Tertiary Care Center Hospital Research Articles

Case Control Study to Evaluate Tear Film Function and Ocular Surface Disorder in Diabetic Patients

BACKGROUND
 Diabetic retinopathy and early development of cataracts are well-known ocular complications of long-standing diabetes. In recent years various researchers have reported ocular surface disorders, particularly dry eyes in diabetic patients which if left untreated may result in a variety of corneal complications. These ocular surface disorders can be clinically diagnosed by performing a detailed slit lamp examination, Schirmer's test and tear film break-up time. Our study intended at assessing tear film and ocular surface disorders in diabetic patients and study tear film function in them and compare it with non-diabetic patients.
 METHODS
 A comparative cross-sectional study was done on 100 diabetic and 100 non-diabetic patients > 30 years of age visiting OPD of health centre of tertiary care hospital of Central India. Clinical data and detailed clinical history were obtained from all subjects through direct patient interviews and reviewing of their medical records followed by a comprehensive ocular examination that included best-corrected vision, slit lamp examination, and Tear Film break up time (TBUT) & Schirmer test.
 RESULTS
 In our study, mean TBUT was found to be significantly reduced in diabetics (15.94 ± 3.8) as compared to non-diabetics (20.13 ± 6.6). No significant difference was found in the Schirmer test reading between diabetics (17.13 ± 3.20) and non-diabetics (19.20 ± 6.23). Diabetic male patients had significantly decreased mean TBUT & mean Schirmer test readings as compared to diabetic females. Mean Schirmer reading & Mean TBUT were lowest in a patients having > 20 years of DM and highest in patients having < 5 years of DM. No positive correlation was found between HbA1c (Glyosylated Haemoglobin) and diabetic retinopathy with TBUT/ Schirmer test readings.
 CONCLUSIONS
 Our study showed that the tear film stability was found to be affected in diabetic patients, as compared to non-diabetic subjects as evident by the lower level of TBUT in diabetic patients. Significantly reduced TBUT with no significant difference in Schirmer test reading in diabetic as compared to non-diabetic subjects might be due to a decrease in basal secretion with normal overall tear secretion. The absence of subjective symptoms of dryness in spite of decreased TBUT in the diabetic group might be due to a decrease in corneal sensitivity caused by diabetic peripheral neuropathy in diabetic patients. There was an increase in the prevalence of DES with an increasing duration of DM. Rheumatoid arthritis was found to be a risk factor for DES. Diabetic males were found to be at risk for developing dry eye syndrome. Hence it can be concluded from our study that every diabetic patient should undergo a comprehensive eye examination which should include various tests for dry eye assessing multiple tear parameters.

An Innovative Three Stitch Technique in Tibia Interlocking Nailing a Retrospective Analysis

Introduction: More recent advances are about the incision technique for intramedullary interlocking (IMIL) nailing, a 3 cm stab incision is sufficient for the procedure of IMIL nailing as compared to commonly used suprapatellar incision of 5–7 cm with splitting of patellar tendon which might result in chronic knee pain restricted range of movement, risk of infection, longer duration of postoperative rehabilitation, and poor wound healing. Objective: A retrospective study and analysis of three stitch technique in posttraumatic shaft tibia fractures to assess the range of motion. Background: Tibial shaft fractures have peaked in incidence in the past decade with sky rocketing amount of road traffic accidents. With the mainstay of making any patient of such traumatic incident being early mobilisation, IMIL nailing for tibia remains one of the finest treatment modalities among plating or external fixator applications. With the increased demands in the field of cosmetology and minimally invasive scar techniques, the 3-stitch technique would have a major impact not only on the early healing of surgical scar but also reduced chances of acquired infections along with advancements in weight-bearing exercises. Materials and Methods: A retrospective analysis of midshaft tibia fractures who were treated with IMIL nailing with 3-stitch technique with a sample size of post op 100 patients. A study was held at a tertiary care hospital and research center. Results: Sample size of postoperative 100 patients out of which 76 showed conclusive results and 24 were lost at follow-up. Conclusion: Good to excellent outcome with a small healed scar was observed in patients who underwent 3-stitch technique IMIL nailing for shaft tibia fractures.

Risk factors for discontinuing oral immunotherapy in children with persistent cow milk allergy.

