Government Kilpauk Medical College Research Articles

EVALUATION OF INCOMPATIBLE CROSSMATCHES AT A TERTIARY CARE HOSPITAL IN CHENNAI – A PROSPECTIVE STUDY

Objectives: The primary goal in blood transfusion is that the transfused blood unit be compatible with the patient during crossmatching. This compatibility testing is performed before every administration of blood component. This cross-matching test helps to detect the presence of antibodies in the recipient against antigens over red blood cells of donor. The aim of this study was to evaluate the incidence and causes of in compatible crossmatches in patients by tube agglutination method. Methods: This was a retrospective cross-sectional study conducted by analyzing incompatible crossmatches encountered during routine compatibility testing between January and December 2021 at the Department of Transfusion Medicine, Government Kilpauk Medical College and Hospital, Chennai, Tamil Nadu, India. The analysis was done in March and April 2022. All crossmatches were done by tube agglutination technique. Data were entered in Microsoft Excel and analyzed. Descriptive statistics were given in summary statistics. Results: Out of the total of 12943 crossmatches performed, 0.3% (n=39/12943) were incompatible. About 76.9% (n=30/39) were seen in females while 69.2% (n=27/39) were seen in the age group 20–60 years. About 35.9% (n=14/39) of the incompatible crossmatches were due to autoimmune hemolytic anemia (AIHA). A root cause analysis protocol was formulated to resolve the incompatibility and ensure safe transfusion. Conclusion: AIHA was the most common cause of incompatible crossmatch. The root cause analysis protocol involves a thorough evaluation of the patient’s clinical condition, underlying pathology, and errors during technical procedure to identify the cause of incompatibility. Protocols should be developed in each blood center and a logical stepwise approach will enable the provision of safe transfusion.

Histopathological study of heart and cardiac vessels in autopsy cases from tertiary health-care center

Background: Atherosclerosis is a chronic inflammatory disease causing more morbidity and mortality in developed as well as in developing countries. Among Indians, atherosclerotic lesions occur 10–15 years earlier, and the lesions are formed in the advanced stage. It is difficult and expensive to evaluate the atherosclerotic lesions in living subjects. Atherosclerosis of cardiac vessels and myocardial infarction are the most common fatal cardiac diseases discovered in autopsies. The incidence of coronary artery diseases is increasing worldwide as well as in India, which carries a huge challenge in diagnosing the same. Aims and Objectives: The aims and objectives are to study the spectrum of histopathological findings in heart and atherosclerotic lesions in cardiac vessels in autopsy cases. Materials and Methods: This is a retrospective study done in the Department of Pathology at Government Kilpauk Medical College and Hospital over a period of 1 year (March 2022–December 2022). In this study, a total of 100 autopsy cases were taken to study the pathology of the heart and the grading of atherosclerotic lesions in cardiac vessels. Heart specimens were received from the Forensic Medicine Department. The atherosclerotic lesions of cardiac vessels were graded according to the American Heart Association (AHA) classification. Results: Among 100 cases studied during a period of 1 year, most of the cases were in the age group of 30–41 years. Male preponderance was noted when compared to females. Out of 100 cases, 79 cases had histopathological evidence of atherosclerosis, and other findings were as follows: one case of giant cell myocarditis, one case of pericarditis, and one case of adenocarcinoma of the lung extending into the coronary vessels. The most common type of atherosclerotic lesion seen was type 7 AHA, most frequently involving the aorta, followed by both coronary ostia and the left anterior descending artery. Conclusion: In this study, atherosclerotic lesions were observed very frequently in younger individuals. It is an indication for the implementation of antiatherogenic preventive measures in young populations. It highlights the importance of screening for cardiovascular risk factors at an early age.

Histopathological spectrum of lung findings in autopsy cases

Background: The incidence of lung pathology is the most common autopsy finding and is responsible for a great deal of mortality and morbidity. It is affected by a wide variety of respiratory pathogens and is involved in many systemic diseases. It is secondarily involved in almost all forms of terminal disease. Radiological findings are usually nonspecific in lung diseases and need prompt histopathological examination to find out the exact cause of death. Aims and Objectives: The aim is to study the spectrum of histopathological findings in lung in autopsy cases. Materials and Methods: This is a retrospective study done in the Department of Pathology at Government Kilpauk Medical College and Hospital during the year 2022. Lung specimens were received from the Forensic medicine department. Gross findings were noted. Following adequate formalin fixation, the tissue specimens were processed and paraffin sectioning was done followed by hematoxylin and eosin staining. The findings were documented and the results were analyzed. Results: Among 100 cases studied during year maximum cases were seen in the age group of 31–40 years (32%). Males (72%) were more commonly affected than females (28%). The most common findings are Pulmonary edema (34%) followed by congestion (32%) and other findings include emphysematous change (13%), pneumonia (10%), tuberculosis (6%), metastatic adenocarcinomatous deposits (1%), primary well-differentiated adenocarcinoma (1%), pulmonary chondroma (1%), and bronchiectasis (1%). Conclusion: The most common finding observed was pulmonary edema. In our study, male preponderance was noted. This study emphasizes to scrutinize the histopathological findings in the lung, especially following a sudden death.

