Gauhati Medical College Hospital Research Articles

Preoperative Super-Selective Embolization versus "On-Clamp" Laparoscopic Partial Nephrectomy for T1 Renal Tumors- A Prospective Randomized Study.

To analyze and compare the intraoperative and post-operative outcomes of "on-clamp" laparoscopic partial nephrectomy (LPN) with "preoperative super-selective angioembolization" before LPN. This randomized clinical study was conducted at Gauhati Medical College Hospital, Guwahati, India, between November 2021 and November 2023. Adult patients of either gender diagnosed with T1 renal tumors were included in the study. All patients underwent diethylenetriamine pentaacetate scan preoperatively and at 1-month follow-up. The patients were randomized using a parallel group design with an allocation ratio of 1:1 to receive either preoperative angioembolization followed by LPN or conventional "on-clamp" LPN. Demographic and baseline parameters were recorded along with pre- and post-operative data. There was no significant difference between the two groups in terms of age (P = 0.11), gender distribution (P = 0.32), body mass index (P = 0.43), preoperative hemoglobin (P = 0.34), and preoperative estimated glomerular filtration rate (eGFR; P = 0.64). One patient in the embolization group required radical nephrectomy because of accidental backflow of glue into the renal artery during embolization whereas four patients required clamping due to inadequate embolization. Preoperative super-selective embolization yielded significantly less blood loss, compared to "on-clamp" LPN (145 [50.76 mL] vs. 261 [66.12 mL], P < 0.01). There was no significant difference between post-operative eGFR (at 1 month) between the two groups (P = 0.71). Preoperative embolization offers improved outcomes in the dissection plane, total operative time, and blood loss, compared to conventional "on-clamp" LPN but has no significant effect on change in eGFR.

A STUDY TO ASSESS THE KNOWLEDGE AND PRACTICE AMONG NURSES ON ACTIVE MANAGEMENT OF THIRD STAGE OF LABOUR WORKING IN OBSTETRICS AND GYNAECOLOGY DEPARTMENT IN SELECTED HOSPITALS OF KAMRUP (M), ASSAM.

Background: Active Management of Third Stage of Labour consists of interventions designed to speed the delivery of the placenta by increasing uterine contractions and prevent post-partum hemorrhage by an averting uterine atony. The Objective: objective of the study was to assess the Knowledge and Practice among Nurses on Active Management of Third Stage of Labour in selected hospitals of Kamrup (M), Assam. Methods: The study was conducted using Descriptive Survey design in Gauhati Medical College Hospital and Maternity &amp; Child Welfare Hospital under Kamrup (M), Assam with a total of 82 Nurses by convenience sampling technique. Self - administered structured questionnaire was used to assess the knowledge and practice on Active Management of Third Stage of Labour. Data was analysed by using the software package named SPSS 20 Version. The nding of the study revealed that only 15.8% of the total Nurses have ade Result: quate level of knowledge 17.1% have good practice on Active Management of Third Stage of Labour. Karl Pearson's correlation coefcient was found to be r=0.565** .Thus there is highly signicant positive correlation between the two variables i.e. Knowledge and Practice of Nurses on Active Management of Third Stage of Labour. There was a signicant association between Knowledge on Active Management of Third Stage of Labour with their Professional Qualication and Exposure to any information on Active Management of Third Stage of Labour .The association of Practice was found signicant with their Years of Working Experience in Obstetrics and Gynaecology Department and Exposure to any information on Active Management of Third Stage of Labour. Conclusion: Knowledge and Practice among Nurses on Active Management of Third stage of Labour in the selected hospitals was low

Clinico-Epidemiological Profiles of COVID-19 Elderly Patients in Guwahati City, Assam, India: A Cross-Sectional Study

