Guru Teg Bahadur Hospital Research Articles

An Evaluation of the Second Trimester Thyroid Function Test in Gestational Diabetes Mellitus: A Case-Control Study.

Gestational diabetes mellitus (GDM) is defined as glucose intolerance in a female with its onset or first recognition during pregnancy. Females with GDM are at higher risk of developing antenatal complications like preeclampsia during pregnancy and increased risk of type 2 diabetes as well as cardiovascular disorders later in their life. Maternal thyroid changes in the first and second trimesters of pregnancy have been widely related to the risk of GDM.Hypothyroidism during pregnancy is associated with early and late complications like abortions, anaemia, gestational hypertension, placental abruption and postpartum haemorrhage, impaired infant neurodevelopment, and low birth weight. This study aims to compare the thyroid function test (TFT) (serum fT3, fT4, TSH)and thyroid peroxidase antibody (anti TPO) between GDM and non GDM pregnant women in the second trimester and to correlate the adverse pregnancy outcomes with TFT in GDM and non GDM women. A nested case-control study was done in the Department of Obstetrics and Gynaecology, Department of Endocrinology, Department of Paediatrics, University College of Medical Sciences, and Guru Teg Bahadur (GTB) Hospital, Delhi. About 350 pregnant women from 13 weeks till 28 weeks period of gestation were screened out of which 40 GDM and 40 non GDM women were selected after performing an oral glucose tolerance test (OGTT). A TFT and anti TPO test were compared between GDM and non GDM participants. Furthermore, various parameters like sociodemographic profile, mode of delivery, pregnancy outcomes, and adverse maternal and adverse neonatal outcomes were compared. The mean age of GDM women is found to be more than non GDM women. The mean TFTvalues are significantly lower in women with GDM as compared to non GDM women. In addition, higher values of anti TPO antibody (thyroid autoantibody) were found in the GDM group which aidsin insulin resistance. Maternal complications like polyhydramnios, preterm labour, and pregnancy-induced hypertension were found to be more frequent in the GDM group compared to the non GDM group, but the results were statistically not significant. There was a higher incidence of caesarean delivery in the GDM group. Thus, we recommend the implementation of routine thyroid function profile testing in all antenatal females especially those who are at risk of developing GDM. Our study is one of the few Indian studies to evaluate the association of TFT in GDM, and we recommend similar research with a larger sample size and postnatal follow-up.

The Journey and Progress of the Department of Neurosurgery at the University College of Medical Sciences and Guru Teg Bahadur Hospital.

Guru Teg Bahadur Hospital (GTBH) associated with the University College of Medical Sciences (UCMS) is one of the largest hospitals associated with a medical college in the National Capital of Delhi, India. The Department of Neurosurgery was initially established here in 1997, but since its inception, has made rapid strides in terms of infrastructure and quality of patient care. The main objective of this article is to depict the history and path of progress of the Neurosurgery Department, from its inception to its present status, along with the inherent and existing challenges in running the department. A retrospective analysis from the time the department was established to its present status was done. The improvement of infrastructure, increase in patient inflow over the years, the number of procedures related to different subspecialties, and existing challenges along with the scope of further improvement were analyzed. There has been a significant upgradation of infrastructure more so in the last 5 years. Both indoor and outdoor patient attendance has increased over the years along with steady significant growth of the number of elective and emergency procedures. However, despite the progress, significant challenges hampering optimal patient care still remain to be overcome. The department right now is providing satisfactory patient care with absolutely no financial burden to the patients. Neurosurgery academic residency has recently resumed, and a wide range of neurosurgical conditions are being successfully treated. If the existing challenges are addressed in a timely manner, the coming years hold a bright future for the department.

Risk Factors of Incident Kidney Stones in Indian Adults: A Hospital-Based Cross-Sectional Study.