Wall motion score index and left ventricular ejection fraction as predictors of cardiovascular events after acute myocardial infarction

Background: Left ventricular ejection fraction serves as a vital gauge of left ventricular overall function and plays a crucial role in assessing the severity and prognosis of ischemic heart disease. Another approach for evaluating left ventricular function is through the assessment of regional function using the wall motion score index. In this study, our objective was to assess and compare the predictive value of both WMSI and LVEF in patients with Acute Myocardial Infarction for their ability to predict all-cause mortality and readmission due to heart failure. Methods: This prospective study was conducted on admitted patients in Government Kilpauk Medical College on 70 patients with Acute myocardial infarction between the first 48 hours of symptoms and before hospital discharge. Follow-up with clinic visits was conducted 3, 6 and 12 months after discharge. The primary endpoint was the composite of all-cause mortality and readmission for heart failure. Results: 63% of patients had LVEF of less than 40%, and 55% had WMSI>1.5. After a follow-up of 1 year, 3.7% mortality and 11% readmission for heart failure were observed. WMSI>1.5 and LVEF<40% were associated with poor survival, while the WMSI proved to be a better predictor for rehospitalisation. 81% of STEMI group patients had EF<40%, but only 18% of the NSTEMI group had EF < 40%, which is statistically significant. There is no superiority between WMSI and LVEF in the STEMI and NSTEMI groups. Killip classification proved to be an independent predictor of mortality, but no statistical significance was observed in readmission. Conclusions: Both LVEF and WMSI were predictors of all-cause mortality, while the WMSI was a predictor for readmission for heart failure.

Efficacy of coblation assisted surgery in obstructive sleep apnea with obstruction at the retropalatal level

Obstructive sleep apnoea syndrome (OSAS) is a common sleep disorder caused by abnormalities in the pharynx and upper airway muscles. Uvulopalatopharyngoplasty (UPPP) is the commonly indicated surgical procedure for the management of OSA. Recent studies state that coblation assisted UPPP can improve the outcomes of OSA. : To study the efficacy of coblation assisted uvulopalatopharyngoplasty in Obstructive Sleep Apnea Syndrome with isolated obstruction at the retropalatal level. This prospective before-after analysis was conducted in Government Kilpauk Medical College Hospital and Government Royapettah Hospital attached to Kilpauk Medical College from September 2016 to September 2017. After a thorough examination, patients with moderate and severe OSA with obstruction at the retropalatal level were selected for the study. Institutional ethical clearance was obtained and all patients signed the written informed consent form.A total of 25 patients were selected for the study and a male predominance was observed (80%). Tonsil size was graded using the Friedman grading scale and the majority of the patients had grade II tonsillar enlargement (52%). Based on tonsil size and Friedman's palate position, the patients were classified using Friedman's system. 11 patients were classified as stage 1, 10 patients were classified as stage 2, 4 patients were classified as stage 3. A success rate of 68% was observed following surgery based on the 50% reduction in the AHI criterion. Uvulopalatopharyngoplasty is effective in the management of OSA. Coblation assisted procedures can reduce postoperative pain and improve the outcomes of surgical therapy.

Correlation of 25-Hydroxycholecalciferol and Glycaemic Status in Recent Onset Type 2 Diabetes Mellitus