BackgroundAs of November 14, 2021, coronavirus disease 2019 (COVID-19 has affected more than 3,44,00,000 individuals in India and resulted in more than 4,60,000 deaths in India.Symptoms of COVID-19 include cough, fever, dyspnea, diarrhea, fatigue, expectoration, myalgia, hemoptysis, abdominal pain, and anorexia.Associated comorbidities such as hypertension, diabetes, cardiovascular illness, and respiratory sicknesses influence the severity and prognosis of the COVID-19. Therefore, this study was conducted to determine the factors associated with the severity and outcome of elderly Indian people diagnosed with COVID-19.MethodologyThis hospital-based descriptive cross-sectional study was conducted among elderly patients with confirmed COVID-19 who were admitted to Gauhati Medical College Hospital from July 21, 2020, to January 15, 2021. The demographic data, exposure history, clinical symptoms and signs, underlying comorbidity, severity of COVID-19, and outcome data of each elderly patient were obtained and analyzed using SPSS software (Version 25.0, IBM Corp., Armonk, NY). The Fisher exact test, chi-square test, and binary logistic regression analysis were used for different study variables.ResultA total of 165 hospitalized COVID-19 elderly patients were included in this study, and their mean age was 68.4 years. The most common symptoms were cough (34.5%), fever (28%), breathing difficulty (22%), weakness (13.1%), and chest pain (3.6%). Those with breathing difficulty (adjusted OR [aOR]: 7.293, 95% CI: 2.229-23.860, p=0.001), loose stool (aOR: 12.142, 95% CI: 1.052-140.209, p=0.045), hypertension (aOR: 2.703, 95% CI: 1.023-7.139, p=0.045), and severity of COVID-19 (aOR: 7.691, 95% CI: 2.870-20.607, P<0.001) had increased risk of poor outcome among the COVID-19 elderly. Being hypertensive (aOR: 2.474, 95% CI: 1.060-5.774, p=0.036) had an increased risk of severity of COVID-19.ConclusionThe most common symptoms of COVID‐19 elderly patients were fever, cough, and breathing difficulty. In elderly COVID-19 patients, hypertension played a crucial role in determining the severity of COVID-19, whereas breathing difficulty, loose stool, hypertension, and moderate-to-severe COVID-19 elderly patients had a poor outcome.

English

BACKGROUND HIV/AIDS is a global pandemic with a national adult (15-49 yrs) prevalence of 0.22 % (NACO 2019) and females constituted around 44 % of the total estimated people living with HIV (PLHIV). HIV infection in women occurs mostly in their reproductive years which leads to transmission to the child thereby comprising the most common mode of acquiring HIV infection in children &lt; 15 yrs. Women account for more than 70 % of the caregivers of seropositive spouses or other family members. This study was conducted to explore the reasons behind increasing HIV prevalence among adult women in the region including their demographic profile, transmission dynamics and clinical profile of HIV/AIDS. METHODS This is a hospital-based observational study among 100 selected adult female patients with HIV/AIDS (as per NACO guidelines) who attended the Gauhati Medical College Hospital from 1st July 2016 to 30th June 2017. A detailed clinical history of the selected cases was obtained in the register of the institutional ICTC centre and was recorded in standard proforma. RESULTS Out of the 100 cases included in the study, 95 were married of which 74 had seropositive husbands while 21 were discordant couples. The mean age of the study population was 31.27 ± 9.7 yrs., with the majority of women being in the age group of 21 – 30 yrs. Among the study group, 13 were illiterates while 6 were graduates. Fever was the most common presenting feature with 59 % followed by weight loss (36 %) and diarrhoea (15 %) respectively. Bacterial respiratory tract infection and oral candidiasis were present in 12 % and 11 % of patients respectively as opportunistic infections. CONCLUSIONS The majority of cases in our study were housewives and the biggest risk was through heterosexual sex with their husbands or primary partners. Only a few attended colleges in the study group while the rest were either illiterates or school dropouts and the majority of them didn’t have comprehensive knowledge of HIV/AIDS. The large gender inequality in education and unemployment may be responsible for the spread of HIV/AIDS in women. KEY WORDS Clinical, HIV/AIDS, Women

HAEMATOLOGICAL PARAMETERS IN COVID-19 PATIENTS: OUR EXPERIENCE IN A TERTIARY CARE HOSPITAL IN THE NORTH EAST INDIA

BACKGROUND: Covid-19 is a disease caused by Severe Acute Respiratory Distress syndrome Coronavirus 2 (SARS-CoV-2). Various changes occur in different haematological parameters in Covid-19 patients. Objective of the study is to evaluate the changes in primary haematological parameters and their signicance in different groups of Covid-19 patients. METHODS: Laboratory data of randomly selected 100 laboratory conrmed SARS-CoV-2 positive patients (Covid 19) in a tertiary care centre (Gauhati Medical College Hospital)were retrospectively collected. Demographic data and laboratory test results of the patients were analysed. RESULTS: Covid 19 is more common in above 50 years of age. It slightly more common in males. Leukocytosis, lymphopenia(P&lt;0.008), thrombocytopenia, decreased haemoglobin levels(P&lt;0.01), decrease red blood cell count(P&lt;0.0001) were most commonly seen in above 50 age group(P&lt;0.05). Monocytosis(P&lt;0.006) was seen in below 50 years age groups. CONCLUSION: Covid-19 is more common in above 50 years age group. Changes in haematological parameters are good index and can be useful as indicators of disease progression and also helpful in disease prevention.