Background The diverse manifestations of urolithiasis providevery interesting epidemiological data. This has prompted various studiesto look into the etiopathogenesis of renal stones, which is believed to be multifactorial, both exogenous and endogenous. VDR Fok1 is a risk factor for renal stone formation and could cause the formation of renal stones through the mechanism of crystal induction and crystallization in the urine. While a few recent studies have shown the role of heavy metals like cadmium and lead in the formation of renal stones, the current knowledge is still insufficient. Methods This case-control prospective study was conducted in Guru Teg Bahadur (GTB) Hospital, a tertiary care facility in Delhi with 30 cases and 30 controls. Patients visiting the department of surgery between November 2011 and April 2013 were enrolled in the study. Cases were defined as patients with renal stones diagnosed on the basis of history and radiological investigations. Controls were selected from the patients admitted to the department of surgery for reasons other than renal stones. The study protocol was approved by the Institutional Ethical Committee of the University College of Medical Sciences, GTB Hospital, Delhi. Written informed consent was obtained from all patients.A structured questionnaire was used to collect data.Metal levels were analyzed by an atomic absorption spectrophotometer (Shimadzu Flame AA-680, Shimadzu Corp., Kyoto, Japan)at Delhi University. The vitamin D receptor gene was measured using genomic DNA.Horizontal agarose gel electrophoresis was used for the quantification of the genomic DNA. Results There were 30 cases and 30 controls in the study. Stress was more prevalent among cases (63%) compared to controls (36%). Nearly 83% of cases had the ff allele of the Vitamin D receptor gene compared to 46% of controls. The median arsenic and lead levels were higher among cases compared to controls.In the unadjusted model of logistic regression, we found stressed patients had three times higher odds of developing renal stones compared to non-stressed patients (OR (95% CI): 2.98 (1.04-8.52); p=0.04). Similarly, patients with higher blood concentrations of arsenic and lead had higher odds of developing renal stones compared to those with lower concentrations. Conclusions There was a definitive role of heavy metals, including lead, cadmium, and arsenic, seen with renal stones. A significant association was seen between the ff allele of VDR polymorphism (Fok1 enzymes) and patients with renal stones. Other parameters, including male and stress factors, seem to have an important role in renal stone formation.

Utility of Bedside Lung Ultrasound in the Assessment of Volume Status in Patients on Chronic Haemodialysis

Aim: The estimation of the ‘dry weight’ in a patient on haemodialysis with end-stage renal disease is an important clinical challenge to date. Physical examination has its limitations in the precise assessment of volume status. The monitoring of blood volume, natriuretic peptides, and bioimpedance spectroscopy are explored as a guide for the ultrafiltration process during haemodialysis (HD) therapy. Unfortunately, none of these methods has shown promising results when used in isolation and has serious limitations. The point-of-care lung ultrasonography has emerged recently as an adjunct to physical examination as a non-invasive, radiation-free technique to estimate extravascular lung water. In this study, the authors aimed to compare the volume status assessment in end-stage renal disease patients on HD using conventional clinical methods, bio-electrical impedance, and chest ultrasound (US). Materials and Methods: A prospective cohort study was conducted on 34 patients undergoing regular HD in the Department of Nephrology dialysis centre at the University College of Medical Sciences Guru Teg Bahadur Hospital, Delhi, India, a multi-speciality tertiary care centre. Parameters included to assess the dry weight of patients were bio-impedance spectroscopy and chest US, measured in two phases: 30 minutes before and 10–60 minutes following the HD session. Results: A total of 100 assessments were done on 34 patients over 6 months. The mean pre-HD extracellular water was 17.52±2.69 L and post-HD was 16.38±2.46 L, showing a significant reduction (<0.001). The bioimpedance analysis showed that 44% of the volume status assessments had fluid overload (≥1.1 L), even when the patients were considered to be in a state of clinical euvolemia, while 79% of the assessments had a Comet Score of ≥3 suggesting a fluid overload state. Most assessments showed a significant reduction in the number of B-lines (i.e., 62% [Comet Score of between 0–2]). The mean post-HD Comet Score was 1.73±1.36 (37%). Conclusion: Chest US to assess Comet Score is highly correlated with the clinical signs and symptoms. Lung Comet Scores can also be highly correlated with ultrafiltration volume, and thus can be used as a good marker for achieving dry weight in dialysis patients.