Introduction: Type 2 Diabetes Mellitus (T2DM) is a non communicable disease caused by increased insulin resistance and beta cells dysfunction. Recently vitamin D has sparked wide spread interest in pathogenesis of diabetes by playing a role in insulin resistance. As a major regulator of homeostasis of calcium, vitamin D directly and/or indirectly improves insulin exocytosis and glucose tolerance. Aim: To estimate the serum 25 hydroxy cholecalciferol level and also to correlate with fasting, two hour postprandial blood glucose and Glycated Haemoglobin (HbA1c) values in recent onset T2DM patients. Materials and Methods: This cross-sectional study was conducted at Government Kilpauk Medical College, Tamil Nadu, India from November 2017-April 2018. One hundred and thirty nine recently diagnosed T2DM patients aged between 30-60 years of both sex, who were on oral hypoglycemic drugs for less than three months duration were included in the study. The patients were grouped into three groups according to their vitamin D levels, Group 1 Vitamin D deficient- 52 patients (≤20 ng/mL), Group 2- Insufficient Vitamin D -33 patients (>20-30 ng/mL), Group 3- Vitamin D sufficient-54 patients (>30 ng/mL). Fasting and 2 hour postprandial glucose, 25 hydroxy cholecalciferol and HbA1c were estimated. Statistical analysis was performed using analysis of variance (ANOVA) and Pearson’s correlation. Results: Out of 139 participants, 64 were males and 75 were females. The mean age of the study population was 50.64±5.343 years. The mean fasting blood glucose values among the three groups were 168.13, 129.61, and 125.33 mg/dL respectively. The mean two hour postprandial blood glucose values among the three groups were 269.44, 212.45, and 194.11 mg/dL respectively. The mean HbA1c among the three groups were 7.481±1.16, 6.027±0.31, and 5.86±0.19, respectively. Decreased 25 hydroxy cholecalciferol level in patients of T2DM showed a statistically significant inverse correlation with fasting and two hour postprandial blood glucose and HbA1c with p-value <0.001. Conclusion: The study suggested that hypovitaminosis D was prevalent in T2DM. The study showed that decreased vitamin D level in T2DM patients was associated with increased fasting, postprandial blood sugar, and HbA1c. So, vitamin D screening in diabetics and supplementation can improve the glycemic status.

Anti-obesity and anticancer activity of Solanum xanthocarpum leaf extract: An in vitro study

Background: Solanum xanthocarpum grows in parts of India as a wild herb. The active principles of this plant are Solasodine, Carpesterol, β-Sitosterol, and Diosgenin. Pharmacological effects such as hypoglycemic, hepatoprotective and hypotensive activity of S. xanthocarpum have been reported. Solasodine, an active component of this plant is reported to have antioxidant activity. Aims and Objectives: The objective of this study is to evaluate the anticancer and anti-obesity property of S. xanthocarpum. Materials and Methods: This study was carried out in Department of Pharmacology, Government Kilpauk Medical College, with laboratory support from Life Teck Research Center, Chennai. Both dry and fresh leaves of S. xanthocarpum were taken and evaluated for anticancer property using MCF cell line and anti-obesity activity using Pancreatic Lipase inhibition activity. Results: There was significant decrease in cell viability with increase in concentration of both dry and fresh leaves which shows anticancer activity. With increase in concentrations of leaf extracts, the inhibition of pancreatic lipase was found but in comparison to Orlistat the standard treatment, the effect was very less. Conclusion: Based on above results, it is concluded that S. xanthocarpum has good anticancer and minimal anti-obesity activity. Further investigations are required to identify the actual phytoactive component.

Differentiating Secondary Dengue Using IgG/IgM Antibody Ratio: A Cross-sectional Study

Introduction: Dengue is a viral infection with diverse clinical manifestations. Infection in most of the patients is subclinical. It may also present as undifferentiated fever, severe dengue like Dengue Haemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS). Secondary dengue infection predisposes to severe dengue, a serious threat to the community as they increase morbidities and mortality. The diagnosis of secondary infection is either by Polymerase Chain Reaction (PCR) to detect the serotype or dengue IgG/IgM antibody ratio. A ratio of more than 1.1 is evidence of secondary dengue. Aim: To find out the prevalence of secondary dengue by measuring the dengue anti-IgG/IgM ratio by Enzyme Linked Immunosorbent Assay (ELISA) test. Materials and Methods: This cross-sectional observational study was conducted at Government Kilpauk Medical College, Chennai for a period of six months from July 2021 to December 2021. Sample size was 450 calculated at 95% confidence level, (CI 28.3-38.3) with 33.3% as prevalence. Blood samples were collected and Nonstructural Protein 1 (NS1) antigen assay was done. The IgG and IgM antibodies assays were done for NS1 antigen positive individuals. The IgG/IgM ratio was calculated in patients who were positive for both IgG and IgM. Statistical analysis was done with Statistical Package for Social Sciences (SPSS) version 20.0. Percentage, mean and standard deviation were calculated. Results: Total of 450 patients were included, out of which 194 were NS1 antigen positive, 106 were males and 88 females with the mean age 25±14.85 years. NS1 antigen was positive in 89.17%. Two-tailed Fisher’s-exact test showed a significant proportion of patients among NS1 positive were positive for both IgG and IgM. An IgG/IgM ratio of >1.1 was found in 62.04%. The association between IgG/IgM ratio of >1.1 and thrombocytopenia was significant [p-value=0.00504, Odd’s ratio (OD) =3.316]. Conclusion: Dengue IgG/IgM antibody ratio of more than 1.1 on the third day of symptom onset and the platelet count assist in the early diagnosis of secondary dengue thereby helps clinicians to initiate the appropriate treatment at the right time, reduce mortality rate and decrease the economic burden of the country.

