Center In Northern India Research Articles

Lessons learned from blunt trauma abdomen: Surgical experience in level I trauma centre.

The number of accident cases is increasing day by day, so as the challenges. With an emphasis on trauma care, the government started a 120 bedded level I trauma centre in northern India catering to a population of 2.8 million in June 2018. Through this article, we aimed to share our experience of blunt abdominal trauma management from a new level I trauma centre. In this retrospective observational study, historical analysis of all available records from July 2018 to March 2020 was done. Inclusion criteria included blunt trauma abdomen with or without associated injuries. Data regarding age, sex, mechanism of injury, time taken to reach the hospital, the pattern of solid organs and hollow viscus injuries, associated extra abdominal injuries, mode of treatment, complications, length of ICU and hospital stay, and mortality were reviewed. Overall, 154 cases sustained abdominal injuries during the study period. Seventy-five percent were male. The most common cause of blunt trauma abdomen was road traffic crashes. Operative management was required in 57 (37.01%) cases while 97(62.98%) were managed non-operatively (NOM). Mean ICU stay was 05.73 days, while the average hospital stay was 12 days (range 10-60 days). Procedures performed included splenectomy, liver repair, primary closure of bowel injury, and stoma formation. Complications occured in 16.88% cases and the overall mortality rate was 11.68%. The study revealed that among 154 cases of fatal blunt abdominal trauma, road traffic crash was the most common cause of blunt abdominal trauma, predominantly affecting males. The visceral and peritoneal injury frequently perceived was liver in 40 cases (25.9%), spleen 66 (43%), intestine 21(13.6%) and kidney 13 cases (09%). Abdominal injury was associated with other injuries like head, chest and extremity injuries in 52.5% cases. Duration of injury, presence of associated injury and preoperative ventilation requirement were independent predictors of mortality apart from contributary factors such as clinical presentation, organ involved and presence of complications.

1447P Efficacy and toxicity profile of trans dermal buprenorphine for cancer pain management: Experience from a tertiary care center in northern India

Buprenorphine is partial agonist activity at the μ-opioid receptor and competitive antagonist activity at the kappa opioid receptor. Transdermal therapeutic system buprenorphine should be of special value in cancer pain control. Such a buprenorphine formulation allows for a stepwise dose increase, similar to that reported for sustained-release morphine. We evaluated the effectiveness and tolerability of transdermal buprenorphine (TDB) treatment for cancer pain management.

Candida auris associated candidemia in trauma patients at tertiary care centre in Northern India

Candida auris associated candidemia in trauma patients at tertiary care centre in Northern India

Clinicopathological profile of female genital tract malignancies reported at a tertiary care center in Northern India

The proportion of cancers of genital tract origin in females ranges from 22.4% to 55.8% in India; thus posing a major health problem. The first step in controlling the cancer burden in any population is to collect information about its salient features in that particular cohort of patients. This study was performed to ascertain the profile of female genital tract malignancies reported at our center regarding the relative frequency of involvement of various sites, age and symptoms at presentation and histological subtypes.All the confirmed cases of female genital tract malignancies received in the Department of Pathology were studied for a period of 2 years from November 2008 to October 2010.A total of 175 cases were reported. The anatomic distributions were: cervix 123 (70.3%), uterus 11 (6.3%), ovary 30 (17.1%), vagina 4 (2.3%), vulva 5 (2.9%) and fallopian tube 2 (1.1%). The mean ages of women diagnosed with these cancers were: cervix (51.1 years), uterus (54.5 years), ovary (46.5 years), vagina (57 years), vulva (54.5 years) and fallopian tube (49.5 years). Women with cervical and uterine malignancies presented commonly with bleeding per vaginum; while those with ovarian malignancies presented mostly with abdominal mass. Women with vaginal and vulval malignancy presented with ulcers and masses. The most common histological subtypes at different sites were; Cervix: Squamous cell carcinoma (SCC) (87%); Uterus: Endometrioid adenocarcinoma (81.8%); Ovary: Serous cystadenocarcinoma (53.3%); Vagina: SCC (75%); Vulva: SCC (60%) and Fallopian tube (50% adenocarcinoma and 50 % metastatic carcinoma).As female genital tract malignancies form a huge burden of morbidity and mortality in India, there is a need to establish better screening programmes aimed at early detection and educate the public regarding the risk factors as well as early symptoms of the disease so that people can adapt appropriate behaviour.