BackgroundThere are no universally accepted criteria for discontinuing milk oral immunotherapy (MOIT) in patients with persistent cow milk allergy (CMA) and little data are available on predictive risk factors for dropping out from oral immunotherapy (OIT), due to allergic reactions or other reasons.MethodsWe retrospectively reviewed clinical records of patients with persistent severe CMA undergoing MOIT in a tertiary care center hospital to investigate risk factors associated with discontinuation of OIT. Persistent and severe allergy was defined as the history of systemic reactions and any milk protein‐specific IgE level >85 kU/ml. All patients were first admitted for an in‐hospital rush phase eventually followed by an at‐home dose increase. We evaluated the effect of various factors on two primary outcomes: the highest dose of milk ingested during the in‐hospital rush phase and during the home OIT phase.ResultsWe identified 391 patients, of whom 131 met the inclusion criteria for the retrospective study, 54 females and 77 males. Data of the home OIT phase were available for 104 patients (27%).Regarding the home OIT outcome, an association for having a cow milk avoiding diet was found with reaching a dose below 10 ml during the in‐hospital rush phase (relative risks [RR]: 2.33, confidence interval [CI]: 0.85; 6.42), an age above than 10 years from the time of admission (RR: 3.29, CI: 0.85; 12.73), and a higher total number of reactions occurred during the hospitalization (RR: 1.54, CI: 1.02; 2.32), whereas the presence of respiratory reactions with wheezing (RR: 1.93, CI: 0.49; 7.61) and an IM adrenaline use was related to a higher risk of having an OIT still in progress (RR: 5.47, CI: 0.33; 7.73).ConclusionsIn this cohort of children with persistent CMA undergoing OIT who presented with respiratory reactions with wheezing, the development of anaphylaxis with the need for IM adrenaline, and age above 10 years were predictors of poor long‐term outcome.

Distinct outcomes in Hispanic/Latinx and non-Hispanic/Latinx patients with metastatic renal cell carcinoma (mRCC) treated with first-line ipilimumab plus nivolumab (ipi/nivo).

4554 Background: Subgroup analyses have reported differences in clinical outcomes by ethnicity in patients (pts) receiving immune checkpoint inhibitors (Cheng et al Ann Oncol 2019; Peravali et al World J Clin Oncol 2021). We sought to compare real-world outcomes between Hispanic/Latinx and non-Hispanic/Latinx mRCC pts treated with first-line ipi/nivo within a safety-net healthcare system and at a tertiary care center in Southern California. Methods: We performed a retrospective analysis of mRCC pts who received ipi/nivo within the Los Angeles County Department of Health Services (a safety-net healthcare system) and the City of Hope Comprehensive Cancer Center (a tertiary oncology center) between Jan 1, 2015 and Dec 31, 2021. Pts were identified using institutional databases and clinical data were compiled from electronic health records. Pts with pathologic diagnosis of stage IV mRCC, age > 18 years and receipt of ipi/nivo as first-line therapy were included. Progression-free survival (PFS) was analyzed using the Kaplan-Meier method and covariates were adjusted using multivariate Cox proportional hazards regression. Results: Of 96 pts, 67 (70%) were male, 90 (94%) had clear-cell histology, and 89 (93%) had intermediate/poor IMDC risk. Forty-two pts (44%) were Hispanic/Latinx while the remainder were non-Hispanic/Latinx (44 pts [46%] White, 7 pts [7%] Asian, and 3 pts [3%] Other). Fifty (52%) and 46 (48%) pts received their care at a tertiary care center and within a safety-net healthcare system, respectively. Median age, IMDC risk classification, BMI, and number of comorbidities were similar between both groups. Pooled analysis by ethnicity revealed significantly shorter PFS in Hispanic/Latinx vs non-Hispanic/Latinx pts (HR 1.60, 95% CI 1.04-2.48, p = 0.03). At 12 months, 19% of Hispanic/Latinx pts (95% CI, 9-32) and 35% of non-Hispanic/Latinx pts (95% CI, 23-48) were alive and progression-free. There was no difference in PFS between pts at the safety-net hospital system vs tertiary care center (HR 1.32, 95% CI 0.87-2.02, p = 0.19). Conclusions: Our real-world analysis of mRCC pts demonstrated poorer outcomes with ipi/nivo in Hispanic/Latinx pts. We are currently interrogating multiple social determinants of health that may contribute to these concerning disparities.