An Overview of Neurotrauma Care in UCMS and GTB Hospital, New Delhi

AbstractUniversity College of Medical Sciences (UCMS) and the associated Guru Teg Bahadur Hospital (GTBH) is one of the largest tertiary care centers in the National capital of Delhi. It caters to a large volume of patients mainly from north east Delhi along with neighboring states of Uttar Pradesh and Haryana. Since the establishment of neurosurgery department in 1997, the department has contributed significantly toward neurotrauma care. With the upgradation of infrastructure in recent years, the department surely has a bright future in neurotrauma services benefiting a huge population. In this article, I have tried to describe the brief history of neurotrauma care, present status of manpower, and infrastructure to manage trauma patients, difficulties yet to overcome and roadmap for future.

Spectrum of Renal Involvement in Cancer Patients: A Cross-sectional Descriptive Study

Introduction: Cancer is associated with multiple renal manifestations like Acute Kidney Injury (AKI), Chronic Kidney Disease (CKD), proteinuria, and electrolyte imbalance. The reason behind renal dysfunction in cancer patients is multifactorial and can be attributed to underlying cancer and treatment modalities, in addition to co-morbidities surgical procedures and infections. Aim: To assess the spectrum of renal involvement in cancer patients presenting at a tertiary care hospital. Materials and Methods: The cross-sectional descriptive study, was conducted in the Department of Medicine of University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India. One hundred consecutive patients referred for nephrology consultation with diagnosed cancer, irrespective of cancer aetiology between the age group of 15-70 years with deranged kidney function test were recruited. Detailed medical and treatment history, including the type of cancer-solid or haematological, cancer status-cured or continuing, treatment given-chemotherapy, radiotherapy or surgery or a combination and associated co-morbidities like diabetes mellitus and hypertension were recorded. Routine investigations and special investigations, including assessment of estimated Glomerular Filtration Rate (eGFR) and estimation of Albumin-Creatinine Ration (ACR) was done. Patients were then segregated, based on their kidney function test into groups with AKI or CKD and underlying cause was valuated. Summary statistics was presented as mean, median or frequency and data analysed using Statistical Package of Social Sciences (SPSS) version 24.0. Results: The mean age of the study population was 53.73±12.20 years with 63% male and 37% female participants; 87% patients had solid cancers, while 13% had haematological cancers. The median duration, since the diagnosis was seven months and the patients were undergoing chemotherapy, radiotherapy or a combination of both; seven patients had surgery for underlying malignancy and an additional six had received chemotherapy or radiation therapy along with surgery. At the time of recruitment, 78% patients had AKI and 22% patients were diagnosed with CKD. Chemotherapy-induced nephropathy was the most common cause of AKI (n=46). In the CKD group diabetes (n=7) was the most common aetiology. Conclusion: The kidneys in cancer patients can be involved in a number of ways, as a consequence of the cancer itself, its treatment, superimposed infections or associated comorbidities. Chemotherapy-induced nephropathy is the most common cause of AKI, whereas, diabetes is the most common cause of CKD in cancer patients.

Detection of Occult Anal Sphincter Injuries in Primipara by 2D Transperineal Ultrasound and its Clinical Association: A Cohort Study

Introduction: Endoanal Ultrasound (EAUS), the gold standard for the detection of occult Obstetric Anal Sphincter Injuries (OASI) has limited clinical application due to its intrusiveness and need for specialised equipment and personnel. A 2D Transperineal Ultrasound (TPU) is simple, non invasive and shows a high degree of agreement with EAUS. Few studies have evaluated the use of 2D TPU in determining the incidence and clinical outcomes of occult OASI in primigravida. Aim: To study the incidence, risk factors, and clinical outcome of occult obstetric anal sphincter injury using 2D TPU in primigravida. Materials and Methods: The present cohort study was conducted in the Department of Obstetrics and Gynaecology in collaboration with the Department of Radiology at Guru Teg Bahadur Hospital, Delhi, India, from November 2018 to April 2020. A total of 200 low risk primigravida ≥36 weeks period of gestation underwent baseline TPU of the anal sphincter complex antenatally and on day 2 postpartum. On the basis of difference between pre and postdelivery measurements, they were divided into group I (n=91): women with occult OASI (diagnosed as thinning of the internal and External Anal Sphincter (EAS), interruption in the anal sphincter, alteration in mucosa and half-moon sign) and group II (n=109): no OASI. Group I was followed at two and six weeks postpartum with TPU and clinical tests were applied at 6 weeks to assess clinical outcomes of sphincter injury. Data was analysed using Chi-square test/Fisher’s-exact test for qualitative parameters, Analysis of Variance (ANOVA) for comparison of predelivery and postpartum measurements; and multiple logistic regression for determining sphincter injury determinants. Results: Incidence of occult OASI was 91/200 (45.5%). Significant risk factors for OASI were lower baseline thickness of anal sphincter, position of baby (p=0.028), longer duration of second stage of labour (p<0.001), greater length and angle of episiotomy (p<0.001) and greater baby weight (p=0.042). Group I had significantly lower pelvic floor muscle strength testing score (p<0.001), Digital Rectal Examination Scoring System (DRESS) resting (p=0.013) and squeeze scores (p=0.008), weaker muscle contraction (p<0.001), reduced anal sphincter tone, and was more clinically symptomatic at six weeks postpartum. Conclusion: The technique of 2D TPU is simple and feasible to detect OASI. Women, who sustain OASI, can be followed up in perineal clinic more meticulously, using TPU for pelvic floor rehabilitation.