Rituximab use in pediatric systemic lupus erythematosus: Indications, efficacy and safety in an Indian cohort.

Introduction: Children with systemic lupus erythematosus have a more challenging and difficult course as compared to their adult counterparts. Today, the aim of therapy for any child with lupus is to keep the child in a state of sustained remission with minimal or no use of steroids. This laudable goal is often difficult to achieve for the child with lupus. In addition to the use of disease modifying agents, sometimes in combination, Rituximab (RTX) is also used as an off-label indication to manage such patients.Objectives: To study the use, efficacy and safety of RTX in a cohort of patients with pediatric lupus followed at a single tertiary level center in Northern India.Methods: This paper is a retrospective review looking at the use of RTX in children with systemic lupus at a tertiary level pediatric rheumatology center in North India over a period of seventeen years. This paper describes the indications, use, efficacy and safety of RTX in childhood systemic lupus erythematosus.Results: RTX was used in 17 of 225 pediatric lupus patients (7.5%), with the most common indication being resistant renal disease (53%). Significant improvement was seen in all domains studied: The mean SLEDAI was 16.25 prior to RTX and reduced to 1.43 six months after the RTX (p value 0.001), steroid use dropped from 100% pre- RTX to 33% at 2 years, there was a sustained reduction in proteinuria in the patients with nephritis from a mean urine spot protein creatinine ratio of 3.1 pre RTX to 0.4 at one year post RTX (p= .006). Finally, 82% of the children had no flare during the follow up (median 24 months). No patient had any adverse event.Conclusions: This study confirms that RTX is very effective in childhood lupus and can be safely used even in a country with a very high burden of infectious diseases. This data adds to the scarce literature in this area from the developing world.

Detection of catheter related blood stream infections in an ICU of a tertiary care center in Northern India

Indwelling medical devices are frequently used in all health setting with critical care units of hospitals for treatment and intervention in patient care.Microorganisms attach to surfaces resulting in the formation of a biofilm which pose a serious public health issue because of its increased resistance to antimicrobial agents and the potential to cause infections.To determine the proportion of bacterial Biofilms in patients with central venous line and to find out the organisms most commonly associated with it.The study was carried out from January 2019 to September 2020. Positive cultures were obtained from 58 of these 102 samples. The isolates were then tested for in vitro production of biofilm using a microtitre plate assay. All the isolates were subjected to antimicrobial susceptibility tests on Muller-Hinton agar by Kirby Bauer disc diffusion method based on CLSI guidelines. Demographic characteristics of the study subjects showed that among 102 catheterized patients isolated with males 58.82% and 41.1% females. Out of 58 isolates, 62.06% were gram negative bacteria (GNB) and 37.93% were gram positive. was most common isolate 27.58% followed by 20.68%, 15.5%, respectively. The total number of positive slime producers, in this study, was 23(39.6%). The highest number of strong slime producer strains was observed in case of (2 out of 5) (4 out of 12) and 3 out of 16)Antibiotic susceptibility patterns showed increased resistance towards penicillin and beta -lactum group of antibiotics, increased sensitivity to linezolid and vancomycin among gram positive organisms. Among gram negative bacteria increased resistance was seen for cephalosporins and aminigylycosides and least resistance for colistin.Colonization of indwelling medical devices with consequent biofilm production is a likely contributory factor to infections. The microorganisms survive in the hospital environment despite unfavourable conditions such as desiccation, nutrient starvation, and antimicrobial treatment. Resistance to antibiotics ladder is increasing and it’s necessary to take actions to reduce its hindrance in the future. Advanced studies in biofilm will help to prevent the more virulent factors which protect the bacteria from host immunity and to get rid of critical complications in therapy.

P-EP026. Clinical profile of children with west syndrome: A retrospective chart review