POS-055 EMPHYSEMATOUS PYELONEPHRITIS IN THE COVID & CANCER ERA- CASE SERIES FROM A TERTIARY CARE HOSPITAL IN CHENNAI, SOUTH INDIA

Emphysematous pyelonephritis (EPN) is a rare yet life threatening, necrotizing renal parenchymal infection with a mortality rate of 20-25%. With advent of CT, early goal directed therapy with antibiotics, aggressive treatment of sepsis and percutaneous drainage techniques, the mortality and morbidity rates are not as grim as earlier reports. Nephrectomy, treatment of the past has been replaced with nephron sparing surgery with better patient outcomes. A retrospective study was conducted at Government Kilpauk Medical College Hospital between January 2020 and April 2022.

CORRELATION BETWEEN RISK FACTORS AND CLINICAL OUTCOMES FOLLOWING INTRAARTICULAR INJECTION OF AUTOLOGOUS PLATELET RICH PLASMA IN EARLY OSTEOARTHRITIS KNEE

Introduction: Osteoarthritis (OA) knee is one of the major cause of disability particularly in the elderly .Management of OA knee with intraarticular Platelet Rich Plasma (PRP) is an emerging new technique. Aim : Aim of our study was to assess the efficacy of intra-articular injection of platelet rich plasma (PRP) in knee osteoarthritis and to investigate the correlation between risk factors likeBody mass index ,ageandseverity of osteoarthritis with clinical outcome after intraarticular injection of platelet rich plasma Study setting : Department of Physical Medicine and Rehabilitation,Government Kilpauk medical college, Chennai, India, from March 2021 to January 2022. Materials and methods : 64 patients with mean age of 56.52 ±7.53 who were diagnosed with grade 1 and 2 knee OA and who had undergone 2 doses of intraarticular injection of PRP were selected for the study and we retrospectively analysed the role of age, BMI, and Kellgren Lawrence grade of OA knee and their correlation with clinical outcome after intervention .Outcome measures used wereVAS and WOMAC scores Results: VAS and WOMAC scores before the procedure and final outcome after procedure using wilcoxn signed rank test showed that there was significant improvement in the outcome scores measured at followup done at 4th month . Subgroup analysis of patients stratified for age, Body mass index (BMI) and, KLgradewas performed for determining the individual effect of each risk factor on the outcome scores . It is found that the effect of PRP on people with BMI less than 25 ,KL grade 1 and age group <60 ,is significantly better than subjects with BMI more than 25 ,KL grade 2 and age group > 60 years. Conclusion: The use of intraarticular platelet-rich plasma definitely improves functional outcome in patients with OA and results in improved quality of life. Higher KL and risk factors like increased age, and BMI, has shown poorer outcome when compared to younger subjects , with lower BMI and KL grade , and hence modification in treatment protocol can be considered for such patients.

Assessment of Liver Function and Its Correlation with Inflammatory Markers and Severity of Disease during COVID-19 Second Wave in a Tertiary Care Centre

Aims: To assess the Liver function in COVID-19 infection and study its correlation with inflammatory markers and severity of disease.
 Study Design: A Retrospective Observational study.
 Place and Duration of Study: Government Kilpauk Medical College, Chennai, India. Two month study period was taken during the second COVID wave (1st May 2021 to 30th June 2021).
 Methodology: The study covered all COVID-19 positive individuals who were over the age of 19. Patients with any chronic liver disease, Hepatitis B or Hepatitis C were excluded. Data was collected from case files. Record was made of the liver function tests and inflammatory markers – C-Reactive Protein and Interleukin-6 (CRP, IL-6). Severe disease was defined as patients with respiratory rate > 30/min, SpO2 <90% on room air or requiring Intensive Care Unit (ICU) admission or mechanical ventilation. Collected data was analysed using appropriate statistical tests.
 Results: 132 patients were included in the study. Out of these 59 patients (44.70%) had elevated Liver function tests (LFTs). Maximum patients (42.37%) had hepatocellular pattern. 59.32% patients were males. Mean age of patients with elevated LFTs was 51.03±13.03 years. ICU admission was required in 40.68% of patients with deranged LFTs compared to 23.28% in patients with normal LFTs, which was statistically significant (P <0.03). A positive correlation was found between deranged LFTs and inflammatory markers (CRP, IL-6). (P <0.001).
 Conclusion: A significant number of COVID-19 positive individuals have abnormal liver function. Inflammatory indicators and elevated LFTs have a positive relationship. Patients with abnormal liver function tests were more likely to have severe illness.

