Case Record Form Research Articles

SCOPE: Surveillance of COVID-19 in pregnancy- results of a multicentric ambispective case-control study on clinical presentation and maternal outcomes in India between April to November 2020.

To determine the clinical manifestations, risk factors, treatment modalities and maternal outcomes in pregnant women with lab-confirmed COVID-19 and compare it with COVID-19 negative pregnant women in same age group. Multicentric case-control study. Ambispective primary data collection through paper-based forms from 20 tertiary care centres across India between April and November 2020. All pregnant women reporting to the centres with a lab-confirmed COVID-19 positive result matched with controls. Dedicated research officers extracted hospital records, using modified WHO Case Record Forms (CRF) and verified for completeness and accuracy. Data converted to excel files and statistical analyses done using STATA 16 (StataCorp, TX, USA). Odds ratios (ORs) with 95% confidence intervals (CI) estimated using unconditional logistic regression. A total of 76,264 women delivered across 20 centres during the study period. Data of 3723 COVID positive pregnant women and 3744 age-matched controls was analyzed. Of the positive cases 56·9% were asymptomatic. Antenatal complications like preeclampsia and abruptio placentae were seen more among the cases. Induction and caesarean delivery rates were also higher among Covid positive women. Pre-existing maternal co-morbidities increased need for supportive care. There were 34 maternal deaths out of the 3723(0.9%) positive mothers, while covid negative deaths reported from all the centres were 449 of 72,541 (0·6%). Covid-19 infection predisposed to adverse maternal outcomes in a large cohort of Covid positive pregnant women as compared to the negative controls.

Tracheostomy in Non-malignant Disorders

Background: Tracheostomy is a surgical procedure, often a life saving measure in a variety of clinical conditions. It is one of the commonest procedures carried out on the critically ill patient. The most common causes of non-malignant airway obstruction are head and severe facial trauma, cerebrovascular accident, coma, respiratory burn and presence of foreign bodies in airway etc. Tracheostomy is an increasingly utilised adjunct in the ICU management of patients. Effective tracheostomy management involved the multi-professional team in a coordinated approach.
 Objectives: To study the indications of tracheostomy in non-malignant disorders.
 Study design: Cross-sectional study.
 Study setting and period: Department of Otolaryngorhinology and Head- Neck surgery (Unit- 1,2,3), General Surgery, ICU, Casualty, Neurosurgery, Thoracic surgery, Burn & Plastic Surgery and relevant OPD in Dhaka Medical College Hospitalfrom6th September 2015 to 5th March 2016.
 Methods: A hospital based cross-sectional study. Fifty patients admitted to hospital, underwent tracheostomy for non-malignant factors. Purposive samplings technique was used. Detail demographic data were collected from the informant and recorded in structured case record form. Clinical examination and relevant investigation were done meticulously. All collected questionnaire checked very carefully to identify the error in the data. Data processing work consist of registration schedules, editing computerization, preparation of dummy table, analyzing and matching of data.
 Result: A total of 50 patients of non-malignant pathology causing airway patency loss in different ward unit of DMCH were selected. In this study, maximum numbers of patients (36%) were between 51-70 years age groups with mean age was 47.23±11.57 years. It was observed that, frequency of non-malignant aetiology for tracheostomy gradually increases with age. Study show that, 51-70 years was most frequent age group (36%). Out of 50 cases 82% were male. Present study show that socioeconomically majority patients were poor class (52%), highest percentage of patient comprised of day labourer (30%). Head trauma (12%) and cerebrovascular accidents (9%) were the most common etiological factor trauma was the major aetilogical group (50%),followed by, central drive problems or neurological disease (38%) and elective tracheostomy was done.
 Conclusion: Head and facial trauma, cerebrovascular accident, coma, respiratory burn and presence of foreign bodies etc. are common aetilogical factors. It was found that tracheostomy is safer alternative to intubation when a prolonged artificial airway is required.
 Bangladesh J Otorhinolaryngol 2022; 28(2): 157-164

Prevalence of behavioral risk factors and their association with dementia in the urban population of North India