Role of Aspergillus Specific IgG Titres as a Therapeutic Target for Chronic Pulmonary Aspergillosis: A Longitudinal Study

Introduction: Chronic Pulmonary Aspergillosis (CPA) continues to be an enigma to clinicians in regions with a high prevalence of pulmonary tuberculosis and is often misdiagnosed as the latter, attributable to the significant overlap in symptoms and radiology. Moreover, although the diagnostic criteria for CPA have been standardised, the role of serological markers in monitoring disease activity and response to therapy is still not well characterised. Aim: To understand the characteristics, risk factors and treatment outcomes in patients developing CPA and to determine the role of serological markers as indicators of disease activity. Materials and Methods: The present longitudinal study was conducted in the Department of Respiratory Medicine, University College of Medical Sciences and its associated Guru Teg Bahadur Hospital, Delhi, India from February 2021 to June 2022. Study included 46 patients suspected of harbouring CPA attributable to their clinico-radiological presentation. The diagnosis of CPA was made using the established criteria. Patients with a confirmed diagnosis of CPA received oral azole antifungals for 6 months and were monitored at 3-monthly intervals for reduction in baseline parameters to determine treatment success/failure. Paired and unpaired parametric variables were compared using the t-test and non parametric methods were compared using the Chisquare test. Results: The diagnosis of CPA was established in 31 (67.4%) patients of whom 77.6% were males and the mean age was 47.3±2.2 years. These patients had been symptomatic for 5.8±1.2 years. Underlying risk factors (such as the history of tuberculosis, chronic obstructive pulmonary disease, diabetes mellitus, history of long-term glucocorticoid use etc.) had been present for 6.9±1.3 years. Patients harboured an average of two risk factors with tuberculosis and diabetes mellitus being the most common local and systemic affliction, respectively. Patients with tuberculosis (p-value=0.001) and chronic steroid use (p-value=0.029) were significantly at higher risk of developing CPA. 6 months of azole therapy led to significant reduction in specific IgG titres (p-value=0.001), and serum precipitins (p-value=0.004). Two patients on itraconazole relapsed within 12 months but were successfully treated with voriconazole. Conclusion: Tuberculosis was the most significant local risk factor leading to the development of CPA, which developed soon after diagnosis of another systemic risk factor. Six months of azole therapy was adequate to induce remission of the disease, activity of which can be monitored though the measurement of serum IgG antibody titres.

P367 Candida sepsis in neonates a neglected pathogen: study from neonatal intensive care unit tertiary care hospital