Introduction. This study was intended to document the clinical profile and treatment outcome of West syndrome in children attending a tertiary care center in Northern India. Methods. Data were collected by a retrospective chart review of children diagnosed with West syndrome between January 2017 to January 2018. Information was recorded pertaining to the age at onset and presentation, etiology, and associated co-morbidities; results of electroencephalography (EEG) and neuroimaging; treatment given; and final outcome. The following drugs were used for treatment: ACTH (n=7), prednisolone (n=17), vigabatrin (n=25), sodium valproate (n=28), clonazepam (n=30), and levetiracetam (n=13) and modified Atkins diet (n=7). The response was categorized as spasm cessation, partial improvement (>50% improvement), or no improvement. Results. Records of 30 children (21 boys) were analyzed. The mean (SD) age at onset was 4 (3, 6.5) months. The median lag time to treatment was 5 (2,14) months. Eight (26%) were premature, 2 (7%) were SGA, birth asphyxia in 56%, neonatal encephalopathy in 62%. EEG findings were compatible with hypsarrhythmia in 13 (43.3%) children and 9 (30%) had modified hypsarrythmia. MRI finding was periventricular leucomalacia (54.1%), cystic encephalomalacia (13.8%), normal MRI (20.7%) and 1 had arrested hydrocephalus. There was no improvement with valproate (93%), clonazepam (89%) and levetiracetam (78%). Cessation of spasm was achieved with vigabatrin (28 %), prednisolone (38.2%) and ACTH (42.8%). Hypsarrhythmia resolved with presence of background and other epileptiform abnormalities in 34 children. Conclusion. The present research highlights limited role of sodium valporate, levetiracetam and clonazepam in initial management of children with West syndrome. However, further studies with larger sample size are required before concluding its limited role.

English

BACKGROUND The debate between fixation and non-fixation of mesh in laparoscopic hernia surgery has been going since the advent of this technique. While earlier studies insisted on mesh fixation, emerging studies are now supporting elimination of mesh fixation. Therefore, a prospective comparative study was performed in tertiary health care centre in northern India to compare the incidence of recurrence, post-operative pain and chronic groin pain between mesh fixation and non-fixation. In this study, we wanted to compare the intra-operative complications, post-operative pain and recovery, duration of hospital stay, incidence of chronic groin pain and pain during follow up visits and incidence of recurrence in laparoscopic inguinal hernia repair between fixation and non-fixation of mesh. METHODS A prospective comparative study was conducted among 50 patients admitted in surgery unit in a tertiary health care centre in northern India from January 2019 to October 2020 and were divided into two groups (group A - fixation, group B - non-fixation). Different factors such as post-operative pain, analgesia required post-operatively, duration of hospital stay, chronic groin pain and recurrence were compared between the two groups. Patients were followed up at 1, 3, 6 and 12 months. RESULTS The mean pain score at the end of 1 month and 3 months was higher in patients in the mesh fixation group. The days required by patients to resume their routine activities was lesser in patients in the non-fixation group. The recurrence rate was found to be similar in both the groups. CONCLUSIONS Mesh fixation offers no clear advantage over non-fixation and non-fixation can be considered as the preferred alternative as this procedure has less chance of postoperative pain, early ambulation and no increased risk of recurrence. KEYWORDS Laparoscopic Inguinal Hernia Repair, Mesh Fixation, Mesh Non-Fixation

Internal quality control in blood and component bank in a tertiary healthcare center in Northern India

Quality control describes steps taken by blood and component bank to ensure that tests are performed correctly. Primary goal of quality control is transfusion of safe quality of blood. It is to ensure availability of efficient supply of blood and blood components. Internal quality control is the backbone of quality assurance program.To analyze the internal quality control of blood components in modern blood banking as an indicator of our blood bank performance.An observational cross sectional study conducted at the Blood and Component Bank, JN Medical College and Hospital from 2018 to 2020. Each blood component was arbitrarily chosen during the study on monthly basis. Selection criteria was 1.0% of total collection or minimum 4 bags per month. Packed red cells were evaluated for hemoglobin, hematocrit, RBC count; platelet concentrates for pH, yield and culture; fresh frozen plasma and cryoprecipitate were evaluated for unit volume, factor VIII and fibrinogen concentration.The mean HCT of packed red cells was 65.75+7.42%, volume was 238+26.25ml, Hb was 20.5+0.15g/dL and RBC count of 5.89x10+0.30x10. The mean platelet yield was 5.7x10, pH was ≥6.8+0.175 and volume was 82.5+13.75ml; cultures were negative and swirling was present in all the platelet units tested. Mean factor VIII and fibrinogen levels were found to be 95.25 +7.37and 307.5+41.37gm/l for FFP respectively. Mean volume, PT and APTT were 215+32.5ml, 14.15+0.325 sec and 29.50+1.5 sec respectively.The quality control of blood components ensures the timely availability of a blood component of high quality with maximum efficacy and minimal risk to potential recipients.