Analysis of Factors Influencing Length of Stay in Hospital among Burns Patients, Pertaining to Blood TransfusionA Cross-sectional Study

Introduction: Blood transfusion is an independent risk factor for death and perioperative infection in trauma patients. Hospital Length Of Stay (LOS) is an indicator of morbidity and can be used to assess wound healing in burns patients. Aim: To analyse the factors influencing hospital length of stay in burns patients, with relevance to blood transfusion. Materials and Methods: This was a prospective observational study on burns patients admitted at burns ward, Government Kilpauk Medical College, Tamil Nadu, India, between September 2014 and August 2015. Patients with age more than 16 years with 15-40% Total Burnt Surface Area (TBSA) and had survived treatment were included after obtaining informed consent. Age, Acute Physiology and Chronic Health Evaluation (APACHE II) score, blood component transfusion, storage age of red cells, surgical procedures and wound infection were studied. Results were analysed using Chi-square test, Analysis of Variance (ANOVA) and Pearson correlation. Results: Of the 122 burns patients studied, mean age was 35.38±12.93 years, 54.09% were males, mean LOS was 22.39±1.23 days, mean TBSA was 26.11±0.40%, mean APACHE II score was 5.02±0.06, 69.67% (n=85/122) patients had received red blood cell transfusion, 59 (48.36%) underwent surgical procedures and 103 (84.43%) developed culture proven wound infections. APACHE II score at admission (r-value=0.260, p-value=0.004), blood transfusions (r-value=0.504, p-value <0.0001), surgical procedures (r-value=0.614, p-value <0.0001) and wound infections (r-value=0.468, p-value <0.0001), surgical procedures (r-value=0.614, p=0.000) and wound infections (r=0.468, p=0.000) were the factors which significantly increased length of hospital stay. Age of the patient (r-value=0.102, p-value=0.265) and storage age of red blood cells (p-value=0.193) did not influence length of stay in burns patients. Conclusion: Minimizing wound infection by proper wound care and medications, and rational use of blood components help in early healing of burns wound with reduced hospital stay.

Association and Outcome of Intracranial Haemorrhage in Newborn with Fungal Sepsis- A Prospective Cohort Study

Introduction: Neonatal sepsis is a leading cause of mortality and morbidity. Inspite of using appropriate antibiotics, those who are bacterial culture-negative, still succumb to fungal infection. Fungal sepsis is common in the neonatal Intensive Care Unit (ICU), especially with invasive procedures and prolonged empirical use of antibiotics. The incidence of fungal infection varies widely across centers, likely due to differences in practice related to modifiable risk factors such as exposure to empiric antibiotics and length of parenteral nutrition. Neonates are at high risk for acquiring infections due to their specific Central Nervous System (CNS) structure as well as functionally immature immune system causing central nervous system infection or intracranial haemorrhage due to sepsis induced coagulopathy. Being Intracranial Haemorrhage (ICH) in neonates often results in devastating neurodevelopment outcome and also having significant mortality in the neonatal period. Aim: To find the association and outcome of intracranial haemorrhage in newborn with fungal sepsis. Materials and Methods: This study was a prospective cohort study conducted at Department of Pediatrics, Government Kilpauk Medical College, Chennai, Tamil Nadu, India, on neonates admitted in newborn ward of the hospital ICU during the period January 2018 to December 2020. Neonates with the diagnosis of fungal sepsis were identified from blood cultures. They were also subjected to Complete Blood Count (CBC), Capillary Refilling Time (CRT), Prothrombin Time (PT), activated Partial Thromboblastin clotting time (aPTT) and cranial ultrasound. Chi-square analysis for descriptive data and Cox Proportional Hazard Regression for survival and non survival neonates and Kaplan-Meier curve analysis was done. Results: Out of total 80 neonates, nine had intracerebral haemorrhage, 21 neonates had intraventricular haemorrhage and no haemorrahge in 50 neonates. More the gestational age, lesser were the chances of intracranial haemorrhage and the difference was statistically significant (p-value<0.001). A total of 50 babies died, majority (42%) were in the gestational age between 37-40 weeks. All the babies diagnosed with C. albicans sepsis succumbed to infection. Conclusion: The present study highlights the fact that the lesser of the gestational age, the more or the chances of intracranial haemorrhage. A close monitoring of the coagulation profile PT and aPTT will help us to identify the babies for more prone for intracranial haemorrhage. Expert cranial ultrasound will pick up the haemorrhage early. Timely treatment measures instituted will help in preventing mortality due to bleeding manifestions in fungal sepsis. The Cox regression analysis reveals that both PT& aPTT and intracranial haemorrhage are the associated risk factors for non survival in fungal sepsis neonates.