Background: Dementia has become a public health problems due to its association with behavioural risk factors; smoking, alcoholism, sedentary behaviour, western type diet, obesity, diabetes, and hypercholesterolemia. Most of these behavioural risk factors appear to be associated with dementia as well as with risk of cardiovascular diseases (CVDs) and diabetes. This study aims to find out the prevalence of behavioural risk factors and their association with cognitive deficit and dementia. Study design and setting: Cross-sectional survey in a hospital. Subjects and methods: After written informed consent and approval from hospital ethic committee, all subjects (n=2002) above 25 years of age (1016 males and 986 females) were randomly selected and recruited from urban population of Moradabad, North India. Clinical data and risk factors were recorded with the help of case record form and validated questionnaires. Assessment of cognitive decline and dementia was made by a new memory function rating scale and behavioural risk factors by validated questionnaires. The association of behavioral risk factors with dementia was calculated by multivariate logistic regression analysis after adjustment of age and sex, obesity, diabetes and CVDs. Results: Low cognitive activity, low education, sedentary behavior, sleep duration, tobacco intake, alcoholism and western diet, were highly prevalent independent risk factors of dementia. Low education was not associated with risk. Logistic regression analysis revealed that regardless of age and body mass index, sedentary behavior, odds ratio and confidence intervals: (men 0.74 (0.69 - 0.79), women, 0.71 (0.63 - 0.74) and tobacco intake (men 0.88 (0.79 - 0.94), women 0.90 (0.84 - 0.97) and sleep disruption (men 0.80 (0.71 - 0.89), women 0.85 (0.79 - 0.91) were strongly (p<001) and significantly (p<0.001) associated with dementia in both sexes, respectively. Alcoholism (men 0.71 (0.65 - 0.78) was also strongly and significantly (P<001) associated with dementia in men but not in women. Low cognitive activity, (men 0.83 (0.75 - 0.92), (women 0.89 (0.84 - 0.99), and western diet (men 0.88(0.80-0.95), (women 0.89 (0.81 - 0.99) were weakly but significantly (p=0.05) associated with dementia in both sexes. Meditation and prayer was inversely associated with dementia among (men 0.92 (0.85 - 0.99) and (women 0.90 (0.85 - 0.97). Conclusions: It is possible that increased physical activity, no tobacco and alcoholism, optimal sleep, intake of healthy foods, meditation and prayer, high cognitive activity, and good sleep for 6-8 hours, can protect against dementia.

Prevalence and Associated Clinical Features of Type 1 Diabetes Mellitus Among Children Presented to a Tertiary Health Care Center of Himalayan Foothills.

Introduction Diabetes Mellitus (DM) is a complex metabolic disorder characterized by chronic hyperglycemia. Knowing its prevalence, associated clinical features, and complications is essential for diagnosing children having diabetes-like clinical features. Since there is a limited study from India and no similar study from this geographical part, the present study was carried out. Material and method It is a cross-sectional study, which includes children aged 1-18 years presented to the pediatric outpatient department (OPD), inpatient department (IPD), and emergency with clinical features of Type 1 Diabetes Mellitus (T1DM). The enrolled cases were assessed for confirmation of T1DM, and clinical features and associated complications were recorded in the case record form. Result A total of 218 children with clinical features of T1DM were enrolled, out of which 32 (14.7%) had T1DM. Among the 32 T1DM patients, 31 (96.9%) of the participants presented with polyuria, 29 (90.6%) had polydipsia, and 13 (40.6%) had polyphagia. Out of 32 children, 3 (9.38%) had diabetic neuropathy, and 1 (3.1%) had diabetic retinopathy. Conclusion We found that many children with diabetes have clinical features of T1DM and uncontrolled blood sugar. This emphasizes the need for early detection and treatment to prevent long-term complications.

Functional outcome of proximal tibia intra-articular fractures after open reduction and internal fixation

Background: Tibial plateau fractures are common fractures which constitute approximately 1% of all fractures. These involves the particular area of tibia and difficult to manage. These fractures require absolute stable fixation to improve the function and to prevent the post traumatic arthritis. We aim assess the functional outcome of patients in proximal tibia fractures treated with ORIF. Methods: Patients assessed at OPD visits with knee injury and Osteoarthritis score (KOOS) and Westerna Ontario and Mc-master university OA index (WOMAC). With informed consent patients are assessed one year after fixation of fractures and data recorded in case record forms. Results: Out of 74 patients studied, majority belonged to age group 21 to 40 years old (44 cases, 59.45%); followed by 21 cases (36.48%) from age group 41-60 years old. 7 patients (9.45%) were found in age groups 61 to 80 years old. Mean KOOS scores shows FAIR outcome in type I, type II, type III and type IV Schatzkers. While poor outcome was found in type V and type V and type VI. High energy trauma is associated with poor functional outcome as compared to low energy trauma. Mean WOMAC scores are found good in type I, type II fractures while fair outcome found in type III and type IV, poor outcome observed in type V and type VI Schatzkers type. Conclusions: As per this study we concluded that fractures treated with ORIF showed good functional outcome. ORIF with buttress plate gives good to fair results.