Clinico-epidemiological profile and outcomes of babies with neural tube defects in a tertiary care center in Northern India

Introduction Neural tube defects constitute a major source of disability among children. Proper management requires accurate diagnosis, an assessment of the severity of the lesion, a decision whether intervention is warranted, the nature of the intervention, and educating the family of the need for lifelong medical care. But to do so, reliable data regarding presentation and outcome is very crucial. Aim of the study To discuss the clinical epidemiological profile and outcome of babies admitted with neural tube defects (NTDs). Material and methods Retrospective observational study was done by extracting data from case notes and follow-up files in Department of Neonatology, PGIMER and Dr. RML Hospital, New Delhi over a period from March 2015 to July 2020. Results A total of 25 babies were included in the study. Majority of babies were born to mother at a median age group of 24 (19–36) yrs and nearly one-third of them were illiterate. The history of maternal periconceptional folic acid intake was seen in only five babies (21%). Two third of babies were male (64%) and the median age at admission was at 9 (1–27) days of life. Majority of the cases were open types of NTDs with most common type being meningomyelocele (88%) followed by occipital encephalocele (12%) and there was one case of closed type of neural tube defect having lipomeningomyelocele (4%). The most common associated anomaly was hydrocephalus (76%) followed by Arnold chiari malformation (56%). Motor weakness in form of paraparesis or paraplegia was present in 21 (84%) babies and sensory deficit was present in 44% babies. Bowel and bladder dysfuntion was present in 48% of cases. Ventriculitis was the most common associated morbidity (38%). Meningomyelocele (MMC) repair was the most commonly performed primary surgery (33%) followed by Ventriculo-peritoneal (VP) shunt repair (24%). Twelve babies (48%) were discharged while 2 (8%) expired and 11 (44%) babies left against medical advice Conclusion Neural tube defect is a congenital disorder with significant morbidity. The clinical severity of the NTDs and the uncertainty in their cause makes this a priority for further research. National policies for prevention, in utero diagnosis, and early surgical intervention are required for a better prognosis.

Efficacy of Trabeculectomy Combined With Limited Deep Sclerectomy Versus Trabeculectomy Alone: A Randomized-controlled Trial.

The addition of limited deep sclerectomy (LDS) to conventional trabeculectomy increases the success rate, especially in pseudophakic eyes. This study aimed to evaluate the efficacy of LDS in enhancing the intraocular pressure (IOP)-lowering outcomes of trabeculectomy. This was a parallel-arm, single-masked, randomized-controlled trial. A total of 68 patients (68 eyes) with moderate to advanced primary open-angle glaucoma or primary angle-closure glaucoma with pseudophakia were recruited at a tertiary eye care center in Northern India and randomized into 2 groups. Thirty-five eyes in group 1 were subjected to trabeculectomy alone and 33 eyes in group 2 were subjected to trabeculectomy with LDS. All cases were supplemented with low-dose subconjunctival mitomycin-C (0.1 mg/mL for 1 min) in both groups. The primary outcome measure was IOP, and success rates were calculated for IOP ≤18/15/12 and ≥5 mm Hg. The secondary outcome measures included evaluation of bleb morphology, presence of an intrascleral aqueous lake, and supraciliary flow on ultrasound biomicroscopy. The mean postoperative IOP at 12 months was 13.4±1.83 mm Hg in group 1 and 12.5±1.67 mm Hg in group 2 (P=0.04). For IOP cutoff ≤15 mm Hg, absolute success was noted in 11 (31.4%) and 22 eyes (66.6%) in groups 1 and 2, respectively (P=0.004). At 12 months, the intrascleral lake was detected in 2 (6%) eyes in group 1 and in 9 (29%) eyes in group 2 (P=0.02). Supraciliary flow was detected in 2 eyes (6.2%) in group 2 and none in group 1 at 12 months (P=0.02). In the Cox proportional hazard model, trabeculectomy with LDS was associated with a lower rate of failure (hazard ratio: 0.32, 95% confidence interval: 0.13-0.75, P=0.009). The addition of LDS to trabeculectomy led to lower mean IOP and higher success rates at 12 months, compared with trabeculectomy alone.