Subthalamic nucleus projection by SVM based MER Data via deep brain stimulation: A study of spike uncovering

This study was conducted at a medical university tertiary care hospital and research center of dedicated Parkinson and movement disorders unit in Hyderabad (South India) with a purpose to optimize projection of STN by applying M.E.R patterns analytically. 52 locally anesthetized Parkinson`s (diseased subjects/patients) underwent bilateral S.T.N-D.B.S. Concurrent M.E.R signal recording was done in a Ben’s-gun pattern setup with a 5core-pentode (5microelectrodes were set in an array scenario). Using spikes and circumstantial (or contextual) background-activity dissimilar parameters plus their phantom estimates in various-frequency-bands which include low-frequency(2Hz–7Hz), :Hz–12Hz, (sub-divided as low-) and superior :21Hz–30Hz and :31Hz-49Hz were computed. The ideal electrode implantation through better clinical-effect/dyskinesia ratio given to the peak spike-rate(S.R) in 86% of the implant. The amplitude mean-background activity in low-chucked frequency-range(FR) was analogous to right depth in 86% and right-hemisphere position in 95% of the implantation.

Whole-Genome Sequencing Enables Molecular Characterization of Non-Clonal Group 258 High-Risk Clones (ST13, ST17, ST147 and ST307) among Carbapenem-Resistant Klebsiella pneumoniae from a Tertiary University Hospital Centre in Portugal.

The carbapenem-resistant Enterobacterales (CRE) strains have been identified by the World Health Organization as critical priority pathogens in research and development of diagnostics, treatments, and vaccines. However, recent molecular information about carbapenem-resistant K. pneumoniae (CRK) epidemiology in Portugal is still scarce. Thus, this study aimed to provide the molecular epidemiology, resistome, and virulome of CRK clinical strains recovered from a tertiary care hospital centre (2019–2021) using polymerase chain reaction (PCR) and the advanced molecular technique whole-genome sequencing (WGS). PCR amplification of carbapenemase genes was performed in 437 carbapenem-resistant K. pneumoniae strains. The most frequent carbapenemases were: KPC-3 (42%), followed by OXA-181 (20%), GES-5 (0.2%), and NDM-1 (0.2%). Additionally, 10 strains (2%) coproduced KPC-3 and OXA-181, and 1 strain coproduced KPC-3 and OXA-48 (0.2%). The genomic population structure of 68 strains characterized by WGS demonstrated the ongoing dissemination of four main high-risk clones: ST13, ST17, ST147, and ST307, while no clones belonging to the European predominant clonal groups (CG15 and CG258) were found. Moreover, we describe one K. pneumoniae ST39-KL62 that coproduced the NDM-1 carbapenemase and the extended-spectrum beta-lactamase CTX-M-15, and one K. pneumoniae ST29-KL54 GES-5 and BEL-1 coproducer. Furthermore, a high prevalence of iron siderophores were present in all CRK strains, with several strains presenting both colibactin and the hypermucoviscosity phenotype. Thus, the data presented here highlight an uncommon molecular epidemiology pattern in Portugal when compared with most European countries, further supporting the emergence and dissemination of nonclonal group 258 hypervirulent multidrug high-risk clones and the need to promote in-depth hospital molecular surveillance studies.

Awareness, perceptions, and attitude towards COVID-19 vaccine among 18-44 years old adults in India: a cross-sectional study

Background: The coronavirus disease 2019 (COVID-19) vaccines currently represent an effective and the only effective weapon to effectively combat the Pandemic. Thus, it is especially important to judge the awareness and perception of general population about the study. With this aim, the study was conducted at a vaccination centre among registered adults aged 18-44 years getting the first dose of vaccination to assess knowledge, perceptions about COVID 19 vaccine.Methods: A descriptive cross-sectional study was conducted from 15 June 21 to 25 June 21 among 612 adults aged 18-44 years adults registered for the first dose of vaccination (COVISHIELD Vaccine) at the vaccination centre of tertiary care hospital in Western Maharashtra.Results: A total of 612 study participants aged 18-44 participated. On assessing awareness, perceptions, attitudes towards the COVID-19 vaccine, most of them liked to prefer COVISHIELD (83.7%) over COVAXIN (12.3%). More than one-third liked to have a second dose at 4–6-week interval, with a similar number favouring 6–8-week interval. On assessing the KAP score mean KAP score (±SD) was 18±4.5 out of 35.Conclusions: This study highlights that overall awareness and perceptions of the study population was good. However, there was inadequate knowledge about certain key aspects of COVID-19 vaccination like contra-indications, duration after which protection starts after inoculation. The findings suggest immediate health education programs, risk communication, should be done effectively to curb, vaccine hesitancy and misinformation.