ESTIMATION AND TO KNOW THE ASSOCIATION OF AUTOANTIBODIES WITH DERMATOLOGICAL DISORDERS IN PATIENTS ATTENDING DERMATOLOGY OUTPATIENT DEPARTMENT

Background: The presence of antinuclear antibodies (ANA) is mainly associated with autoimmune diseases and connective tissue diseases (CTD). In addition, their presence is found in healthy people. While the actual frequency of positive assays in healthy individuals varies with methodology, nevertheless, up to 20% or more of otherwise healthy people can express an ANA. The basis of this seropositivity is puzzling. One possibility is that ANAreactivity represents vagaries of the assays, allowing the detection of antibodies of either low titer or low avidity. ANAand Anti double-stranded DNA (Anti-ds-DNA) antibodies in dermatological disorders other than CTD, and Vasculitis were not studied till now to our knowledge. Hence this study has been taken up. Aim: Estimation and to know the association, of autoantibodies with dermatological disorders, to better understand the diseases in patients attending the dermatology outpatient department (OPD). Objectives: 1. To nd out the percentage of positivity for ANAby the Indirect Immunouorescent Assay (IFA) method. 2. To nd out the percentage of positivity for anti-ds DNAantibodies by the Enzyme-Linked Immunosorbent Assay (ELISA) method. 3. Percentage of positivity of both ANAand Anti-ds DNAantibodies in patients with dermatological problems. 4. To know the association of autoimmunity with various dermatological disorders for a better understanding of these disorders. Materials & Methods: Ahundred patients were selected after taking written informed consent and after inclusion and exclusion criteria got fullled. Details of the patients were entered in the case record form and later were uploaded in a Microsoft excel sheet. One millilitre of the venous blood sample was drawn in adults of each of the age categories 18-27, 28-37, 38-47, and 48-57. The upper age limit of 57 is selected for the sake of convenience. Sera were analysed for ANAand Anti ds DNAantibodies by using IFAand ELISAmethods respectively. Results were recorded and analysed. Results: In a total of 100 patients 11% and 13% were positive for ANA and Anti ds DNA respectively. For ANA and Anti ds DNA positivity the mean age was 34.5 ± 12.5 and 40.7 ± 10.7 respectively and females outnumbered males in both. Both ANAand Anti ds DNAwere positive in 3% of which all were females with a mean age of 41 ± 9. ANA positivity was found commonly in Telogen efuvium (3), melasma (2), and Tinea (2). Anti-ds DNA positivity was found commonly in Miliaria Rubra (2), and Tinea (2). Both ANAand Anti ds DNA were positive in telogen efuvium, melasma and tinea. Conclusion:ANA, Anti ds DNA, both ANAand Anti ds DNAwere positive in otherwise healthy dermatological patients with diagnoses like telogen efuvium, melasma, tinea, miliaria etc., to the extent of 11%, 13%, and 3% respectively. It is not known if autoantibody positivity in these diseases is just a chance association or if the autoimmune mechanism got triggered by these diseases. Prospective longitudinal studies are necessary to conrm these nding

Human-pet Relationship, Pet Abandonment, and Clinical Correlation for Patients Infected with Dermatophytosis of the Glabrous Skin

Objective: The study on human-pet relationship and pet abandonment among dermatophytosis patients is limited. This study aims to review these correlations. Materials & Methods: A two-year retrospective cross-sectional study was conducted. Case record forms were reviewed for clinical manifestations, fungal identification, human-pet relationships, and changes in the relationships after dermatophytosis diagnosis. Results: A total of 230 dermatophytosis patients from the Dermatology outpatient clinic, Siriraj Hospital, were included. The mean age was 41.9 ± 19.1 years and 51.3% were female. Among 170 cases with positive fungal culture, zoophilic dermatophytosis from M. canis infection was identified in 15.9% which was predominately found in females and manifested as shorter duration of onset, and higher involvement on exposed areas when compared to anthropophilic dermatophytosis. Most (71%%) of patients with M. canis infection classified themselves as pet-lovers. The relationship with pets had changed after the dermatophytosis diagnosis in 41% of them which was statistically different from 8.8% in non-pet lovers (P = 0.001). The overall pet abandonment rate was 26.6%. The abandonment rate was 40.9% among non-pet lovers, while 30.6% was reported among pet lovers. Conclusion: Zoophilic M. canis infection was associated with rapid onset and on predominant-exposed areas. Some pets could be asymptomatic, so identification of the reservoirs of dermatophytosis is important in the treatment process and helps prevent future recurrence. Paying attention to human-pet relationships and pet abandonment is critical. Knowledge about dermatophytosis transmission, and appropriate pet management should be advised to decrease abandonment.