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM IntroductionSignificance of Candida species in neonatal intensive care units (NICU) is increasingly being recognized. It is the third most common cause of late-onset sepsis in NICU patients and accounts for 9 to 13% of bloodstream infections (BSI) in neonates. Although Candida albicans has historically been the most frequently isolated species, recently non-albicans Candida (NAC) have emerged as an important opportunistic pathogen, notably Candida tropicalis, C. parapsilosis, C. krusei, C. glabrata, and C auris. This changing trend and the increasing use of azoles agents is now a matter of concern due to the emerging resistance of the non-albicans species to azoles.AimTo evaluate the Candida sepsis in neonates from neonatal intensive care units from a tertiary care hospital.Material and MethodsA cross-sectional study was conducted in the Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, East Delhi, India, during the period of July 2021 to December 2021. Overall, 30 suspected Candida sepsis patients from neonatal intensive care units were enrolled in the present study. The Candida spp. Isolated was identified as per standard mycological techniques. Preliminary identification was done by colony morphology on SDA, chromogenic media (Hichrome, Himedia Pvt. Ltd.), grown at 45°C, germ tube test, chlamydospore formation, and was confirmed by carbohydrate fermentation and assimilation tests. Antifungal susceptibility testing (AFST) was performed for Fluconazole (25 μg), and amphotericin B (AMB, 100 units) using the disc diffusion method on Muller-Hinton agar supplemented with 2% glucose and methylene blue (5 mg/ml). Zone diameters were interpreted as per the approved Clinical Laboratory Standards (CLSI-M44-A) guidelines. Quality control for AFST was performed using C. albicans-ATCC 90028 and C. parapsilosis-ATCC 22019.Statistical analysisThe statistical analysis was done using Statistical Package for Social Sciences (SPSS) version. The P-value ˂0.05 were considered as statistically significant.ResultOut of 30 Candida species from suspected septicemia neonates, non-albicans Candida (NAC) species accounted for (87%) compared to C. albicans (13.4%). Candida tropicalis was predominant at 9 (30%) followed by C. glabrata 8 (27%), C.parapsilosis 4 (13.3%), and C. krusei 3(10%), Pichia species (4.2%), and C.auris (3.4%). Antifungal sensitivity of the NAC isolates demonstrated >85% resistance to fluconazole amongst C. glabrata, C. parapsilosis, though amphotericin B had 100% sensitivity in all Candida species. The risk factor for candidemia as observed in our study were low birth weight 26(87%), use of broad-spectrum antibiotics 25 (83.4%), presence of an orogastric tube 18 (60%), and total parental nutrition 9 (30%) were significantly associated statistically (P <.05, paired t-test). The overall mortality amongst these neonates was 16.6%.ConclusionFungal BSI has emerged as an important cause of morbidity and mortality in neonates. Reporting of fungal bloodstream infections and the spectrum of species involved are essential measures in neonatal intensive care units in order to implement appropriate preventive and therapeutic strategies.

P374 Fungal coinfection in patients with SARS-CoV-2: Atertiary care hospital study

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PMBackgroundThere is a high risk of developing fungal co-infections in patients infected with SARS-CoV-2, few studies have been conducted on the incidence and risk of these secondary infections. The incidence of Candida infection due to different Candida species is increasing in COVID patients.MethodsThis retrospective study comprised a total of 23 patients with upper respiratory infection investigated in the Department of Microbiology of University College of Medical Sciences (UCMS) and Guru Teg Bahadur Hospital (GTBH), Delhi from April 2021 to June 2021. Identification was done using DNA sequencing.ResultsOf the 23 cases, identification by DNA sequencing, C. albicans was present in 34.78%, C. tropicalis in 30.43%, Pichia kudriavzevii in 26.08%, C. parapsilosis in 4.3%%, and C. auris in 4.3%.Conclusion C. albicans is the leading pathogen in our patients, along with the rise in the incidence of P. kudriavzevii which is usually an environmental contaminant. Regular surveillance and infection control practices are future ventures to reduce the burden of infection.

Effect of vitamin D supplementation on serum VEGF levels in vitamin d deficient polycystic ovarian syndrome patients

To estimate and compare serum VEGF levels before and after vitamin D supplementation in vitamin D deficient PCOS patients. The present study was conducted in Department of Obstetrics and Gynaecology in collaboration with Department of Biochemistry at University College of Medical Sciences (UCMS) and Guru Teg Bahadur Hospital (GTBH), Delhi from November 2017 to April 2019 (including enrollment of subjects, data analysis and thesis writing). Considering a standard deviation of 36.5 before supplementation and 42.7 after supplementation in VEGF levels in case of PCOS patients in study of Irani et al., to estimate an absolute difference of 31 units pg/ml decrease in VEGF levels, at α= 5% and power= 80%, a sample of 26 cases is required. Since there is a follow up of 3 months adding an attrition of 15%, the total sample size becomes 30 cases. Significant increase in serum vitamin D levels post supplementation was observed from pre supplementation 9.524±4.41 to post supplementation 32.07±12.40; p-value &amp;#60;0.001. We observed significant fall in angiogenesis marker, serum VEGF levels post vitamin D supplementation from 773.547±344.173 to 639.97±119.02, p value 0.004 which suggests negative correlation between serum Vitamin D and serum VEGF levels. Vitamin D supplementation in PCOS patients who are vitamin D deficient, leads to significant fall in angiogenesis marker serum VEGF, which is manifested as improvement in clinical and biochemical parameters in these patients.