Clinical, anamnestic, and sociodemographic predictors of positive SARS-CoV-2 testing in children: A cross sectional study in a tertiary hospital in Italy.

We aimed to identify clinical, anamnestic, and sociodemographic characteristics associated with a positive swab for SARS-CoV2, and to provide a predictive score to identify at risk population in children aged 2-14 years attending school and tested for clinical symptoms of COVID-19. Cross sectional study. Outpatient clinic of the IRCCS Burlo Garofolo, a maternal and child health tertiary care hospital and research centre in Italy. Data were collected through a predefined form, filled out by parents, and gathered information on sociodemographic characteristics, and specific symptoms, which were analysed to determine their association with a positive SARS-CoV-2 swab. The regression coefficients of the variables included in the multivariate analysis were further used in the calculation of a predictive score of the positive or negative test. Between September 20th and December 23rd 2020, from 1484 children included in the study, 127 (8.6%) tested positive. In the multivariate analysis, the variables retained by the model were the presence of contact with a cohabiting, non-cohabiting or unspecified symptomatic case (respectively OR 37.2, 95% CI 20.1-68.7; 5.1, 95% CI 2.7-9.6; 15.6, 95% CI 7.3-33.2); female sex (OR 1.49, 95% CI 1.0-2.3); age (6-10 years old: OR 3.2, 95% CI 1.7-6.1 p<0.001; >10 years old: OR 4.8, 95% CI 2.7-8.8 p<0.001); fever (OR 3.9, 95% CI 2.3-6.4); chills (OR 1.9, 95% CI 1.1-3.3); headache (OR 1.45, 95% CI 0.9-2.4); ageusia (OR 1.3, 95% CI 0.5-4.0); sore throat (OR 0.48, 95% CI 0.3-0.8); earache (OR 0.4, 95% CI 0.1-1.3); rhinorrhoea (OR 0.8, 95% CI 0.5-1.3); and diarrhoea (OR 0.52, 95% CI 0.2-1.1). The predictive score based on these variables generated 93% sensitivity and 99% negative predictive value. The timely identification of SARS-CoV2 cases among children is useful to reduce the dissemination of the disease and its related burden. The predictive score may be adopted in a public health perspective to rapidly identify at risk children.

Clinical profile of sickle cell disease patients attending pediatric department of a tertiary care hospital and Sickle-Thal center: A cross-sectional study

BACKGROUND: Sickle cell disease (SCD) is a major public health problem in certain states of India associated with morbidity and mortality in children. The characteristics and clinical features of SCD are different in India as compared to those in developed countries with considerable clinical diversity.AIMS: This study aimed to describe clinical features in patients with SCD at the time of diagnosis and first visit.SETTING AND DESIGN: Department of Pediatrics at tertiary care hospital or Sickle-Thal Society Amravati,India (Both Collectively called as Unit). Design: Cross sectional Study.MATERIALS AND METHODS: All SCD patients 0–18 years, attending unit from October 1, 2019, to March 31, 2021, were included in the study. Data collected were based on history, clinical examination, and review of old records. The sample size was 153.STATISTICAL ANALYSIS: Data was analyzed by using software statistical packages in social sciences (SPSS) version 16. Mean, standard deviation (SD), proportions were calculated and Chi -square test of significance was used.RESULTS: Of 157 SCD patients (145 families), 90 (57.32%) were males and 67 (42.68%) females. The mean age of diagnosis and unit visit was 53.59 and 115.74 months, respectively. At diagnosis, paleness (68%), pain (54%), and fever (45%) were common complaints with other nonspecific complaints. Pallor (97.45%) and palpable spleen (53.90%) were common signs at the first unit visit. The spleen was palpable in 65 (42.48%) even after 5 years.CONCLUSION: SCD patients had paleness, pain, and fever as the most common complaints. Palpable spleen was seen even after 5 years of age. Early suspicion is key for diagnosis.