TO STUDY THE PREDICTORS OF MORBIDITY & MORTALITY IN CRITICALLY ILL PATIENTS OF COVID 19 IN ICU & THEIR OUTCOMES

World is now recovering from COVID-19 pandemic which started about 3 years ago in Hubei, China. Many patients were severely affected ending up in intensive care units. It is observed by clinicians that biochemical markers such as LDH, Ferritin, Interleukin-6, D-dimer, and C-reactive protein, as well as radiological parameters such as CT severity scores, can predict morbidity and mortality in COVID-19 patients. Haematological parameters such as lymphopenia , increased neutrophil to lymphocyte ratio also indicate severe disease and poor prognosis. Materials And Methods: This was retrospective observational study conducted in tertiary care centre in Marathwada region of Maharashtra, India. Patient's details like age, sex, symptoms, comorbidity, highest mode of ventilation and ICU stay duration were noted in the case record form (CRF) in each case. CT Chest, inammatory biomarker and CBC for lymphocyte & Platelet were noted. Among non-survivors, the Observations And Results: most prevalent symptom was breathlessness, followed by cough, fever, and sore throat . Breathlessness (p value 0.003), reduced urinary output (p value 0.004), and chest pain (p value 0.0002) were statistically signicant predictors of higher mortality. Comorbidities such as diabetes mellitus (, pulmonary conditions (COPD and asthma), and chronic kidney disease were also associated with higher mortality. Additionally, higher CT severity scores were correlated with increased mortality, as were elevated levels of biomarkers such as D-dimer, LDH, Ferritin, IL-6, CRP, and reduced lymphocyte and platelet counts. The study showed that ICU admission had a statistically signicant impact on patient outcomes (p<0.00001). The study found that advanced age, co-morbidities such as diabetes mellitus, Conclusion: asthma, COPD, and chronic kidney disease, symptoms such as breathlessness, reduced urinary output, and chest pain, a higher CT severity score, elevated levels of biomarkers such as CRP, LDH, ferritin, IL-6, D-dimer, creatinine, and the N/L ratio, thrombocytopenia, and lymphopenia were all associated with higher mortality in critically ill COVID-19 pneumonia patients

To Evaluate the Frequency of Newly Diagnosed Ischemic Heart Diseases in RA Patients

Background: Patients with RA have higher rates of morbidities and mortalities than in general population, which is highly attributed to an increased risk of CVD among RA patients and often untreated, leading to a decrease in life expectancy. Owing to its high prevalence and prognostic importance, professional societies and experts groups have increasingly emphasized the importance of CVD prevention and prompt recognitions in patients hospitalized with RA. Objective: To evaluate the frequency of newly diagnosed ischemic heart diseases in RA patients. Methods: It was a hospital based cross- sectional study. Study was conducted at Medicine Department of Chittagong Medical College Hospital (CMCH) for six months period from July’2018 to December’2018. A total 58 diagnosed RA case were selected purposively from both outdoor and indoor of Medicine Department of CMCH. Those having different comorbid condition like stroke, heart failure, chronic kidney disease, diabetes, pregnancy, encephalopathy, bleeding disorder, hypothyroidism, hyperthyroidism or unwilling to be included in the study were excluded. Patients’ demographics, serology results including rheumatoid factor (RF), anti-cyclic citrullinated peptide antibody (anti-CCP) and antinuclear antibody (ANA), as well as, disease activity score in 28 joints (DAS28) were recorded in a case record form. Results: Percentage of the patients newly diagnosed as hypertensive and diabetic were 8.6% and 5.2% respectively. RA patients with IHD were 14%, had prolonged disease duration 3.56 ± 2.16 and high disease activity 27.6%. Percentages of patients had hypercholesterolemia, low high density lipoprotein (HDL), High Low density lipoprotein (LDL) were 81%, 98.3% and 100% respectively. Conclusion: Proportions of the patients were newly diagnosed as hypertensive and diabetic were 8.6% and 5.2% respectively. RA patients with IHD were more aged, had prolonged disease duration and high disease activity.

