to control blood pressure and preventing its complications. Therefore, this study was done in our tertiary care hospital to understand the medication adherence level in hypertension patients. Aims and Objectives: To assess adherence to antihypertensive medications in hypertensive patients using pre-tested structured questionnaire. Materials and Methods: A prospective observational study was conducted for 3 months in 100 hypertensive patients. The adherence status of patients to antihypertensive medications was assessed using an eight-item Morisky’s Medication Adherence Scale (MMAS-8). Results: Majority of the study participants in our study were &gt;50 years (68%) and females (64%). We observed that patients taking combination therapy better adhered to medication than monotherapy. We assessed in detail the medication adherence level among study participants using MMAS-8 and analyzed the reasons for non-adherence. Conclusion: The medication adherence rate in our study was found to be moderate to high, which needs to be maintained to attain optimal clinical benefit and also to prevent hypertension-related complications.

E-HEART score: A novel scoring system for undifferentiated chest pain in the emergency department.

Cardiovascular disease is the leading cause of death worldwide. As there is an increase in the global burden of ischemic heart disease, there are multiple scoring systems established in the emergency department (ED) to risk stratify and manage acute coronary syndrome (ACS) in patients with chest pain. The objective of this study was to integrate point-of-care echo into the existing history, electrocardiogram, age, risk factors, and troponin (HEART) score and evaluate a novel scoring system, the echo HEART (E-HEART) score in risk stratification of patients presenting with undifferentiated chest pain to the ED. The E-HEART Score was also compared with existing traditional scoring systems for risk-stratifying acute chest pain. A diagnostic accuracy study involving 250 patients with chest pain at the ED of a single tertiary care teaching hospital in India was conducted. The emergency physicians assessed the E-HEART score after integrating their point-of-care echo/focused echo findings into the conventional HEART score on presentation. The primary endpoint was the occurrence of major adverse cardiovascular events (MACE) within 4 weeks of initial presentation. The accuracy of the E-HEART score was compared with other conventional risk stratification scoring systems such as the thrombolysis in myocardial infarction (TIMI), history, electrocardiogram, age, and risk factors, Troponin Only Manchester ACS (T-MACS), and HEART scores. A total of 250 patients with a median age of 53 years (42.25-63.00) were part of the study. Low E-HEART scores (values 0-3) were calculated in 121 patients with no occurrence of MACE in this category. Eighty-one patients with moderate E-HEART scores (4-6) were found to have 30.9% MACE. In 48 patients with high E-HEART scores (values 7-11), MACE occurred in 97.9%. The area under receiver operating characteristics (AUROC) of E-HEART score is 0.992 (95% confidence interval: 0.98-0.99), which is significantly higher than AUROC values for HEART (0.978), TIMI (0.889), T-MACS (0.959), and HEAR (0.861), respectively (P < 0.0001). At a cutoff of E-HEART score >6, it accurately predicted ACS with a sensitivity of 92% and a specificity of 99% with a diagnostic accuracy of 97%. The E-HEART score gives the clinician a quick and accurate forecast of outcomes in undifferentiated chest pain presenting to the ED. Low E-HEART scores (0-3) have an extremely low probability for short-term MACE and may aid in faster disposition from the ED. The elevated risk of MACE in patients with high E-HEART scores (7-11) may facilitate more aggressive workup measures and avoid disposition errors. E-HEART is an easily adaptable scoring system with improved accuracy compared to conventional scoring systems.

Antihypertensive therapy is associated with improved visuospatial, executive, attention, abstraction, memory, and recall scores on the montreal cognitive assessment in geriatric hypertensive patients.

The prevalence of Mild Cognitive Impairment (MCI) has increased over the past few decades. However, it can potentially be reversed if detected early. Early detection of MCI using the sensitive Montreal Cognitive Assessment (MoCA) might prove to be an important cog in the wheel in identifying and slowing down this morbid pandemic in hypertensive persons. To study the association of antihypertensive agents on cognitive scores and prevalence of MCI using the MoCA. This is a single-center, controlled, observational, cross-sectional study in a tertiary care teaching hospital in India. Cognitive assessment was done using the Montreal Cognitive Assessment. Data on MoCA scores were comprehensively analyzed. A total of N=210 patients (n=105 the in study and control groups) were included in the study. The median (IQR) MoCA score (out of 30 points) in patients taking antihypertensives was 26 (25 - 27), while it was 24 (22 - 25) in the control group. There was no difference in MoCA scores between patients taking lipophilic or hydrophilic antihypertensives. Similarly, there was no difference in MoCA scores between patients taking different drug regimens. Anti-hypertensive therapy and lower blood pressure had a statistically significant positive association with visuospatial, executive, attention, abstraction, memory, and recall MoCA scores. Patients on antihypertensive therapy also had a lower prevalence of MCI. MoCA scores were similar in patients on either lipophilic or hydrophilic drugs and were similar between patients on different antihypertensive drug classes.