Efficacy of Different Doses of Cisatracurium for Intubation for Surgeries under General Anaesthesia- A Randomised Clinical Study

Introduction: Cisatracurium is a new non depolarising, Neuromuscular Blocking Drug (NMBD) with fast onset and short duration of action. It is a stereoisomer of atracurium with a potency of approximately 3 to 4 times greater than that of atracurium. As it is devoid of histamine release, it reduces the chances of adverse effects during operative procedures. However, the optimum intubating dosage needs to be established in patients. This warrants the need for studies focusing on the efficacy of different doses of cisatracurium and their outcomes. Aim: To study the efficacy of three different doses of cisatracurium {2x Effective dose (ED) 95, 4x ED95, and 6x ED95} for the time of onset of action, duration and haemodynamic stability offered for intubation. Materials and Methods: A double-blind, randomised clinical study was conducted from December 2017 to July 2019 at a tertiary care hospital and research center, Kolhapur, Maharashtra, India. Total 90 patients, undergoing surgeries under general anaesthesia were allocated into three groups, group A received 0.1 mg/kg, group B received 0.2 mg/kg and group C received 0.3 mg/kg of cisatracurium. Time taken for Train Of Four (TOF) to reach 0 was taken as the onset of action, and appearance of TOF 2/3 or patient’s attempt to breathe was taken as duration of action. Haemodynamic changes were also assessed preoperatively and postintubation immediately after confirmation of placement of ETT. Results: Mean age 33.23±6.26 years in group A, 37.70±10.80 years in group B, 38.23±8.764 years in group C (p-value=0.06). Least time was required for the TOF to become zero by group C (5.10±1.01 minutes) as compared to groups A and B (9.91±1.39 and 7.48±1.45 minutes) which was statistically significant (p-value &lt;0.001). The duration of action was also more in group C (49.83±5.33) compared to group A (27.23±6.97) and group B (36.17±7.62) (p-value=0.00001). Group C had better haemodynamic stability as the heart rate remained more stable than group A and group B. Conclusion: Higher dose of cisatracurium provides faster onset, longer duration of action with better cardiovascular stability. This predictable recovery from non depolarising muscle relaxation makes it a good choice of muscle relaxant agent for intubation.

Maternal Kalp Hastalığının Doğum Şekli ve Olumsuz Perinatal Sonuçlar Üzerindeki Etkilerinin Değerlendirilmesi: 10 Yıllık Tersiyer Merkez Deneyimi

Objective: The aim of the present study was to evaluate the effect of severe maternal cardiac disease during pregnancy on mode of delivery and adverse perinatal outcomes.Material and Methods: The study comprised 108 pregnant women with cardiac disorder who delivered at a tertiary care center hospital between 2010 and 2020. Mode of delivery, adverse maternal and perinatal outcomes was interpreted according to the woman’s status based on her type of heart disease and a modified World Health Organization classification.Results: The distributions of the women according to the modified World Health Organization classifications were 56.4%, 26.8%, 11.2%, and 5.6% for WHO classes I, II, III, and IV, respectively. The ratios of cardiac diseases were 65.7%, 21.2%, and 13.1%, respectively, for rheumatic, and congenital heart disorder, and others. Nulliparity, ethnicity, and history of caesarean section rates were similar among the classes. Gestational age at delivery and birth weight were significantly lower in classes III–IV than in classes I–II. Prematurity, small for gestational age rates, and admission to neonatal intensive care unit were increased in classes III–IV compared to those in classes I–II. While vaginal delivery rates were 54 (60%) in Class I-II and 10 (55.5%) in Class III-IV, the cesarean section rates were 36 (40%) in Class I-II and 8 (44.5%) in Class III-IV. There was a significant difference between the cesarean section rates. The presence of adverse obstetrical outcomes was similar among the classes. During this period, a total of 3 maternal mortalities occurred. Maternal morbidity and maternal mortality were increased in classes III–IV compared those in classes I–II.Conclusion: Pregnant women with cardiac diseases should be administered using a multidisciplinary approach that combines consultants from both obstetrics and cardiology to reduce maternal mortality and morbidity and adverse fetal outcomes.