Vitamin D Levels and Early Onset Sepsis in Newborns

Aim: To find out association between vitamin D level and early onset neonatal sepsis (EONS). Methods: This case control study was conducted at a tertiary care center in Northern India during June 2018 to May 2019. Neonates with culture-proven EONS were included as case and neonates without EONS were enrolled as control. 25OH-D levels were evaluated with other routine blood samples. Statistical analysis was done by using unpaired t test and chi-square test. Results: Sixty-two infants were enrolled in each group; baseline characteristics were comparable in both groups. Risk of EONS increased 8 times in neonates with 25OH-D level <30 ng/mL (odds ratio = 8.2; 95% confidence interval [CI]: 3.08-21.82; P = .000). The 25OH-D level was significantly lower in EONS group than control group. Optimal cut-off for 25OH-D was 25 ng/mL to predict EONS with a sensitivity and specificity of 88.7% and 79%, respectively (area under the curve: 0.84; 95% CI: 0.76-0.92; P = .000). Conclusions: Vitamin D insufficiency is significantly associated with EONS. Vitamin D deficiency significantly increases risk of EONS. Maternal vitamin D supplementation may improve neonatal vitamin D levels and may decreases risk of EONS. Further studies including maternal vitamin D level are required for implementation.

Metabolic complications of childhood obesity.

Context:Childhood obesity is a global health problem. A percentage of 2.3 of Indian boys and 2.5 of Indian girls are obese. Childhood obesity is associated with many morbidities like diabetes mellitus, coronary artery disease, musculoskeletal problems, and increased mortality.Aims:The aim of this study is to estimate burden of metabolic complications of obesity in child and parents of obese children and compare it with normal-weight children.Settings and Design:The study was done at a tertiary health center in northern India. It was a cross-sectional study.Methods and Material:We enrolled 60 obese children and age- and sex-matched 26 controls, based on Indian Academy of Pediatrics (IAP)2015 body mass index (BMI) charts. Anthropometric parameters and metabolic complications in family were compared between cases and controls. Clinical markers of metabolic derangements and laboratory metabolic profile were assessed for obese children.Statistical Analysis Used:Descriptive statistics was used to describe frequencies. Chi-square test and Mann–Whitney test and Spearman correlation were used for comparison.Results:The prevalence of obesity and obesity-related complications was high in families of obese children. Ten percent of obese children had impaired fasting glucose and 30% had Haemoglobin A1c (HbA1c) in prediabetes category. Forty percent of obese children had dyslipidemia, 45% had transaminitis, and 46.7 were vitamin D deficient. A percentage of 41.7 of obese children had fatty liver on ultrasound.Conclusions:The family health and child weight are linked through home environment and genetics. The metabolic complications of obesity prediabetes, dyslipidemia, fatty liver, and lower vitamin D level are common in childhood obesity. Regular screening and interventions of metabolic complications are essential for saving child's future health.

A study of various diagnostic tests to identify offending allergens in patients of allergic rhinitis in a tertiary care centre in northern India

Background and Objectives: Allergic rhinitis, a global health issue, if left untreated cause serious conditions like asthma, sinusitis or ear infections. Precise identification of allergens is worthwhile since it may lead to improvement in therapy. Therefore, this study was undertaken to determine the common inhalant allergens causing allergy in and around Saharanpur by skin prick test, serum IgE levels, nasal smear eosinphilia and AEC levels. Materials and Methods: 50 patients diagnosed clinically to have allergic rhinitis were included in the study. Absolute eosinophil count, nasal smear for eosinophils, and total IgE levels (wherever possible) were determined. Skin prick tests using 46 common inhalant allergens were done and results analysed. Results: Increased absolute eosinophil count, nasal smear positive for eosinophil and raised total IgE levels were found to be present in 56%, 22% and 97% of the patients respectively. Frequency of positive skin prick test response to various group of allergens were — Pollen (80%), Dust (70%), Mite (52%), Insects (50%), Fungi (48%) and Epithelial antigens (20%). Overall, pollen of Parthenium (in 70%) followed by House dust (in 64%) were found to be the most common offending allergens. Conclusion: It can be concluded that skin prick test along with serum IgE levels used to identify the causative allergens is useful in the patients of allergic rhinitis. Keywords: Allergic rhinitis, Skin prick test, Aeroallergens, Nasal smear eosinophils, IgE.

Prevalence of Dengue Serotypes and Its Correlation With the Laboratory Profile at a Tertiary Care Hospital in Northwestern India.