Assessment of Severity of Knee Pain and its Relationship with Serum and Urine Biomarkers in Individuals with Osteoarthritis Knee

<h3>Research Objectives</h3> To assess the severity of knee pain in persons with primary osteoarthritis (OA) knee and find out the possible association between severity of knee pain and (serum and urine) biomarkers. <h3>Design</h3> A cross-sectional study. <h3>Setting</h3> A tertiary care teaching hospital in India. <h3>Participants</h3> Persons presenting with knee pain, with diagnosis of primary osteoarthritis Knee (unilateral/ bilateral) with a Kellgren-Lawrence score of 3. <h3>Interventions</h3> Nil. <h3>Main Outcome Measures</h3> The severity of knee pain was assessed with a visual analog scale (VAS). Among biomarkers, C-telopeptide type-II Collagen (CTX-II) and N-telopeptide- type-I Collagen (NTX-I) were assessed from urine. From serum, cartilage oligomeric matrix protein (COMP), N-terminal propeptide of collagen type-IIA (PIIANP), and hyaluronic acid (HA) were assessed. Besides these, erythrocyte sedimentation rate (ESR) and C-reactive Protein were assessed. In this study, we calculated the correlation coefficients between pain (VAS) scores and individual biomarkers. <h3>Results</h3> A total of 96 persons (47% were female) with OA knee grade III participated in the study. The mean age and body mass index (BMI) of the participants was 59 years and 26.6 kg/m2. None of the participants were using any walking aids or any orthosis/ knee brace. The mean ESR and uric acids were 14.05 mm/hour and 5.40 mg/dL. Using spearman's correlation coefficient, the study found a correlation among VAS pain and ESR (p<0.001, r=0.51), CRP (p=0.002, r=0.31) and HA (p=0.024, r=0.23). However, the study failed to demonstrate any association between the intensity of knee pain and bony biomarkers- CTX-II (p=0.14, r=0.15), NTX-I (p=0.67, r=0.43), COMP (p=0.06, r=-0.20) and PIIANP (p=0.26, r=0.12). <h3>Conclusions</h3> The study confirmed the relationship between the intensity of knee pain and inflammatory markers- ESR, C-reactive protein and HA. <h3>Author(s) Disclosures</h3> The study was supported by extramural research grant (ICMR).

Efficacy of Intra-articular, intra-osseous Injections of Platelet-Rich Plasma in Osteoarthritis Knee: A Randomized Clinical Trial

<h3>Research Objectives</h3> To evaluate the efficacy of intra-articular, intra-osseous Injections of platelet-rich plasma (PRP) and compare its efficacy with intra-articular injection of PRP in OA Knee. <h3>Design</h3> A parallel 2 group, prospective randomized clinical trial. <h3>Setting</h3> A tertiary care teaching hospital in India. <h3>Participants</h3> A total of 64 persons with OA knee with a Kellgren-Lawrence score of 3 were randomized into two groups. <h3>Interventions</h3> Persons in Group-I received 8ml of single intra-articular PRP injection, and persons in Group II received 18 ml of PRP (two-intra-osseous injections (5ml each in femoral-condyle and tibia plateau) and one intra-articular injection (8ml) of PRP (total 18 ml of PRP, for single joint)) the in the target knee joint under fluoroscopic guidance. All persons (n=64) were followed up at 3 and 6 months. <h3>Main Outcome Measures</h3> Clinical outcomes were evaluated using the visual analog (VAS) pain intensity scores and knee injury and osteoarthritis outcome score (KOOS) questionnaire. <h3>Results</h3> There was no disparity between the two groups in baseline demographic and clinical parameters. Both groups demonstrated statistically significant improvement in VAS pain scores and KOOS scores (pain, symptoms, ADL, sport/recreation, and quality of life) at baseline, 3- and 6 months. However, comparing the two groups revealed no significant difference in VAS scores and KOOS scores at six months. Persons in Group-II reported increased injection-associated pain following interventions. Except for injection-associated pain, no other adverse events were reported in any person. <h3>Conclusions</h3> Though both groups showed significant improvement following PRP injections, additional injections of PRP in the subchondral region did not provide additional benefits (pain-relief and KOOS scores) than intra-articular-PRP injections at 6 months. <h3>Author(s) Disclosures</h3> The institutional intramural research grant supported the study.