Prescription pattern in ischemic heart disease inpatients at B. P. Koirala Institute of Health Sciences: a cross sectional study

Background: Drug utilization pattern studies seek to screen, evaluate and suggest appropriate modifications in prescription practices. It would help to make patient care rational and cost effective. Objective was to analyze the drug prescribing pattern for treatment of ischemic heart disease (IHD). Methods: A prospective cross-sectional observational study was conducted in patients of IHD admitted in intensive coronary care unit and medicine ward for the period of six months. Data were collected in preformed case record form. The data were analyzed for drug use indicators, demographic parameters, morbidities, pattern of drug use using Microsoft excel 2010. Results: A total of 145 patients were enrolled out of that 89 (61.38%) were males. The mean age was 60.01±12.71 years and majority (26.89%) belonged to age group of 61-70 years. A total of 1208 drugs were prescribed in 145 patients. Most frequently prescribed drugs were antiplatelet group of drugs 100% encounters, followed by hypo-lipidemics (98.62%). Average number of drugs per encounter was 8.33 and percentage of drugs prescribed by generic name was 5.04%. Conclusions: IHD was more common in males than females. The most commonly prescribed drug classes were anti-platelet drugs followed by hypolipidemic agents.

Study on Clinical Manifestations Of Biliary Ascariasis Patients in Sadar Hospital, Cox’s Bazar

Aims: Aim of the study was to know the clinical presentations of biliary ascariasis. Materials and Methods: It was a cross-sectional observational study had been carried out on 50 patients over a period from January 2017 to December 2018 at the Department of Medicine, Sadar Hospital, Cox’s bazar. The clinical presentation, ultrasonographic findings, management and follow up of patients diagnosed to have biliary ascariasis were recorded in a pre-designed case record form and finally all the relevant data were processed and analyzed. Results: This study revealed that maximum patients of biliary ascariasis belonged to 31-40 yrs age group. Number of female patients was more (86%) in comparison to male patients (14%). Among female patients, 20.93% patients were pregnant. Most of the patients 92%came from rural areas. All patients in this study presented with upper abdominal pain. Other complaints were nausea, vomiting, fever and jaundice. Most of the patients (38%) had history of passage of worm with vomitus. Ultrasonographic profile of this study revealed that ascaris was most commonly entrapped in the common bile duct (80%). The percentage of complications was 38%. Acute acalculous cholecystitis was the commonest. The percentage of Cholangitis and acute pancreatitis was also significant. Conclusion: Bangladesh is an endemic zone for ascaris lumbricoides infestations. Ultrasonography is the investigation of choice for diagnosis and follow up of the patient of biliary ascariasis. Majority of the patient can be managed with conservative treatment and mechanical removal of worms by endoscopy. This study recommends that proper hygiene and regular deworming can prevent biliary ascariasis. J Dhaka Med Coll. 2021; 29(1): 87-93

Retrospective analysis of maternal near miss and the applicability of previous caesarean section delivery as a predictor of risk at a tertiary level hospital of India

Background: Caesarean section (CS) rate is showing an alarming increase in India, as a result, high-risk pregnancies with previous CS are becoming more frequent. Objective: The present study compared the additional risk for previous CS among a retrospective cohort of women who had maternal near miss (MNM). Materials and Methods: Record analysis of women with MNM between April 2019 and March 2020 at the tertiary level teaching hospital of Kolkata, India. Data for the selected study variables were extracted from the patient's case record forms. The main outcome measures were crude odd's ratio for risk of post-partum haemorrhage (PPH), repeat CS and adverse birth outcome; difference of mean for units of blood products transfused, number of clinical signs and hospital stay and adjusted odds ratio for PPH. Results: In this study, 100 records were analysed. The mean age of the cohort was 27.65 years with a standard deviation (SD) of 6.25 years. Forty women had previous CS, among whom 27 (67.5%) had a single CS while 13 (32.5%) had CS twice. A number of clinical signs, duration of hospital stay, total units of packed red cells (PRBCs) and total units of blood products transfused were similar between the groups. Women with previous CS had a significantly higher risk for PPH and having a repeat CS in the present pregnancy. CS at the present pregnancy was the only predictor for PPH after adjusting for other variables. Conclusion: It is difficult to ascertain whether a patient's antepartum and intrapartum course prior to delivery is responsible for the patient's morbidity, or if the previous CS is responsible for some component of the adverse outcomes. Repeated, poor-quality, repeated, closely-spaced CS, can likely result in maternal morbidity, especially PPH. The effect of CS not only affects the incident pregnancy, but future ones as well.

