Center In South India Research Articles

Primary Thyroid Malignancies in Children and Adolescents - A Retrospective Analysis from a Tertiary Cancer Centre in South India

Primary Thyroid Malignancies in Children and Adolescents - A Retrospective Analysis from a Tertiary Cancer Centre in South India

Management of Disseminated Rhinosporidiosis: Experience From a Single Tertiary Institution.

This study aims to present a series of patients with disseminated rhinosporidosis with diagnostic and therapeutic features. A retrospective study was conducted in a tertiary health care centre in South India from 2007 to 2020 with disseminated rhinosporidiosis. Twelve patients with multiple sites of involvement like the nose, nasopharynx, oropharynx, larynx, lacrimal sac and skin were included in the study. All patients underwent surgical excision, followed by peroral dapsone for one year. The age group was around 30-55 years, with male predominance (11:1). Pond bathing history was present in 50% (n=6). The most common site of lesion was the nose (100%), oropharynx (83.3%), skin (75%), larynx (50%) and less commonly, nasopharynx (41.6%) and lacrimal sac (25%). One patient underwent surgery four times (8.3%), followed by thrice and twice by five (41.6%) and six (50%) patients, respectively. On two years of follow-up, two patients (16.6%) had a recurrence in the nose and larynx whereas eight patients (66.6%) had no recurrence and two patients (16.6%) were lost to follow-up. This original article highlights the rare occurrence of disseminated rhinosporidiosis, the possibility of which should be kept in mind, mainly when two or more sites are involved. The most significant number of disseminated rhinosporidiosis cases in the literature is reported here. Dissemination with the cutaneous and multisite disease is rarely reported and poses difficulty in management. Early diagnosis and intervention prevent the dissemination of spores into various parts of the body.

Prevalence and Risk Factors of Endometriosis Among Infertile Women in a Tertiary Care Center in South India

Prevalence and Risk Factors of Endometriosis Among Infertile Women in a Tertiary Care Center in South India

Epidemiological Study of Pediatric and Adolescent Poisoning Cases in a Rural Tertiary Care Centre in South India

Pediatric poisoning covers the entire spectrum of cases from accidental ingestion in toddlers to intentional abuse in teenagers. Epidemiological surveillance of oral ingestion of poisonous substances in children and adolescents in a particular area is necessary to determine the extent and characteristics of the problem, according to which related preventive measures can be taken. This was a retrospective, observational study including all pediatric poisoning patients (between the age of 0 to 19 years) received at the Trichy SRM Medical college & Research Centre, Irungalur, Trichy during the 2 year period from May 2021 to April 2023. A total of 52 cases were received in the casualty department of our hospital during the study period. Out of this, Male patients were predominant (53.85%). Most of the cases belonged to the age group between 16- 19 Years . Most of the cases were from the Rural areas (82.69%).Accidental Poisoning (61.54%) is more common followed by suicidal poisoning (38.46%). The substances involved in Poisoning are Kerosene(19%),Rat Killer (10%), Paracetamol(10%), Oleander(8%), ant-killer (8%), Organo-phosphorus Poisoning(6%) among many others. Most of the time the poisoning happened inside Home(65%) followed by area surrounding home(17%). Oral route (88%) was the most common way of taking poison. Most cases took less than 4 hours (71%) to reach the hospital. Vomiting was the most common symptom in most of the cases. 23 cases (44%) were requiring intensive care of which only 8 cases (15%) needed more than 3 days of ICU care.

D-dimer as a Predictor of ICU Admission and Mortality in COVID-19 Patients: Insights From a Two-Year Retrospective Study From a Tertiary Care Center in South India

D-dimer as a Predictor of ICU Admission and Mortality in COVID-19 Patients: Insights From a Two-Year Retrospective Study From a Tertiary Care Center in South India

EP.12A.37 Erlotinib: A Beacon of Hope in EGFR TKI-Progressed Lung Cancer, A Real-World Experience from a Tertiary Care Cancer Centre in South India

EP.12A.37 Erlotinib: A Beacon of Hope in EGFR TKI-Progressed Lung Cancer, A Real-World Experience from a Tertiary Care Cancer Centre in South India

Standardization And Evaluation Of An In-House ELISA For The Detection Of Rabies Antibody In A Tertiary Care Centre In South India