Neonatalna sepsa - kliničko-etiološki profil u zdravstvenoj ustanovi tercijarnog nivoa u Južnoj Indiji

Introduction/Objective Neonatal sepsis is the leading cause of morbidity and mortality among neonates. Neonates are at risk of sepsis due to several immaturities that they possess inherently. Sepsis is classified as early-onset or late-onset neonatal sepsis. Pathogenesis is different in both types. This study aims to determine the pattern of microorganisms causing sepsis and the clinical presentation of neonates admitted with suspicion of sepsis to the Government Kilpauk Medical College Hospital, a tertiary medical care centre. Methods Descriptive cross-sectional study performed in Government Kilpauk Medical College and Hospital, India. Results Out of 207 neonates admitted with suspected sepsis, 112 were male and 97 were female. Male to female ratio was 54.1% : 45.9 % (1.2 : 1). On categorizing the newborns based on birth weight, 11 newborns were of very low birth weight, 107 were of low birth weight, 88 had normal birth weight, and one baby weighed more than 4,000 grams. Blood culture was positive in 88 out of the 207 cases (42.51%). Klebsiella was the commonest microorganism causing sepsis (45%) in our Neonatal Intensive Care Unit. Other Gram-negative isolates included Escherichia Coli (31%), Pseudomonas (6%), Enterobacter (1%) and Acinetobacter (2%). The Gram-positive organisms grown were coagulase-positive and coagulase-negative Staphylococci (8%), Group B Beta Hemolytic Streptococcus (5%) and Enterococcus (2%). Late-onset sepsis cases were found to be 1.5 times more common than early-onset sepsis. The best overall sensitivity among Gram-negative isolates was to Imipenem (92%), followed by Amikacin (82.66%) and the best sensitivity among Gram-positive isolates was to Vancomycin (84.61%), followed by Cloxacillin and Ampicillin (61.53%). Out of 88 positive cultures, 6 were multi-drug resistant (6.8%). Conclusion Acquiring knowledge about the microorganisms causing sepsis in neonates helps prevent morbidity, mortality and the development of antibiotic resistance.

A RETROSPECTIVE STUDY OF RHINO-ORBITAL MUCORMYCOSIS

BACKGROUND: Mucormycosis is a rapidly progressing, life threatening, opportunistic fungal infection caused by angioinvasive mucorales species of the phylum zygomycetes.The major risk factors of the disease are uncontrolled diabetes mellitus, COVID-19 infection,prolonged usage of high dose of systemic corticosteroids,immunocompromised status and neutropenia. These create a nidus for fungal infection through nasal mucosa which spreads up through paranasal sinuses into orbit manifesting as rhino-orbital mucormycosis. AIM 1. To study the epidemiology and various clinical patterns of presentation of rhino-orbital mucormycosis in post covid patients. 2. To analyse the risk factors associated with progression of rhino-orbital mucormycosis in post covid patients. METHODS: A retrospective study of 25 patients diagnosed as rhino-orbital mucormycosis in post covid patients at Government Kilpauk Medical College Hospital between April and July 2021 was done. RESULTS: In our study,males (64%) are more commonly affected with age preponderance of 51-60 years(28%). The mean age of presentation was 52.1+/-4.49years.The most common symptom of the disease is nasal discharge with sinus and orbital pain(52%).The most common form of presentation is orbital apex syndrome in seven patients(28%).Five patients had loss of vision, of which four were due to central retinal artery occlusion(16%) and one due to cavernous sinus thrombosis.MRI imaging of these patients showed sinus involvement(100%) in all cases ,orbital(48%) and cerebral involvement(8%).The major risk factors responsible for progression of disease in our study are uncontrolled diabetes, prolonged usage of high dose steroid therapy, medial wall involvement, optic nerve head involvement and artery thrombosis. CONCLUSION: Post covid patients presenting with nasal discharge with sinus and orbital pain symptoms need to be diagnosed and managed properly to avoid spread of infection and fatal complications. Aggressive surgical debridement of infected tissues helps in increasing the survival rate of the patients. Patients with risk factors need to be closely monitored to prevent vision loss and cosmetic disfigurement surgeries.