Association of Cartridge Based Nucleic Acid Amplification Test (CBNAAT) Grading on the Basis of Cycle Threshold Value with Conventional Microbiological Diagnosis in Pediatric Tuberculosis

Background: Microbiological confirmation of tuberculosis disease in children remains difficult due to paucibacillary disease and inability to obtain optimal samples. Recently introduced Cartridge based nucleic acid amplification test (CBNAAT) has improved microbiological diagnosis in pediatric tuberculosis.&#x0D; Objectives: We aimed to study association of CBNAAT grading based on cycle threshold value with conventional microbiological diagnosis.&#x0D; Methodology: This prospective study was conducted over a period from November 2016 to October 2017 in the Departments of Microbiology and Pediatrics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi. CBNAAT positive pediatric TB cases ≤12 years were recruited and subjected to Ziehl-Neelsen staining for acid fast bacilli (AFB) &amp; culture on Lowenstein Jensen medium. CBNAAT positivity was graded based on cycle threshold value: very low, low, medium and high.&#x0D; Results: Smear and culture positivity was highest (100%) among specimens with high positive CBNAAT result based on CT value. Time to culture positivity was inversely related to CBNAAT grading (p=0.000).&#x0D; Conclusion: CBNAAT grading has significant positive association with smear and culture positivity.&#x0D; Bangladesh Journal of Infectious Diseases 2020;7(2):72-77

Maternal Pregnancy Associated Plasma Protein-A Levels in Late First Trimester as a Predictor of Miscarriage- A Cross-sectional Study

Indroduction: Miscarriage is the most common complication of pregnancy. Defective implantation is one of the common causes of miscarriage. Pregnancy Associated Plasma Protein-A (PAPP-A) is secreted from syncytiotrophoblast and it enables trophoblast invasion. Few studies have shown association of PAPP-A with miscarriage. However, there is limited data available to establish the role of PAPP-A as a predictive marker of miscarriage, especially in Indian population. Aim: To determine the potential of maternal PAPP-A level estimation in asymptomatic women in late first trimester (10-13 weeks) with viable foetus in predicting subsequent miscarriage. Materials and Methods: This was an observational, cross-sectional study conducted from November 2016 to April 2018 at University College of Medical Science and Guru Teg Bahadur Hospital, Delhi, India. Asymptomatic pregnant women (N=500) at 10-13 weeks of gestation were recruited from an antenatal clinic after confirmation of foetal viability. A 2 mL of blood sample was collected and serum PAPP-A level was measured. Independent t-test and Chi-square test was used to compare continuous data and Mann-Whitney U test was used to compare PAPP-A Multiple of Median (MOM). Logistic regression was used to estimate risk of miscarriage. Results: Out of 500 participants, 9 were lost to follow-up. From remaining N=491, 32 (6.5%) women had a miscarriage. PAPP-A levels were significantly decreased in miscarriage group compared to ongoing pregnancy group with median MOM 0.116 (0.080-0.17) and 1.25 (0.665-3.249) respectively (p-value &lt;0.001). PAPP-A MOM value of ≤10th percentile sensitivity and specificity of detection of miscarriage was 81.25% and 94.98% and at ≤5th percentile sensitivity and specificity was 40.62% and 97.82%, respectively. Lower the percentile cut-off of serum PAPP-A value, higher was the specificity and positive predictive value for prediction of miscarriage. By applying logistic regression we found that if PAPP-A MOM decreases by 1 unit the chances of miscarriage increased by 1.2 times. By this model 63.2% of cases could be explained (Nagelkerke R Square=0.632). For prediction of pregnancies likely to miscarry, the area under Receiver Operator Characteristic (ROC) curve (95% CI) was 0.969 (0.955-0.983). Conclusion: Low serum PAPP-A levels from asymptomatic women in late 1st trimester is a good predictive marker of miscarriage.