BackgroundRapid fluorescent focus inhibition test (RFFIT), a neutralization-based assay for detecting rabies antibodies, is the gold standard. The National Action Plan for Dog Mediated Rabies Elimination (NAPRE) is a national program that strategizes the establishment of enzyme-linked immunosorbent assays (ELISA) to detect rabies antibodies. ObjectiveWe developed an in-house ELISA to screen for rabies antibodies using rabies vaccine antigen to study vaccine response among health care workers (HCWs) who received pre-exposure prophylaxis and a few animal bite victims who received post-exposure prophylaxis with rabies vaccine. Study designA prospective study was carried out from April to September 2023 at the Department of Clinical Virology of a tertiary care center in South India. A total of 161 serum specimens, which included 155 serum samples from study participants and 6 samples from a reference laboratory (as controls), were obtained during the study period. Rabies antibody was determined by the in-house standardized ELISA developed using the rabies vaccine and compared with the reference assay, RFFIT. The accuracy indices of the in-house ELISA were estimated by MedCalc software (version 22.023). ResultsA panel of 86 positive and 75 negative serum samples was used for evaluating the in-house standardized ELISA. The sensitivity, specificity, positive and negative predictive values of the in-house ELISA were 98.8%, 100%, 100%, and 98.7% respectively. The accuracy of the in-house ELISA is 99.4%. ConclusionELISA can be a practically feasible and less expensive assay compared to RFFIT which is a cumbersome procedure with a long turn-around time of 3-4 days.

Cytogenetic spectrum and clinical presentation of Klinefelter syndrome: A comprehensive study from South India

BackgroundKlinefelter syndrome (KS) is a common sex chromosome abnormality that mostly presents as testicular failure and a myriad of other clinical features. The phenotypic features and their severity vary between individuals, age groups and cytogenetic subtypes. Karyotyping remains the method of choice for the diagnosis of KS despite advanced molecular testing in this modern era. The objective of this study was to determine the cytogenetic subtypes, clinical presentation and hormonal profile of patients with KS. MethodsRetrospective observational study comprised patients with KS determined by cytogenetic analysis at the tertiary care centre in south India from 2001 to 2019. Clinical details including testicular size, hormone levels and semen analysis were obtained from the medical records. ResultsThere were 147 KS (145 post-natal and 2 pre-natal) patients ranging in age from two days to 51 years, 116 (74.8%) patients being ≥18 years. Classic (cKS), mosaic (mKS) and variant KS (vKS) accounted for 126 (85.7%), 9 (6.1%) and 12 (8.2%) cases and their mean ages were 26.6, 29.6 and 12.8 years, respectively. cKS and mKS had diverse clinical presentations including several co-morbidities of which small testes were most common (94.8%). vKS presented with behavioural problems (58.3%) without any comorbidities. Testosterone (p < 0.05), FSH and LH levels were abnormal in >90% of patients. ConclusionAll three cytogenetic subtypes of KS were seen in our patients. cKS was seen in all ages, mKS was common in adults and vKS was seen predominantly in children. Early diagnosis of KS and timely medical intervention may alter the clinical outcomes and improve the quality of life.

Profile of Nonresolving Pneumonia in a Tertiary Care Center in South India: A Prospective Study

Profile of Nonresolving Pneumonia in a Tertiary Care Center in South India: A Prospective Study

Autonomic Dysfunction in Fibromyalgia Patients: Electrophysiological Evidence from a Cross-sectional Study in Kochi, India

Background: Over the decades, studies from various populations have found fibromyalgia and dysautonomia to be linked. However, recent evidence from Indian populations contradicts these findings. Methods: This cross-sectional study, conducted in a quaternary care centre in South India, recruited 30 women with fibromyalgia (2016 ACR criteria) and 30 age and sex-matched controls. We assessed all participants using Composite Autonomic Symptom Score (COMPASS-31) questionnaires, Sympathetic Skin Response (SSR) for sympathetic dysfunction and Heart Rate Variability battery of tests for parasympathetic dysfunction. Results: Median age of the women was 40 years. Fibromyalgia group reported severe levels of pain and disease impact on life. Fourteen participants (46.7%) with fibromyalgia tested positive for either sympathetic or parasympathetic dysfunction or both, while none of the control participants tested positive for either (odds ratio [OR] = 53.6, 95% confidence interval [CI] = 3–957, p = 0.0068). Conclusion: Dysautonomia is strongly associated with fibromyalgia syndrome. Further research is needed to determine causality.

Higher prevalence of poor prognostic markers at a younger age in adult patients with myelodysplastic syndrome – evaluation of a large cohort in India