UTILITY OF PANEL OF IMMUNO HISTOCHEMICAL MARKERS IN CARCINOMA BREAST-OUR EXPERIENCE IN A TERTIARY CARE HOSPITAL

Background: Breast cancer is the leading cause of malignancy in Indian females accounting for 16% of all malignancies. It causes lot of anxiety and emotional stress in the patient. Immunohistochemical panel of markers in breast carcinoma helps to categorize various tumour subtypes, gives valuable information on prognosis and also helps to determine, plan and predict response to therapy. Aims and Objectives: 1. To evaluate the expression of ER, PR, Her2neu, Ki67, CK5/6, EGFR in breast carcinoma to predict and plan therapy. 2. To categorize breast carcinoma based on molecular classication in our hospital. Materials and Methods: A prospective study of 278 cases of Breast Carcinoma obtained by trucut biopsy and Modied Radical mastectomy at Government Kilpauk Medical College was parafn processed and stained using hematoxylin and eosin. The lab reporting was done according to the standard system using College of American Pathologists (CAP) protocol. Immunohistochemistry was done using a panel of markers. Relevant demographic and clinical details of the patient were obtained and studied. Results: In the present study, breast carcinoma is commonly seen in the post menopausal age group. Invasive breast carcinoma (NOS type) is the most common histological variant. Grade 2 is the most common histological grade. Molecular testing showed most of the tumors belonged to Luminal A. CK5/6 and EGFR expression was high in Triple Negative Breast carcinomas. Conclusion: A thorough histomorphological and molecular studies help in understanding the tumour pathology and thereby providing prompt hormonal and targeted therapies improving the patient survival and prognosis.

CLINICAL PROFILE AND COLONOSCOPIC FINDINGS IN ADULT PATIENTS PRESENTED WITH CHRONIC DIARRHEA

Background: Chronic diarrhea is a common and challenging problem in all age groups particularly in the elderly. It accounts for signicant morbidity and mortality in adults. It can be caused by a number of both neoplastic and non neoplastic lesions. For accurate diagnosis of various colorectal lesions, colonoscopy is the gold standard, simple, convenient and cost effective procedure. The present study aims to scrutinize the clinical prole and colonoscopic ndings in patients with chronic diarrhea in a tertiary care centre in South India Method: st This is a hospital based prospective observational study conducted from 1 September 2018 to 30th September 2019 at Department of Gastroenterology, Government Kilpauk Medical College Chennai ,128 patients were included in the present study. Study was cleared by institutional ethics committee of the hospital. Results: We evaluated 128 patients (mean age 47.03,),66% of the patients were males, and majority of the patients were in the age group 50-59 years. The most common clinical presentation other than diarrhea was bleeding per rectum 42% followed by mass per abdomen (23%), abdominal pain (21%) and 14% had spurious diarrhea. Colonoscopy was normal in 13%, colorectal growth accounted for 32%, Mucosal ulceration in 23%, Ileocecal lesions in 17%, polyps in 15%. The most common diagnosis was carcinoma colon (34%), followed by IBD (UC-17%, Crohns-9%) Tuberculosis in 13%, Polyposis in 8%, SIBO and Chronic Pancreatitis in 5%each, Radiation proctitis and IBS in 3% each. Conclusion:Chronic diarrhea causes signicant mortality as age advances, the leading cause for which was found to be Carcinoma colon in this study. For accurate diagnosis of various colorectal lesions, colonoscopy is the gold standard, simple, convenient and cost-effective procedure.