A Comparative Study of Diagnostic Performance of CT and MRI for Abdominal Staging of Paediatric Renal Tumours-A Report from Tertiary Care Centre Hospital

Objective: To compare the diagnostic performance of CT and MRI for local staging of pediatric renal tumours. Materials and Methods: The study population was derived from our hospital Medical College Kolkata and Hospital. Baseline abdominal imaging performed with both CT and MRI.A retrospective review was done with 50 renal tumour cases selected and planned for nephrectomy over a study period of one year from October 2020 to November 2021. Each case was evaluated for capsular penetration, lymph node metastasis, tumour thrombus, preoperative tumour rupture, and synchronous contralateral lesions. The surgical and pathological findings were the reference gold standard. Results: The sensitivity of CT and MRI for detecting capsular penetration was 70% and 60%, respectively (P=0.73), while specificity was 84.3% and 84% (P=1.0). The sensitivity of CT and MRI for detecting lymph node metastasis was 80% and 53% (P=0.22), and specificity was 88% and 92% (P=1.0). Synchronous contralateral lesions were identified by CT in 5/12 cases and by MRI in 8/12 cases. Conclusion: CT and MRI have similar diagnostic performance for detection of lymph node metastasis and capsular penetration. MRI was more accurate in detecting contralateral synchronous lesions; how-ever these were observed in a very a smaller number of cases. Hence either modality can be used for initial loco–regional staging of paediatric renal tumours

Safety and efficacy of the patency capsule

Introduction and aimsThe patency capsule is an effective diagnostic method for preventing video capsule retention in the small bowel during capsule endoscopy. The most frequently associated complication when using the patency capsule is symptomatic retention. The aim of the present study was to evaluate the effectiveness and safety of patency capsules administered to patients at a tertiary care hospital center. Materials and methodsA retrospective observational study was conducted that included all the patients with confirmed Crohn’s disease that were administered a patency capsule, within the time frame of January 2019 and December 2020. PC diagnostic yield, sensitivity, specificity, positive predictive value, and negative predictive value were evaluated, in relation to capsule endoscopy and double-balloon endoscopy findings. Complications associated with the patency capsule were also identified. ResultsThirty patients were included, in whom the patency capsule had 83% sensitivity, 100% specificity, 100% positive predictive value, and 96% negative predictive value, with a diagnostic yield of 96.7%. There was one complication (3.3%) and it resolved spontaneously. ConclusionsThe patency capsule is a safe and effective method for reducing video capsule retention during capsule endoscopy in patients with Crohn’s disease.

Seguridad y eficacia de la cápsula Patency

Introduction and aimsThe patency capsule is an effective diagnostic method for preventing video capsule retention in the small bowel during capsule endoscopy. The most frequently associated complication when using the patency capsule is symptomatic retention. The aim of the present study was to evaluate the effectiveness and safety of patency capsules administered to patients at a tertiary care hospital center. Materials and methodsA retrospective observational study was conducted that included all the patients with confirmed Crohn's disease that were administered a patency capsule, within the time frame of January 2019 and December 2020. PC diagnostic yield, sensitivity, specificity, positive predictive value, and negative predictive value were evaluated, in relation to capsule endoscopy and double-balloon endoscopy findings. Complications associated with the patency capsule were also identified. ResultsThirty patients were included, in whom the patency capsule had 83% sensitivity, 100% specificity, 100% positive predictive value, and 96% negative predictive value, with a diagnostic yield of 96.7%. There was one complication (3.3%) and it resolved spontaneously. ConclusionsThe patency capsule is a safe and effective method for reducing video capsule retention during capsule endoscopy in patients with Crohn's disease.

Histomorphological spectrum of intracranial space occupying lesions: Experience at tertiary care centre

An “Intra-cranial space occupying lesion” (ICSOL) is defined as a mass in the cranial cavity with a diverse etiology like benign or malignant neoplasm, inflammatory or parasitic lesion, haematoma or arterio-venous malformation. The aim was to study the histomorphological spectrum of intracranial space occupying lesions at a tertiary care centre hospital in order to give accurate pretherapeutic diagnosis to facilitate better therapeutic results. This prospective and descriptive type of study of two years duration was carried out from November 2017 to October 2019 in Govt. Medical College and Superspeciality Hospital, Nagpur in the Department of Pathology. A total of 300 samples were received from Department of Neurosurgery. Detailed collection of clinical data was done in all patients regarding age, sex, clinical symptoms and radiological findings.The samples were received in 10% formalin and subjected to routine histopathological processing. Slides prepared were stained with hematoxylin and eosin stain. Special stains were done wherever required. Total 300 cases were studied of which 261 cases (87%) were neoplastic in nature and 39 cases (13%) were non neoplastic. Amongst primary tumours, most common were gliomas (48%) followed by meningiomas (20%) and schwannomas (9%). ICSOLs can present with nonspecific clinical features. Radio diagnostic investigations are helpful adjunct tools but cannot give exact diagnosis. Histopathological examination remains a gold standard for diagnosing and grading of tumours on which basis clinician can decide further line of management.