BackgroundThe karyotype is a major determinant of prognosis in myelodysplastic syndrome (MDS). Details of the cytogenetic profile of MDS in South Asia are limited because cytogenetic services are not widely available.MethodsWe performed a retrospective analysis of the cytogenetic and clinicopathologic profile of adult primary MDS seen consecutively at a tertiary-care centre in South India between 2003 and 2017. Patients were re-categorised according to the 2022 World Health Organisation (WHO) and the International Consensus classifications (ICC).ResultsThere were 936 patients aged 18–86 years (median age 53, 65% males), with MDS with del 5q, low blasts and increased blasts in 7.5%, 58.4% and 34.1% respectively. Clonal abnormalities were seen in 55% of patients, with solitary abnormalities in 29.8% and complex karyotypes (CK, ≥ 3 abnormalities) in 15%. The most frequent abnormalities were monosomy 7/deletion 7q (16.1%), deletion 5q (14.5%), trisomy 8 (11.5%), and deletion 20q (5.1%). Cytogenetic prognosis groups were distributed as follows: very good, 2%; good, 55.6%; intermediate, 16.2%; poor, 15%; very poor, 11.2%. Clinical (IPSS-R) risk stratification (842 patients) showed: very low-risk, 3.9%; low-risk, 30.9%; intermediate-risk, 24.2%; high-risk, 21%; very high-risk, 20%. Age-adjustment (IPSS-RA) raised the very low-risk group to 12.4%; the other groups decreased by 1–3% each.ConclusionThe most significant finding of this cytogenetic analysis of MDS in India is that abnormal karyotypes with poor prognosis markers including monosomy 7 and CK were more frequent than in most other reports, among patients who were overall younger. Trisomy 8, deletion 20q, the IPSS-R intermediate-risk and both high-risk groups were more common than in the West. Trisomy 8 was less common than in South-East Asia while CK and deletion 20q were comparable. Evaluation of such large cohorts highlights the unique features of MDS in different parts of the world. These findings suggest that there could be differences in predisposing factors, environmental or genetic, and emphasise the need for further exploration to better understand the varied nature of MDS.

Unveiling the enigma of spontaneous regression in hepatocellular carcinoma: A case report from a tertiary care center in South India

Unveiling the enigma of spontaneous regression in hepatocellular carcinoma: A case report from a tertiary care center in South India

Spectrum of Kikuchi-Fujimoto Disease: A 10-Year Study in a Tertiary Care Centre in South India.

Background Kikuchi-Fujimoto disease (KFD) is a benign lesion of the lymph nodes predominantly seen in younger women and is a condition associated with a good prognosis due to its indolent nature. Since KFD is chiefly a diagnosis of exclusion, it is liable to a higher degree of misdiagnosis. Aim In our study, we attempt to document and analyse the demographic, clinical, and pathological spectrum of cases diagnosed as KFD in a South Indian tertiary care centre over a period of 10 years. Methodology This study was conducted in a retrospective observational manner. Descriptive statistics, including simple frequency and percentage, were used to analyse and summarise the collected data. Results Among the 44 cases obtained, 36 patients were female and eight were males, with an age range of eight to 70 years. The mean age of the affected population was 26 years. Fever was a presenting complaint in 63.6% of cases, and 100% of the cases had lymphadenopathy, chiefly affecting the posterior cervical group of nodes (32/44 cases). Multiple lymph node groups were involved in 22 cases. Most of the nodes were larger than 1 cm in their greatest dimension. On analysis of peripheral smears, 43.2% of patients showed leukopenia. Anti-nuclear antibody (ANA) analysis showed a positive status among two patients, simultaneously establishing the diagnosis of systemic lupus erythematosus (SLE). A history of treated tuberculosis was present in four patients, and one patient had a history of non-compliance with TB treatment. Two patients had recently been diagnosed with TB and were on treatment. The involved nodes were subjected to fine-needle aspiration studies in 13 patients; 12/13 cases showed reactive lymphadenitis, while one case had atypical lymphoid cells. The involved nodes of all the patients were excised and sent for histopathological analysis. The diagnosis of KFD was confirmed on the biopsy. Conclusion In this study, we note the clinical presentations of all the patients diagnosed with KFD and elaborate on the investigations that were employed to verify the diagnosis via exclusion that enabled differentiation of KFD from its close mimickers, which have specific treatment. Keeping this entity in mind is essential in order to prevent overdiagnosis, as most often this condition resolves spontaneously, and in occasional cases, symptomatic treatment is sufficient for its management.

Clinical Usefulness of Fagotti’s Predictive Index Value, and Its Correlation with CT Based Peritoneal Cancer Index: Experience from a Tertiary Care Oncology Center in South India

Clinical Usefulness of Fagotti’s Predictive Index Value, and Its Correlation with CT Based Peritoneal Cancer Index: Experience from a Tertiary Care Oncology Center in South India

Increased surge of secondary bacterial infections leading to sepsis among COVID 19 patients in a tertiary care centre in South India

Increased surge of secondary bacterial infections leading to sepsis among COVID 19 patients in a tertiary care centre in South India

An Analysis of the Results of Breast Imaging Reporting and Data System 4 Lesions in Tertiary Care Center in South India

An Analysis of the Results of Breast Imaging Reporting and Data System 4 Lesions in Tertiary Care Center in South India

Biologics in ocular inflammatory diseases - Experience from a tertiary referral eye care center in South India.