English

Consultation-liaison psychiatry holds a special place, especially in general hospital setting. We wanted to study the socio-demographic variables, reasons for referral, and clinical correlates of psychiatric referrals from different wards in a tertiary care hospital. This was a retrospective chart-review study carried out in the Gauhati Medical College Hospital, Guwahati, for a period of one month (May 2019). Demographic data of the participants was collected. Their primary medical / surgical diagnoses were noted along with the department where they were admitted. The reason for psychiatric consultation as well as the psychiatric diagnoses were analysed by descriptive statistics with the use of GraphPad InStat. Most of the sample was men (men: women: 106:72), mostly between 11 to 30 years (44.38%) and Hindus (Hindu: Muslim: 140:38). Majority of the consultations was from the Department of Medicine (47.19%), followed by Orthopaedics (15.17%) and Surgery (14.61%). Among the surgical/medical illnesses, most of them had fractures (ten), closely followed by neurological conditions like cerebrovascular accident (five) and head injury (four). Deliberate self-harm was the most common reason for psychiatric liaison (56), that constituted a high number with poisoning (45) as well as hanging (six) and cut neck (five). Psychiatric consultation was asked for use of alcohol in a substantial number of patients (45). Addressing the psychiatric comorbidity while continuing treatment for the surgical/medical illnesses gives a holistic approach towards our patients that can influence not only the course but also the quality of life of them.

P0587CLINICAL PROFILE AND SHORT-TERM OUTCOMES OF ACUTE KIDNEY INJURY IN PATIENTS WITH PRE-ECLAMPSIA AND ECLAMPSIA

Abstract Background and Aims Acute kidney injury (AKI) is rare in women during pregnancy and puerperium. Although sepsis remains the predominant cause of AKI in pregnancy in developing countries, pre-eclampsia and eclampsia are important causes and can be life threatening. The primary focus of this study was to analyze the clinical profile as well as maternal and fetal outcomes of AKI in pregnant females with pre-eclampsia and eclampsia. Method A prospective study of patients admitted with pre-eclampsia or eclampsia and AKI in Gauhati Medical College Hospital from June 2018 to June 2019. Clinical profiles and outcome data were recorded. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Results A total of 26 cases were recorded. The mean maternal age at delivery was 27.5 ± 5.1 years. At least one recorded preexisting medical condition, including hypertension, diabetes mellitus, or chronic kidney disease was present in 5 cases (19.2%). Cesarean section was performed in 9 cases (34.6%). Eighteen patients (69.2%) developed AKI in third trimester and 6 (23.1%) within 12 weeks postpartum. Four patients (15.4%) were treated with dialysis. Four women (15.4%) died and 2 (7.7%) remained dialysis dependent 12 weeks after delivery. Low birth weight (&amp;lt;2500 g), small for gestational age or preterm birth (&amp;lt;37 weeks gestation) occurred in 11 pregnancies (42.3%). There were 2 (7.7%) neonatal deaths. AKI occurring before 34 weeks of gestation had worse fetal outcomes as compared to those after 34 weeks (p&amp;lt;0.05). Conclusion AKI in pregnancies with pre-eclampsia or eclampsia can not only lead to maternal mortality and morbidity but also poor perinatal outcomes. Preeclampsia or eclampsia presenting with AKI early during gestation had worse fetal outcomes.

Postpartum depression and associated risk factors: A descriptive study in Tertiary Care Teaching Hospital

Background: Postpartum depression is a mood disorder that can affect women after childbirth which may cause feeling of extreme sadness, anxiety, and exhaustion that may lead to hamper of daily care activities for themselves and others. Aim: To determine presence of depression and associated risk factors among postnatal mothers. Methods and material: Fifty postnatal mothers, aged between 18–44 years were selected from the Department of Obstetrics and Gynaecology, Gauhati Medical College Hospital (GMCH), Guwahati, Assam, India. The presence of postpartum depression and maternal bonding with baby were assessed by using the Edinburgh Postnatal Depression Scale (EPDS) and the Postpartum Bonding Instrument. Results: The prevalence of postpartum depression among mothers was 26%. Prevalence was found higher among the Muslim postnatal mothers. ‘Confidence and anxiety’ and ‘aggression to baby’ were found more significant which adversely affected bonding with their babies. Conclusions: Postpartum depression was found in a high number of mothers and it adversely affected bonding to their babies.