OUR SURGICAL EXPERIENCE IN ACUTE MESENTERIC ISCHEMIA- VARIOUS PATHOPHYSIOLGICAL TYPES – A CASE SERIES

BACKGROUND: Mesenteric ischemia is a frequently lethal condition resulting from critically reduced perfusion to the gastrointestinal tract. It accounts for 1-2% of hospital admissions for abdominal pain. Mortality due to mesenteric ischemia ranges from 24% to 96% with an average of 69%. AIM: The aim of this case series is to outline the clinical presentation and challenges in diagnosis of acute mesenteric ischemia and emphasize the importance of early diagnosis and intervention in reducing the mortality and morbidity. This article presents a series of 4 cases of the 3 major types of acute mesenteric ischemia – 2 cases of Acute Mesenteric Arterial Thrombosis(AMAT), one case of Acute Mesenteric Arterial Embolism(AMAE) and one case of Mesenteric Venous Thrombosis(MVT). MATERIALS AND METHODS: A total number of 4 patients who had undergone emergency laparotomy for acute mesenteric ischemia during the month of December 2020 in the Department of General Surgery, Government Kilpauk Medical College were studied. All 4 cases have been analysed during this study period of one month and followed up until discharge from the hospital. RESULTS: This case series consisted of 4 cases. Out of 4 cases, 3 were cases of Superior Mesenteric Arterial Occlusion due to thrombus and emboli and 1 was a case of Superior Mesenteric Vein Occlusion by thrombus. All 4 were male patients. All 4 patients presented with sudden onset of abdominal pain with or without vomiting. Abdominal distension, constipation and clinical features suggestive of bowel gangrene was not seen in all cases. Out of 4 cases, 2 cases were diagnosed early and taken up for immediate surgery and had a better outcome postoperatively with shorter hospital stay. Denitive diagnosis could not be made at time of admission for one case and was taken up for surgery late after the general condition of the patient deteriorated and extensive gangrene of the small bowel was seen during surgery. One case succumbed to septic shock after surgery following delayed presentation. This case series attempts to highlight that the key to successful management in acute mesenteric ischemia is a high index of suspicion leading to early diagnosis, aggressive resuscitation and early mesenteric revascularization. CONCLUSION: Despite the remarkable advances in in vascular surgical technique, vascular imaging, percutaneous intervention and surgical critical care, mesenteric ischemia remains a complex and often disheartening disease. Acute mesenteric ischemia is a life threatening vascular emergency that requires a high degree of clinical suspicion and early intervention to avoid a poor outcome. As Acute Mesenteric Ischemia often affects elderly patients, we have to consider the possibility of acute mesenteric ischemia in all elderly patients presenting with abdominal pain that is out of proportion to the ndings on physical examination

ECG CHANGES IN PATIENTS WITH COVID-19 – A RETROSPECTIVE OBSERVATIONAL STUDY AT A TERTIARY CARE HOSPITAL IN CHENNAI

Background:A global outbreak of corona virus disease, caused by severe respiratory corona virus 2, has emerged since December 2019. However electrocardiographic manifestations of patients with COVID-19 have not been fully described. We aim to investigate ECG characteristics in COVID-19 patients and risk factors of ICU admission Methods:This retrospective observational study included the patients with COVID-19 at the Government Kilpauk Medical College, Chennai between June 1st and 31st, 2020. Demographic, clinical and ECG characteristics were collected and comparison were made between ICU and non ICU admission groups. Logistic regression was used to identify risk factors of ICU admission Results:Among the 159 patients included ST-T abnormalities were the most common ECG feature followed by arrhythmias. Compared with non ICU group, the ICU group showed higher heart rate and P wave duration and was more frequently associated with CVD, ST-T abnormalities, arrythmias, QTc prolongation and pathological Q waves. ST-T abnormalities and history of CVD were associated with increased risk of ICU admission Conclusion:COVID-19 is frequently related to cardiovascular manifestations including ECG abnormalities and cardiovascular comorbidities. ST-T abnormalities and CVD at admission were associated with increased odds of ICU admission

ASSESSMENT OF DISEASE SEVERITY AND PROGNOSIS IN COVID-19 PATIENTS BASED ON LUNG INVOLVEMENT IN TERTIARY CARE HOSPITALS IN CHENNAI

Background: Corona virus disease 2019 (COVID 19) is caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) infection.This disease,which is quickly spreading worldwide,has high potential for infection and causes rapid progression of lung lesions,resulting in a high mortality rate.This study aimed to assess the severity and prognosis in COVID-19 patients based on lung involvement(CT-Chest). Methods: All lab confirmed cases of Covid 19 (RT-PCR positive) 369 patients admitted in Government Kilpauk medical college who were on follow up from october to november 2020, in Chennai were included. All patients underwent complete laboratory data including imaging studies-X-ray and CT- chest. Results:Among 369 of the admitted patients,67% were males,38% in 20-40 years 36% in 40-60 years of age.Among that 280 (75.9%) had non severe disease,89(24.12%) had severe disease.Regarding diseases outcome 38(10.3%) died and 331(89.7%) are alive.Compared to the patients with the stages of COVID-19: Asymptomatic (no lung involvement) - 28.4% Mild – Stage I (score I to II – 5 to 25% area involved) -36.3% Moderate – Stage II (score II to IV – 25 to 50% area involved) - 22.5% Severe – Stage III (score IV to V - more than 50% area involved} – 12.7% 12.7% of patients need ICU admission & mechanical ventilation and 10.3% of patients succumbed to death. Conclusion:From this study we have assessed the patient severity by using CT chest in covid 19 RT PCR positive patient. According to this study patient had more severe lung involvement needs mechanical ventilation and ICU admission