Clinical, Radiological and Spirometric Analysis of Treated Tuberculosis Patients-A Cross-sectional Study

Introduction: Post-Tuberculosis (TB), complications may involve the lungs, mediastinum, pleura, chest wall, or any combination of these structures. It can also affect the caliber of the airways which might lead to the increase in their resistance and decrease in the airflow, severely impairing the quality of life. Due to a lack of controlled trials in this population, no evidence-based recommendations for the investigation and management of post TB complications are currently available. Aim: To study the clinical symptoms, radiological involvement and the Spirometry pattern of previously treated TB patients. Materials and Methods: This cross-sectional study was conducted in the Department of Respiratory Medicine, Shri MP Shah Government Medical College and Guru Govind Singh Government Hospital, Jamnagar, from July 2018 to December 2019. Total 102 patients with history of TB and currently sputum negative were enrolled in the study. All patients underwent clinical examination, microbiological examination, chest radiograph, and spirometry. Data was collected from case record form and entered into MS excel 2016. Data analysis was done in Statistical Package of Social Science (SPSS) Software version 26. Results: Out of the 102 patients, there were 66 (64.70%) males and 36 (35.29%) females. Of the study population, 13 (12.74%) was asymptomatic, 7 (6.86%) had dyspnea, 17 (16.66%) had cough and 65 (63.72%) had both cough and dyspnea. Spirometry analysis revealed that 26 (25.49%) were normal, 6 (5.88%) had restrictive pattern, 69 (67.64%) had obstructive pattern and 1 (0.98%) had mixed pattern. Chest radiograph revealed unilateral chest involvement in 78 patients (76.47%) and 24 patients (23.52%) had bilateral chest involvement. Conclusion: There is high prevalence of post-TB pulmonary disability causing clinical symptoms, radiological involvement and spirometry changes and thus should be assessed early to prevent further complications.

Metabolic Derangements with Anticonvulsants in Children with Generalised Tonic-clonic Epilepsy: A Cross-sectional Study

Introduction: Epilepsy is one of the most prevalent noncommunicable neurologic conditions, accounting for significant disability and mortality. The effects of Antiepileptic Drugs (AEDs) on total cholesterol, triglycerides, High-Density Lipoprotein (HDL) cholesterol, low-density lipoprotein cholesterol, and apolipoprotein levels have been demonstrated in many studies, mainly conducted with adults. However, there have been very few studies in children. Derangement of lipid profile and other metabolic abnormalities could lead to the development of metabolic syndrome in children. The adverse metabolic effects of anti-epileptics are underestimated, as only a few studies have been done in this area, which is a legitimate concern. Aim: To assess the impact of AEDs on metabolic parameters in children with epilepsy. Materials and Methods: This was a descriptive, crosssectional study conducted in the Department of Paediatrics and Pharmacology at Pt. BD Sharma PGIMS, Rohtak, Haryana, India. The study included 100 children with epilepsy from May 2022 to October 2022. A predefined case record form, including demographic and clinical characteristics, was filled for each participant. The parameters recorded were age, gender, outpatient number, type of epilepsy, history of duration of epilepsy, current AED history, and seizure frequency over the preceding six months, as per the case record form. Guidelines from the International Diabetes Federation were used for diagnosing metabolic syndrome in children. The data was entered into Microsoft excel and presented using descriptive statistics. The chi-square test was used to differentiate between categorical variables. Results: The mean age of the study participants was 10.2±2.97 years. There were more males (62%) than females (38%). A 48% of the patients received monotherapy, while 52% received polytherapy. A total of 24% of the patients had derangement in lipid profile (increased triglycerides and decreased HDL), with 14% of patients on monotherapy and 10% on polytherapy. The difference in metabolic derangements between monotherapy and polytherapy was not statistically significant (p=0.25). Out of 100 participants, 3% fulfilled the criteria for metabolic syndrome, with a predominance in males. Conclusion: Metabolic derangements are known with 1st generation AEDs, but 2nd generation AEDs can also lead to significant metabolic abnormalities.

Oral Health Complaints in Pregnant Women Visiting a Tertiary Care Hospital in Mumbai, India: A Retrospective Observational Study