SEISMIC EVALUATION AND RETROFIT ON AN EXISTING HOSPITAL BUILDING

The nonlinear pushover analysis was used to evaluate an existing 8-storey reinforced concrete framed hospital building under seismic force and presented in this manuscript. The ‘Guru Teg Bahadur Hospital' is one of the important hospitals at Delhi-India, it was selected for this research. The three-dimensional frame model was used to model the building with a fixed base. The beams and columns were modeled by using three-dimension line frame elements with the centre lines joined at nodes. Diagonal strut elements were used to model the brick masonry infills. The slabs were considered as rigid diaphragms. The plastic hinge rotation capacities as per Federal Emergency Management Agency 356 (FEMA 356) with Performance Levels were adopted in this study, considering the axial force-moment and shear force-moment interactions. The nonlinear pushover analysis of the selected building was done with infills and it was observed that the infills (due to their small number in the considered building) do not make any appreciable effect on the performance level, except their failure at an early stage. The Capacity Spectrum Method (CSM) and Displacement Coefficient Method (DCM) were used to estimate the performance point of the building. The values of various coefficients as per Federal Emergency Management Agency 440 (FEMA 440) were adopted. The DCM was observed to give slightly higher target displacements, as compared to CSM. It was observed in the nonlinear pushover analysis that the unreinforced masonry (URM) infills collapse before the performance point of the building for the Maximum Considered Earthquake (MCE). As the intervention inside the functioning hospital is extremely difficult, it was explored whether it is possible to safeguard the infills by stiffening the building by providing external buttresses. Two cases of retrofitting schemes with 1.2m wide and 3m wide buttresses in transverse direction were used and analysed. It was found that this is not a practicable approach, as the infills collapse even with 3m wide buttresses.

A study of the association of leukopenia with disease severity and mortality in patients diagnosed with COVID-19

Background: It has been observed in patients suspected with COVID-19 or presenting as confirmed cases of COVID-19 that a decreased total white blood cell count (leukopenia) is quite a common haematological presentation. In this study we aimed to determine the effect of leukopenia on the progress and severity of COVID-19, as well as to establish the association of leukopenia with disease severity and overall mortality.Methods: This was a longitudinal study conducted at Guru Teg Bahadur hospital, New Delhi from 1st July 2020 to 3rd August 2020. A sample size of 34 cases each in two groups (group A and B) was taken as one random case each day for the duration of the study; group A consisting of the patients presenting with leukopenia, while group B comprising of the patients with a normal leukocyte count.Results: The mean duration of hospital stay in group A was found to be 5.5±2.23 days, while the mean duration of stay in group B was found to be 2.9±1.17 days, showing a significant difference in the two groups with a p&lt;0.001. It was also seen that a total of 8 out of 34 cases in group A and 2 out of the 34 cases in group B had expired during their hospital stay; a significant difference seen among the two groups with a p=0.04.Conclusions: Thus, in conclusion, this study demonstrates a definite and significant association between a decreased leukocyte count (leukopenia) and disease severity and mortality in patients with COVID-19.

Frailty in Elderly Patients with Acute Coronary Syndrome in India

Background: Association of frailty in Indian elderly patients with acute coronary syndrome (ACS) has not been investigated. Our objective was to estimate the prevalence of frailty due to the severity of ACS in elderly patients in India. The study also aimed to find out the association between the number of health deficits with ACS severity among elderly patients and to explore the association of frailty with conventional risk factors for coronary artery disease among the patients. Materials and Methods: A cross-sectional study was performed for a period of 18 months where 100 elderly patients ≥60 years age, having ACS, regardless of gender, were recruited from the Department of Medicine, Guru Teg Bahadur Hospital, Delhi. Frailty was assessed with the help of Fried index along with a number of deficits in health. Assessment of ACS was done on the basis of the ECHO findings that took into account the left ventricular ejection fraction. Results: The occurrence of frailty was 44% among elderly patients presenting with ACS. The association between the number of health deficits with the severity of ACS at presentation among elderly patients was found to be statistically significant (P

Markers of Fibrinolysis in Indian Patients with Isolated Head Trauma.