Duplex kidney anomalies and associated pathology: a single centre retrospective review

Background: Duplex kidneys are common developmental renal anomaly with an incidence of 1% in healthy adult population.Adult individuals may present as non-functional moiety, calculus disease or an incidental finding. Duplex kidney is defined as a renal unit comprised of two pelvicalyceal systems. Based on the degree of fusion, it can present as bifid renal pelvis, partial ureteric duplication (Y-shaped ureter), incomplete ureteric duplication with ureters joining near or in bladder wall (V-shaped ureter) and complete ureteric duplication with separate ureteric orifices. The purpose of this study is to retrospectively review the various duplex kidney anomalies and associated pathology.Methods: This is a retrospective study, performed at Department of Urology, Gauhati Medical College Hospital, a tertiary centre, from September, 2018 to August, 2019. Preoperative imaging, plain intravenous urography or computed tomography intravenous urography was done.Results: 29 patients were diagnosed with variants of duplex kidney anomaly. It includes right side, left side and bilateral anomalies. Among all the patients 4 had incidental findings. 16 patients had associated renal or ureteral calculus. 5 patients had associated ureteropelvic junction obstruction while 1 patient had ureterovesical junction stricture. We found single patient in each group of duplex kidney anomaly associated with non-functional moiety with renal cell carcinoma, ureterocele with urothelial malignancy and horseshoe kidney with ureteropelvic junction obstruction respectively.Conclusions: Duplex kidney anomaly in most individuals is of no clinical significance. High index of suspicion along with good quality imaging can accurately detect specific anomaly and associated condition.

Correlation of epidermal growth factor receptor score with prognostic variables in transitional cell carcinoma of urinary bladder among north-eastern Indian population

Background: Epidermal growth factor receptor (EGFR) has demonstrated over expression in bladder tumours and correlation with stage and grade of tumours. The aim of present study was to find the relation between score of the EGFR in Transitional Cell Carcinoma (TCC) of bladder and its various prognostic variables.Methods: This is a retrospective study conducted in Dept of Urology, Gauhati Medical College Hospital between Dec 2016 and July 2017. Forty cases of TCC bladder that were operated either by TURBT or radical cystectomy have been taken. However, patients with CKD, pre-existing systemic disease and UTI were excluded from the study. Presence of EGFR and its score were analysed. The rating was done as 0 (non-immunoreactive), 1+ (weak), 2+ (moderate) and 3+ (strong). The correlation between EGFR score and the various factors like age, sex, stage, size of tumour, presence of CIS, tumour grade, muscle invasion, number of tumours and type of stalk were evaluated statistically using chi square tests.Results: Average age is 59.825 years and male to female ratio is 5.6:1. EGFR score is not significantly related with age, sex, stage of disease, muscle invasiveness or number of tumours whereas size of tumour, presence of CIS changes, grade of TCC and type of tumour stalk bears statistically significant relation with EGFR score.Conclusions: Studies have shown EGFR positivity to be associated with high tumour stage, tumour progression, and poor clinical outcome. Authors have found size &gt;3cm, CIS changes, high grade tumours and broad-based stalks to be significantly associated with higher EGFR scores among patients with TCC of bladder.

Single center experience of urinary bladder malignancy: a 10-year retrospective analysis of hospital data

Background: Albeit the EAU, NCCN and AUA guidelines provide an excellent evidence-based protocol for the management of MIBC and NMIBC, these guidelines differ with respect to critical issues such as risk level definitions and management strategies. The NE part of the country has always bore the brunt of heavy oncological catastrophe like urinary bladder carcinoma related to extensive tobacco and pesticide usage. MIBC treatment usually encompasses RC with AC/NAC (Level I evidence for NAC use in MIBC exist) but the majority of patients seen at our center have already progressed to advanced stage at presentation and could not undertake full treatment.Methods: Cancer registry of the last 10 yrs at Dept. of Urology and Renal Transplant Gauhati Medical College Hospital was searched for demographic, clinical, pathological and prognostic data and results summarized using statistical parameters of univariate analysis.Results: There were a total of 168 patients in the NMIBC group with a majority in the 60-70-year age group. The most common grade was G2 and all DM type 2 and CKD were significantly associated in all the patients analyzed. Chemical exposure in the form of pesticide and smoking was a constant phenomenon in all patients of NMIBC and MIBC (n=66) population. CKD was significantly associated in the MIBC population along with positive urine cytology.Conclusions: Despite a paucity of high level evidence regarding the majority of management topics in Urinary Bladder cancer in NE part of the country, there was general agreement among the various guideline panels and management guidelines at our institution. Identification of the upfront clinical parameters suggesting severity of disease and time to progression are the two most important domains which will decide the future of UB carcinoma treatment in this part of the world. Categories of evidence synthesized and grades of recommendations will have to be constantly gazed upon to modify and enhance treatment strategies.