Introduction: Pregnancy results in a lot of changes within the oral cavity, and recent reports have suggested an association between dental issues and poor pregnancy outcomes. Although many studies indicate that dental procedures can be carried out safely on pregnant patients to alleviate pain and promote better oral health, dental health is not given importance in pregnancy mainly due to fear and misconceptions that dental care can adversely affect the foetus. Aim: To summarise the dental presenting complaints and clinical examination findings of pregnant women and to evaluate the proportion of those compliant with the respective dental treatment services recommended by the dentist. Materials and Methods: It was a retrospective observational study analysing data pertaining to all pregnant patients who reported to the Department of Dentistry at Seth G.S. Medical College and King Edward Memorial Hospital in Maharashtra, India between December 2017 and September 2018. There was no formal sample size estimation, and all eligible patients’ data available in the department registry, which was maintained as part of routine clinical care, were analysed. A structured Case Record Form (CRF) was used to collect demographic and clinical data from these registers, and descriptive statistics were used to summarise the data. Results: The mean±Standard Deviation (SD) age of study sample was 27.69±4.584 years. A total of 81 patients’ data were included for the analysis. The most common presenting complaint and examination finding were pain and dental caries, respectively. The most common treatment plan suggested and performed was medication, followed by extraction. The number of patients who followed up was 37 (45.67%). Conclusion: Pain and carious tooth were the most common presenting complaint and examination finding, respectively. The proportion of patients who came for follow-up was not adequate, warranting enhanced awareness activities to reduce stigma over dental care during pregnancy.

Association of cardiovascular and metabolic diseases with risk of dementia in the urban population of North India

Background/Aim: Dementia has become a public health problem due to its association with biological risk factors; obesity, diabetes, hypertension and hypercholesterolaemia. Most of these risk factors, appear to be associated with dementia as well as with risk of coronary artery diseases (CADs) and stroke. This study aimed to find out the association of biological risk factors with cognitive impairment and dementia. Methods: Cross-sectional survey in a hospital was performed. After written informed consent and approval from hospital ethic committee, all subjects (n = 2002) above 25 years of age (1016 males and 986 females) were randomly selected and recruited from urban population of Moradabad, North India. Clinical data and risk factors were recorded with the help of case record form and validated questionnaires. Assessment of cognitive decline and dementia was made by Singh's memory function rating scale and biological risk factors by physical examination, sphygmomanometer and electrocardiography. The association of biological risk factors with dementia was calculated by multivariate logistic regression analysis after adjustment of age and sex. Results: Obesity, diabetes, hypertension, CAD and hypercholesterolemia were highly prevalent independent risk factors among patients with dementia. Multivariate logistic regression analysis showed that regardless of age and body mass index, diabetes mellitus and CAD were highly significant (p < 0.001) risk factors of dementia. Hypertension and family history of dementia were weakly but significantly(p < 0.05) associated with dementia. Conclusion: It is possible that increased frequency of obesity, diabetes, hypertension and CAD may increase the risk of dementia in an ageing population. Prevention and control of these biological risk factors may cause decline in the risk of dementia.

A study on the safety and tolerability of antiretroviral drugs prescribed in ART center of a rural-based tertiary care hospital

Background: Human immunodeficiency virus (HIV) is a serious health problem worldwide. The mainstay treatment of HIV infected individuals is antiretroviral therapy (ART). Although ART is effective, it has its drawbacks as it is causes various adverse drug reactions (ADRs) which negatively affects patient compliance resulting in treatment failure. Various studies have been conducted in western population to study the adverse effects of ART, but such study in Eastern India is scanty. This study was conducted to fill the void and to help optimize treatment in this area. Aim and Objectives: The aim of the study was to find the incidence and type of ADRs among patients on antiretroviral drugs and to evaluate the severity assessment of the ADRs caused by them. Materials and Methods: Pre-structured case record form was used to collect information regarding demography, disease, treatment, etc., of 188 patients who came to the ART center after taking consent. ADRs were noted on the basis of patient complaints and changes diagnosed by the physician (if any) during routine visit. Descriptive statistical analysis was performed and inference drawn. Results: Most of the subjects followed Tenofovir-Lamivudine-Efavirenz regimen of whom 89% experienced at least one ADR, central nervous system (CNS) being the most affected. Followed by Zidovudine-Lamivudine-Nevirapine regimen of whom 96% presented with at least one ADR where gastrointestinal (GI) side effects were maximum. Common CNS side-effects were dizziness followed by insomnia. Common GI side effects was anorexia followed by nausea and vomiting. Most of them were mild in severity assessment scale. Conclusions: The study shows the ART regimens used by HIV patients and assess the ADRs caused by them. It helped to obtain information regarding demographic factors and disease pattern in this region. Further and more elaborate studies are needed to have proper insight and practical gains in this regard.