A retrospective study on the prevalence of weak D antigen (Du) in a blood bank in a tertiary care hospital in Maharashtra, India

Background: One of the most immunogenic blood groups known to humans is the Rhesus (Rh) blood group. The Rh blood group with variable expression of D antigen is one of the complex systems in immunohematology. Sometimes, the variable expression of RhD antigen leads to the presence of weaker forms that are not detected by routine laboratory procedures. Aims: The study was conducted to determine the frequency of RhD negativity and weak D antigens. Settings and Design: This retrospective study was conducted in the Department of Immunohematology and Transfusion Medicine at a tertiary care center hospital for three years from June 2017 to June 2020. Materials and Methods: All the serial Rh grouping tests were conducted by the gel technique or by the tube method with two Anti-D reagents. Negative D antigen samples were further tested for weak D antigen by Coombs Test. Statistical analysis used the Statistical Package for Social Sciences (SPSS). Results: Out of a total of 17262 samples, 15400 (89.2%) tested Rh-positive, and 1866 (10.8%) tested Rh-negative. Weak D was positive in 52(0.027%) samples out of the RhD negative samples. Conclusion: The frequency of weak D antigen is low, but the strong immunogenicity of RhD antigen calls for the need for appropriate testing. This is of concern in RhD negative pregnant females, as it can cause alloimmunization if accidentally weak D antigen-positive blood is transfused.

ABCL-321: Clinicopathological Profile of Gastrointestinal Lymphoma Diagnosed Over a Period of 6-Years: A Tertiary Care Center Experience

Context GI lymphomas (GIL) comprise approximately 1%–10% of all malignancies that arise in the gastrointestinal tract (GIT). GILs show heterogeneity in terms of distribution patterns, histopathological subtypes, disease manifestations, and treatment offered. Objective To determine the clinicopathological profile of lymphomas in the GIT. Design This is a retrospective study. All GIL-related data were retrieved from a database maintained by the Department of Pathology, All India Institute of Medical Sciences, New Delhi. The cases with incomplete diagnoses were reviewed, and an appropriate immunohistochemistry (IHC) panel was performed, followed by reclassification according to the 2017 WHO classification. Setting This is a hospital-based study from a tertiary care hospital and referral center with maximal investment by the central government. The biopsy, hematology, and radiology workup were done as a part of patient management and came at a minimal cost. The costs of histopathological diagnosis and routine blood counts, X-rays, and biochemistry are free. Patients or Other Participants Demographic details of all the cases were retrieved from the database. We have selected only those cases that had adequate diagnostic tissue and had an incomplete diagnosis for review. Results A total of 391(8.21%) cases of GIL were identified out of 4,758 total cases of lymphomas diagnosed over a period of 6 years, from 2015 to 2020. Out of these 391 cases of GILs, 364 were primary GILs, and 27 cases were secondarily involved GIL. Males are predominantly affected (M:F=3:1). The mean age is 40.6 yrs, with a range from 2 to 88 yrs. In the GIT, the stomach is the most common site of involvement (50%), followed by small intestine (28%) and large intestine (21.25%). DLBCL-NOS is the most common GIL (56.25%), followed by MALToma (15.35%), Burkitt lymphoma (10.5%), high-grade B-cell lymphoma-NOS (6.14%), T-cell NHL (3.84%), and other rare lymphomas, including IPSID, mantle cell lymphomas, duodenal type follicular lymphoma, and plasmablastic lymphomas. Conclusions It will be the largest single-institution study from India regarding gastrointestinal distribution and various subtypes of GILs. The stomach is the most common site of involvement for GILs, and DLBCL-NOS is the most common subtype of lymphoma involving the GIT, which is similar to studies published in western literature. Grant acknowledgments SERB ECR/2015/452, EEQ/2016/402, AIIMS-A_653

National Early Warning Score in Predicting Severe Adverse Outcomes of Emergency Medicine Patients: A Retrospective Cohort Study.