A study to assess burnout among nurses of maternity department in Gauhati Medical College Hospital, Assam

A study to assess burnout among nurses of maternity department in Gauhati Medical College Hospital, Assam

Surgical management of bronchiectasis: a 5-year review of a single center’s experience

Bronchiectasis continues to be a major cause of morbidity and mortality in developing countries. The purpose of this study is to present our experience in surgical treatment of patients with bronchiectasis during a 5-year period and their early- and late-term results. Records of 48 patients who underwent surgical resection for bronchiectasis from April 2009 through March 2014 at Cardiothoracic Surgery Department of Gauhati Medical College Hospital were reviewed. Variables analyzed were age, sex, symptoms, etiology, extent, indication and type of operation, mortality, morbidity, and the result of surgical therapy. There were 42 (87.5 %) male and 6 (12.5 %) female patients with an average age of 33.7 years (range, 19–47 years). The indications for surgery were failure of conservative treatment in 21 patients (43.75 %), recurrent hemoptysis in 20 (41.66 %), destroyed lung in 5 (10.42 %), and endobronchial obstruction in 2 (4.17 %). Thirty-four patients (70.83 %) had complete resection with lobectomy, pneumonectomy, or bilateral lobectomy, and 14 (29.17 %) had incomplete resection with segmentectomy or lobectomy with segmentectomy. There were no perioperative deaths; complications occurred in 10 patients with a morbidity rate of 20.83 %. Follow-up data were obtained for 44 (91.66 %) of the patients for a mean of 9 months (range, 4 months to 3.5 years). The symptoms disappeared in 21 patients (47.43 %) and improved in 17 (38.64 %). Improvement of symptoms was observed more significantly in the patients undergoing complete resection. Surgical resection for bronchiectasis obtains satisfactory long-term results with acceptable morbidity and mortality rates. When possible, complete resection should be performed.

The potential risk factors and the identification of hearing loss in infants.

To identify potential risk factors for hearing loss from the infant with high risk criteria as guided by the Joint Committee on Infant Hearing (JCIH, 2000). 490 infants with age range of 2days to 6months who had undergone detailed audiological evaluation during for the period of 3years at Gauhati Medical College Hospital were taken for the study. The hearing screening was performed on each infant using Distortion Product Otoacoustic Emission (DPOAE) testing. The infants who failed DPOAEs screening were followed up and Auditory Brainstem Response testing. Out of 490 high risk infants who had undergone detailed audiological evaluation 145 infants were found to be having hearing loss. Out of 145 infants 73 infants were male and 72 infants were female. The risk factor for hearing loss with the highest incidence was hyperbilirubenemia, Apgar scores of 0-4 at 1min or 0-6 at 5min was the second most prevalent risk factor, followed by TORCH infections. This study suggests the need for review of high risk register that is used along with the physiological and electrophysiological hearing test to screen the infants. The high risk register remains helpful in determining follow up plans so that children who may develop late onset of hearing loss will not be missed. Being aware of which risk factors are more likely to cause hearing loss in infants would be helpful to plan for follow up these children.

A general study of carcinoma oesophagus in Assam.

A general study has been performed in the Gauhati Medical College Hospital(GMCH), Gauhati on Carcinoma oesophagus. Altogether 687 cases of carcinoma oesophagus cases were admitted in. the CMCH during the years s 1988 to 1992 i.e. 5 years period of time and studied. This study recorded incidence, age and sex distribution, presenting symptoms, methods of diagnosis, relation to tobacco habit and also treatment procedures and prognosis were also recorded along with its analysis.

Multiple primary cancers in E.N.T. domain—A carcinogenic field defect

Fiftysix cases, selected at random, from amongst the patients attending the E.N.T. out patient department of Gauhati Medical College Hospital from September, 1976 to August, 1978 have been studied for multiple and single primary malignant lesions associated with other histopathological mucosal changes in the oropharyngeal region. The finding of synchronous and metachronous carcinomas and histopathological evidence of dysplasia dyskeratoses, together with hyperplasia, hyperkeratosis, acanthosis, spongiosis in sites other than the primary cancer suggest a carcinogenic field defect over a wide area. The subject, which has not been studied much, requires further research as it is of immediate value in cancer control programmes defining the risk of subsequent primary malignancies or a malignant neoplasm in a patient. Besides, it will also be useful to collect more informations on presently applied therapeutic regimens to evaluate their carcinogenic potential for a future and fresh malignant neoplasm.