Assessment of Antimicrobial Prescribing in Ophthalmology Outpatient Department of a Tertiary Care Hospital

Background: Analysing drug prescribing pattern is crucial to prevent antibiotic resistance in community. The study aims to analyse the pattern of antibiotic drug prescription in outpatient department (OPD) of Ophthalmology. Methods: It was an observational study done over 3 months period in OPD of Ophthalmology DMGMC & H. Data were collected from case record form for demographic profile, nature of disease and type of antibiotic prescribed and route of administration. Results: A total of 250 patients were analysed from Ophthalmology OPD. Maximum patients belonged to 20-50 years (66.8%). The proportion of male (58%) as compared to females (42%). Average drug prescription was 1.08. Most commonly used antibiotic was Moxifloxacin. Maximum patients were diagnosed with conjunctivitis (22.8%) followed by external hordeolum (16%), cataract (12%) blepharitis (10%) and dacryocystitis (10% each). Among antibiotics fluroquinolones were used most (42.08%), followed by broad spectrum antibiotic chloramphenicol (20.8%) followed by aminoglycosides (16.8%). Maximum number of drugs were administered in topical form (64.8%).Conclusion: The present study found that fluroquinolone antibiotic was prescribed maximum. Most common dosage form of prescribed drug was eye drop. Antibiotics need to judiciously used in all OPD set up to prevent drug resistance.

An Institution Based Cross-Sectional Observational Aetiological Study Correlating the Clinico-Pathological Findings in Patients Presenting with Acquired Palmoplantar Keratoderma.

Palmoplantar keratoderma (PPK) is a heterogeneous group of hereditary or acquired disorders characterised by excessive epidermal thickening of the palms and soles. Proper knowledge about the aetiology of the disease and clinico-demographic profile helps in planning management and predicting outcomes. To determine the prevalence of different dermatoses and describe their clinico-histological correlation in acquired palmoplantar keratoderma. An institution-based cross-sectional study conducted after obtaining Ethics-Committee permission and consent from participants. Patients of any age or gender presenting with acquired PPK were recruited. The calculated sample size was 67 by using the prevalence rate (p) of 22.2%, allowable error (L) of 10%, the confidence level of 95% (z = 1.96), and an infinite population size of 20,000. Patients were evaluated by taking demographic and clinical data in a pre-designed case record form, necessary laboratory investigations and histopathological examination that wereevaluated by three blinded experts. The pooled data were analysed with statistical software. Among the 67 participants, Psoriasis was diagnosed clinically in 39 (58.2%) and histologically in 7 (10.4%), Lichen planus (LP) clinically in 16 (23.9%) and histologically in 9 (13.4%), Pityriasis rubra pilaris (PRP) in 8 (11.9%) patients clinically and 7 (10.4%) histologically and Hyperkeratotic eczema (HKE) in 4 (6%) clinically and 43 (64.2%) histopathologically. There was very poor inter-rater agreement (Kappa = 0.148, SE 0.0047, 95% CI 0.057 to 0.24). The clinico-pathological correlation was found to be agreeable in 17.9% Psoriasis, 56.2% LP and 87.5% PRP. HKE was commonly misdiagnosed as Psoriasis in 65.1% of patients. Hyperkeratotic lesions of the palm and sole often present with overlapping clinical features and a skin biopsy has to be done to aid in diagnosis. Stratification of the clinical expertise of clinicians was done during the analysis.

Prospective audit of the phenotype, causes and correlates of trachomatous and non- trachomatous trichiasis in a peri-elimination setting.

To explore the burden, clinical features and associations of trichiasis due to trachomatous and non-trachomatous aetiologies. Consenting patients presenting with trichiasis of either eyelid (of one or both eyes) attending the outpatient department, cornea and oculoplasty clinics of a tertiary eye care hospital in New Delhi between August 2018 to March 2020 were included. A comprehensive examination including visual acuity and anterior segment evaluation and photography was performed. Grade of trichiasis, laterality, presence and grade of entropion, and information on corneal opacity, conjunctival scarring, Herbert's pits, and pannus, if present, were recorded in the case record form. Overall, 302 patients (454 eyes) with trichiasis were recruited. The most common attributed cause of upper eyelid trichiasis (276 patients, 405 eyes) was trachoma (26% of patients), followed by Stevens-Johnson syndrome (23%), blepharokeratoconjunctivitis (17%) and old age (10%). A total of 296/405 eyes (73%) had some form of corneal involvement. Trachoma was not identified as the cause of trichiasis in any eye with lower eyelid-only disease. Only about a quarter of upper eyelid trichiasis in this peri-elimination setting was attributed to trachoma. A distinction between trachomatous and non-trachomatous trichiasis is imperative to meaningfully determine whether elimination of trachoma as a public health problem has occurred. These data may have implications for population-based estimates of TT prevalence in India and other peri-elimination settings.