Background and aimDengue fever is an emerging arboviral public health problem in a large endemic population in the tropical and sub-tropical areas of the world, with varying degrees of clinical presentation. This study was aimed at analyzing the clinical and laboratory dynamics of the four dengue serotypes.MethodsThis institutional review board (IRB)-approved hospital-based observational study was performed with 100 in-patients with dengue infection above 12 years of age, without co-morbidities or known malignancy, in a tertiary care center in Northern India.ResultsOut of 100 patients, four had concurrent infection with two serotypes. Dengue virus serotype-2 (DENV 2) was the most common serotype (34%) and had the maximum percentage of cases of severe dengue (20.6%). The mean total leukocyte count did not differ between the serotypes. DENV 4 had a significantly higher mean neutrophil percentage and a significantly lower mean lymphocyte percentage than DENV 1 (p-value 0.001 and 0.02, respectively), with a higher percentage of cases of severe dengue (20% vs 14.3%, non-significant). Thrombocytopenia was present in all serotypes of infection. There was a significant difference in the derangement of liver function in DENV 2, 3, and 4 as compared to DENV 1. Mean serum albumin levels were significantly lower in DENV 3 and 4 infections. Cases with co-infection had a much higher derangement of liver function and lower mean serum albumin than infections with a single serotype. The mean blood urea and creatinine levels were in the normal range for all serotypes. No mortality occurred in our study.ConclusionDENV 2 is the most common serotype with maximum severity at our hospital. DENV 2 and DENV 4 have a high percentage of cases with severe dengue (20.6% and 20%, respectively). The mean lymphocyte percentage was significantly lower while hepatic involvement and hypoalbuminemia were greater in DENV 4. Initial serotyping in patients with dengue can help monitor the epidemiological trends and help estimate the clinical and laboratory trends of the different serotypes of dengue infection. Particular care should be taken in patients with co-infection.

Long-term epilepsy control, motor function, cognition, sleep and quality of life in children with West syndrome

PurposeTo assess epilepsy, motor function, cognitive, sleep, and quality of life outcomes and their predictors in a follow-up cohort with West syndrome (WS) at ≥5 years of age. MethodsCross-sectional evaluation in a follow-up cohort of WS (aged 5–14 years), between July 2018 and December 2019, was performed at a tertiary-care referral center in Northern India. 164 children were assessed in-person for epilepsy severity, functional status (gross motor and hand function), social quotient, behavioral comorbidities, sleep problems, and quality of life (QoL) using Early Childhood Epilepsy Severity Scale, Gross Motor Function Classification System, Manual Ability Classification System, Vineland Social Maturity Scale, Diagnostic and Statistical Manual of Mental disorders-5 criteria, Children’s Sleep Habits Questionnaire, and PedsQL-Epilepsy module respectively. Furthermore, 238 children with the inability to visit the hospital were assessed through telephonic interview along with retrospective case record review for epilepsy control, gross and fine motor measures. Results402 children with WS (75 % boys) with regular follow-up were studied and the majority (80 %) had underlying structural etiology. The median age (interquartile range) of the cohort was 92 (78–107) months. Of these, 60 % had evolved to Lennox-Gastaut syndrome (LGS). The following long-term outcomes were observed: ongoing epilepsy (261/402), unfavorable motor status (130/402), moderate to profound intellectual disability (111/164), autistic spectrum disorder (42/164), attention-deficit hyperactivity disorder (18/164), poor sleep (135/164), and impaired QoL (115/164). Non-structural etiology (odds ratio [OR] = 3.8, 95 % confidence interval [CI]: 2.1−5.5, p=<0·0001) and older age (>5 months) at the onset of epileptic spasms (OR = 2·9, 95 % CI: 1.5−5.0, p=<0·0001) were associated with enduring seizure freedom for more than two years. ConclusionThe present study revealed a preponderance of structural etiology and a high rate of transition to LGS. Early age at onset of spasms (before five months) and structural etiology were the predictors of unfavorable long-term epilepsy outcome. QoL was impaired in more than two-thirds of patients and it correlated significantly with cognitive, sleep, motor, and behavioral outcomes. However, the results of our study should be interpreted in the context of significant attrition of the original cohort.

Assessment of burden of drug-resistant tuberculosis at a tertiary care centre in northern India: a prospective single centre cohort study

ObjectivesWe aim to define the burden of rifampicin monoresistant tuberculosis (TB) at a tertiary care centre in northern India as well as determine the second-line drug susceptibilities (SL-DST) in a...