BackgroundFor emergency triage, it is very important to identify patient severity according to their vital signs and chief complaint. Several studies have examined the predictive value of the National Early Warning Score (NEWS) for specific emergency patients and have shown it to be effective. However, few have studied the utility of NEWS in emergency triage for general emergency medicine patients. The aim of this research was to investigate the performance of NEWS in emergency triage with regard to predicting adverse outcomes.MethodsThis was a retrospective cohort study carried out at a tertiary care center hospital in Jinhua, China. A total of 62,403 patients attending the emergency department (ED) from January to December 2018 were included. The NEWS, Modified Early Warning Score (MEWS), and quick Sepsis Related Organ Failure Assessment (qSOFA) score were obtained from emergency triage. Multivariate logistic regression analysis was performed to evaluate the associations between the NEWS, MEWS, and qSOFA, as well as those between other parameters with ED mortality. The predictive performances for emergency observation, death, and intensive care unit (ICU) admission of NEWS, MEWS and qSOFA were compared to the area under the receiver operating characteristic curve (AUROC).ResultsOf the total participants, 6502 were placed under emergency observation, 106 died in the ED, 638 were admitted to the ICU, and 324 died in-hospital. The NEWS, qSOFA, age, and gender were significantly associated with ED mortality. NEWS was significantly better at discriminating all outcomes, and the area under the curve and 95% confidence intervals for ED mortality, observation in ED, composite of ED mortality and ICU admission, and in-hospital mortality were 0.862 (0.859–0.865), 0.691 (0.687–0.695), 0.859 (0.856–0.861), and 0.805 (0.802–0.808), respectively.ConclusionNEWS shows good performance in discriminating critical emergency patients in ED triage for emergency medicine patients.

Pseudoexfoliation Syndrome and Associated Factors Among Adults at Gondar University Comprehensive Specialized Hospital Tertiary Eye Care and Training Center: A Cross-Sectional Study.

BackgroundPseudoexfoliation syndrome is an age-related disorder characterized by the deposition of a distinct fibrillar extracellular material in various tissues and organs of the body. Glaucoma and cataract are the consistently reported clinical consequences of Pseudoexfoliation syndrome on the eye. This study aimed to estimate the proportion of pseudo-exfoliation syndrome and associated factors in Gondar university comprehensive specialized hospital tertiary eye care and training center.Methods and MaterialsInstitution-based cross-sectional study was conducted from January to March 2019 at Gondar university comprehensive specialized hospital tertiary eye care and training center among 295 patients. Consecutive 295 participants aged above 40 years were involved in the study. A structured questionnaire and ocular examination were used to collect the data. Data were entered into EPI-INFO 3.5.1 and exported to SPSS version 20 for analysis. Factors associated with pseudoexfoliation syndrome were ascertained by chi-square and independent t-test. Statistical significance was considered when p-value <0.05.ResultsA total of 295 adults participated in the study with a response rate of 92.8%. The median (±IQR) age of study respondents was 64(±9) years and 67.8% were males. The proportion pseudoexfoliation syndrome was 34.6% [95% CI: 29.2–40.7%]. The mean IOP and mean age were significantly higher among patients with pseudoexfoliation syndrome. Age, sex, high IOP, glaucoma, outdoor work, and rural residence were significantly associated with the proportion of pseudoexfoliation syndrome.ConclusionThe proportion of pseudoexfoliation syndrome among participants aged ≥40 years was high. Age, sex, high IOP, glaucoma, outdoor work, and rural residence were factors having a significant association with the proportion of pseudoexfoliation syndrome.

8-years experience with ataxia telangiectasia: A series of 7 cases

Introduction. Ataxia telangiectasia (AT) is an autosomal recessive multisystemic neurodegenerative disease, considered a rare and orphan disease. Methods. A cohort of case series from 2012 to 2020. We included patients younger than 18 years, admitted with diagnosis of ataxia telangiectasia from a tertiary care hospital and national referral center in Peru. Year of diagnostic, mortality, demographics, genetic test, and other main clinical outcomes were described. Results. A series of seven cases are presented (4 are women, between 6 and 15 years old) from different provinces of Peru. Five cases had a diagnostic delay. Two cases died at 9 and 12 years. Three cases have a brother with AT. The most frequent reason for consultation (6/7) was recurrent lung infection, followed by postural instability. All had delayed psychomotor development, recurrent respiratory, and digestive infections. The main laboratory results were lymphopenia (5 cases), neutropenia (6 cases), IgA deficiency (5 cases), and elevated alpha-fetoprotein (4 cases). Conclusion. AT considerably deteriorates the quality and prognosis of life of patients.