To analyze the utility of biologics in noninfectious uveitis and other ocular inflammatory diseases in a South Indian patient population. This was a retrospective observational study conducted at the uveitis and ocular inflammatory diseases clinic of a tertiary eye care hospital in South India between 2016 and 2023. Records of 76 patients on biologics were retrieved from our databases. The mean age was 34.84 ± 17.383 years. In 75% of patients, the duration of follow-up was 52.75 months. Overall, anterior nongranulomatous uveitis was the most common anatomic type of uveitis (34.21%). HLA B27-associated uveitis was the most common etiology (34.21%) in whom biologics were used. Patients <18 years of age formed 23.7% with a mean age of 10.77 ± 2.75 years. Mean duration of follow-up in patients <18 years of age was 36 months. In this subgroup, panuveitis was the most common anatomic subtype (61.1%) and juvenile idiopathic arthritis was the most common etiology (27.7%). The most commonly used biologic in this study was adalimumab (36.84%). Additional conventional immunomodulators were used along with biologics in 50 patients (65.78%), of which methotrexate was the most common (50%). Adalimumab and rituximab were biosimilars, while tofacitinib was the generic version. There was a significant decrease in the mean number of flareups post-biologics (P = 0.001). Adverse effects were seen in 14 patients (18.42%). The success rate of biologics was low in the parsplanitis group <18 years (33.3%), Blau-associated uveitis (50%), and idiopathic uveitis (30%). In this study, we have analyzed the results of biologics in different anatomic types of ocular inflammation and etiologies. The success rate of biologics was low in parsplanitis, idiopathic uveitis, and Blau-associated uveitis and higher in other etiologies.

Risk Factors, Clinical Profile, and Outcomes of Coronary Artery Disease in the Elderly

Objectives This study aimed to identify risk factors in patients diagnosed with angiographically significant coronary artery disease (CAD) after 65 years of age (elderly) with a subset analysis of more than 75 years, analyze their clinical, angiographic profile and assess their major acute cardiovascular and cerebrovascular events (MACCE). Methods This was an observational retrospective and prospective study conducted from January 2022 to June 2023 among consecutive elderly who underwent CAG for suspected or diagnosed CAD between 2010 and 2018 at a tertiary center in South India. Results A total of 1,511 patients satisfied eligibility criteria with mean age of 69.38 years and male preponderance (69%). Male gender, dyslipidemia and current tobacco use contributed to angiographically significant CAD by multiple logistic regression analysis but none of the risk factors contributed in the more than 75-year age group. Female patients had higher incidence of atypical presentation, less revascularizations and higher MACCE. Fourteen percent of patients with significant CAD developed MACCE over a median 3.5-year hospital follow-up. Survival analysis of 1,027 patients with significant CAD showed one, three, 5-year mortality rate of 4.3%, 6.9% and 10.8%, respectively, with left ventricular dysfunction and triple vessel disease being associated with worse survival. MACCE and 5-year survival was significantly better among those who underwent revascularization including those with significant left main or triple vessel disease. Conclusion This study showed a high prevalence of traditional risk factors in elderly patients among which male gender, dyslipidemia, current tobacco use were found to predict angiographically significant CAD. Triple vessel disease and left ventricular dysfunction were associated with worse survival. Mortality was significantly lower among elderly who underwent revascularization compared to medical management.

Study on the public awareness of stroke risk factors, symptoms, treatment and rehabilitation: A community based cross sectional survey from a tertiary referral centre in South India

Background: The incidence of Non communicable diseases (NCDs) including stroke is increasing in India over the past few years. Thrombolysis therapy has revolutionized management of acute ischemic stroke. In spite of such recent advances in stroke therapy, the public remains uninformed about stroke symptoms and management. Objective: To assess the public awareness of stroke risk factors, symptoms, treatment and rehabilitation measures. Methods: The study was a community-based cross-sectional study, designed as an online survey. The tool used for the survey was a semi-structured online questionnaire. Results: Regarding the risk factors of stroke, of the participants, 41 (14.8%) were aware of valvular heart diseases, 18 (6.5%) of lack of exercise, 238 (85.9%) of dyslipedemia, 236 (85.2%) of hypertension, 222 (80.1%) of smoking, and 154 (55.6%) of diabetes. Regarding symptoms of stroke, of the participants, 209 (75.5%) were aware of loss of balance, 240 (86.6%) of speech abnormalities, 261 (94.2%) of facial weakness, and 234 (84.5%) of weakness. Conclusion: Efforts should be made to educate the public regarding uncommon symptoms of stroke, thrombolysis treatment and rehabilitation measures, so that people make beneficial health care decisions in stroke management.

EGFR Mutations, ROS1 and ALK Rearrangements, Smoking and Gender Association in Non?Small Cell Lung Cancer Patients at a Tertiary Care Centre in South India

EGFR Mutations, ROS1 and ALK Rearrangements, Smoking and Gender Association in Non?Small Cell Lung Cancer Patients at a Tertiary Care Centre in South India