PREVALENCE, RISK FACTORS AND TREATMENT OUTCOMES IN NEONATES WITH RETINOPATHY OF PREMATURITY (ROP) WITH BIRTH WEIGHT

Retinopathy of prematurity (ROP) is one of the major cause of the preventable childhood blindness worldwide. One year prospective interventional study was conducted in a tertiary care centre in Northern India. All neonates with birth weight ≤ 2000 grams with gestational age ≤35 weeks were screened for ROP and divided into two groups, infants with birth weight &lt;1750 grams (Group A) and ≥1750 grams (Group B). Prevalence of ROP, risk factors and laser treatment outcomes were compared between two groups. Of 191 neonates screened, 61(31.93%) developed ROP, out of which Infants with very low birth weight were at signicantly higher risk of developing severe ROP requiring treatment. In addition, high concentration and uctuating oxygen administration, sepsis, shock, intravenous uids &gt;10 days were observed to be statistically signicant risk factors in infants &lt;1750 grams. Timely screening and early treatment of threshold ROP results in desirable structural and functional outcome.

A contemporary insight into the sero-epidemiology of Toxoplasma gondii infection in the foot-hills of Himalayas: A cross-sectional study from a tertiary care center in Northern India.

BackgroundToxoplasma gondii infects 30-50% of the world’s population with high diversity in the geo-epidemiology and seroprevalence. The burden of toxoplasmosis and its determinants from remote and vulnerable regions of India is unknown. Therefore, this study aim to evaluate the prevalence of toxoplasma antibodies and factors associated with seropositivity among individuals from Uttarakhand and adjoining areas.MethodsSerum samples from 442 cases were tested for anti-Toxoplasma IgG and IgM antibodies by Enzyme-linked Immunosorbent Assay. Association of seropositivity of toxoplasmosis with age, gender, place of residence, dietary habits, and comorbidities were analyzed using binary logistic regression analysis.ResultsThe overall Toxoplasma seropositivity was found to be 36.88% [95% Confidence Interval (CI)=30.40–39.28]. While anti-T. gondii IgG was present in 34.84% [95% CI=30.40–39.28], anti-IgM was detected in 6.33% [95% CI=4.06–8.61]. The overall and IgG seroprevalence increased with age in both the genders and there was a sharp increase in the seropositivity after the age of 40 years [adjusted Odds Ratio (aOR)=2.98, p-value=0.030]. The seropositivity rate was significantly higher in individuals from Uttarakhand in both the hilly region (aOR=5.61; 95%CI:[2.14-14.68]) and plains (aOR=5.14; 95%CI:[2.2-12.02]). Multivariable logistic regression analysis also showed that being rural residents (aOR=3.23; 95%CI:[1.67-6.23]) and presence of comorbidities (aOR=8.64; 95%CI:[4.62-16.18]) were potential risk factors of Toxoplasmosis. On the other hand, consumption of vegetarian diet was found to have a protective effect (aOR=0.46; 95%CI:[0.28-0.75]).ConclusionSeroprevalence of T. gondii antibodies was relatively high in Uttarakhand, particularly in rural and hilly terrain, indicating a necessity for the implementation of integrated public health strategies to prevent and control toxoplasmosis in this region.

Virtual consulting in the times of COVID-19

Background: Confinement and economic uncertainty, along with disease-specific issues such as pain and suffering may uniquely impact rheumatology patients, putting non-COVID morbidity at par with COVID-related losses.Methods: We conducted a review of records to explore the clinical profile and interventions in rheumatology patients at a tertiary care center in Northern India to identify the potential problems and propose direction for the future.Results: In our experience spanning 5 weeks, among 508 rheumatology patients who sought teleconsultations, rheumatoid arthritis was the most common diagnosis (35.2'), and 43' were asked to continue the same treatment over tele consults, whereas investigations were awaited for another 16'. Nearly one-third (29.9') required an intervention, though this largely consisted of dose titrations (104 of 152, 68.4'). Certain diseases such as myositis were under-represented among consults (1.2') but over-represented (33.3') among admissions. Among the 54 patients who were asked to rate their teleconsultation experience, the voice and consultation quality were rated and average of 9.9 each, and 88.9' (48/54) said they would prefer teleconsultations until the pandemic is over.Conclusion: A sizeable proportion of rheumatology patients can be managed with teleconsultations, with some requiring greater assistance, calling for a triage protocol for the times ahead. With propositions for a deliberate transition into the realm of virtual consulting, chronic caregivers can hope to reach an optimal balance between e-consults and in-person visits.