Context:Head injury causes disseminated intravascular coagulation as the most severe complication which is associated with high mortality. Elevated levels of markers of fibrinolysis such as D-dimer and fibrinopeptide A (FPA) have been correlated with poor outcome in these patients.Aim:The study aimed to correlate the levels of plasma fibrinogen, D-dimer, and FPA with outcome in patients with isolated head trauma.Settings and Design:This cross-sectional descriptive study was conducted in the Departments of Pathology and Neurosurgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, on 100 patients admitted within 12 h of isolated head trauma.Subjects and Methods:Plasma fibrinogen, D-dimer, and FPA were measured in 100 patients admitted within 12 h of isolated head trauma. While plasma fibrinogen and D-dimer were estimated in all patients, FPA was measured in 45 patients.Statistical Analysis:SPSS (20.2) software was used for mean, standard deviation, and median values of the quantitative parameters, and for all qualitative parameters, their frequencies were obtained. P < 0.05 was considered significant.Results:Elevated D-dimer (>250 ng/ml) and FPA (>3 ng/ml) were observed in 64% and 91.1% patients, respectively. Both D-dimer and FPA were elevated in 66.6% of patients. Disseminated intravascular coagulation (DIC) score, calculated using standard criteria, was ≥5 in 28% of patients indicating overt DIC. Hypofibrinogenemia was observed in 48% of patients. D-dimer, FPA, and DIC score was significantly (P < 0.001) higher and plasma fibrinogen significantly (P < 0.001) lower in nonsurvivors as compared to survivors. Elevated D-dimer and FPA and low fibrinogen levels were seen in patients irrespective of severity of injury.Conclusions:Elevated D-dimer and FPA were frequently observed in patients with isolated head trauma. As these markers rise soon after injury and indicate poor outcome, their measurement will help identify patients who will benefit with additional therapy, thus reducing morbidity and mortality.

Correlation of expression of aberrant immunophenotypic markers in T-ALL with its morphology: A pilot study.

INTRODUCTION:Aberrant expression of immunophenotypic markers is commonly found in patients of acute leukemia. T-ALL also shows aberrant markers such as CD13, CD33, CD117, CD10, and CD79a. Morphologically, T-ALL has been categorized into L1, L2, and L3 subtypes. Till now, no study has been done to correlate these markers with morphological features of T-ALL. This study aimed to correlate the expression of aberrant immunophenotypic markers with morphology in T-ALL.MATERIALS AND METHODS:All the cases of T-ALL diagnosed by flow cytometry over a period of 2½ year were taken out from the records of Hematology Section of Department of Pathology of University College of Medical Science and Guru Teg Bahadur Hospital and Max Hospital, Saket. Their peripheral blood smear was screened to correlate the morphology of blasts with the expression of aberrant markers.RESULTS:A total of 40 cases of T-ALL were identified during 2½ year period of our study. Morphological correlation was available for 23 cases. Aberrant expression of CD10 was present in 6 (35.3%) cases, CD79a in 9 (47.36%) cases, CD117 in 5 (42.28%) cases and myeloid antigen CD33 in 5 (38.46%) cases. CD117 and CD33-positive cases showed L2 morphology with the presence of convolutions, while cases with expression of CD79a had L1 morphology with absent-slight convolutions. CD10-positive cases had L1/L2 morphology with absent occasionally present convolutions.CONCLUSIONS:There seems to be an association of aberrant markers with L1 and L2 morphology. However, this needs to be tested for statistical significance on a larger sample size.

Bacteriological profile of sepsis and its correlation with procalcitonin in patients with diabetes mellitus

Bloodstream infections can lead to life-threatening sepsis and require rapid antimicrobial treatment. It is an accepted opinion that diabetes worsens prognosis of infection, particularly sepsis, although there is not much data published on this subject. The aim was to study the bacteriological profile of sepsis in patients of diabetes mellitus (DM) and the correlation of procalcitonin as biomarker of sepsis and blood culture positivity. Study was conducted at University College of Medical Sciences (UCMS) and Guru Teg Bahadur (GTB) Hospital from December 2013 to November 2014. Thirty known diabetic patients with signs and symptoms of sepsis were enrolled for the study irrespective of age, sex, and type of diabetes. Blood samples were taken for blood culture, estimation of procalcitonin and blood glucose levels, fasting and postprandial and glycosylated hemoglobin, and other relevant biochemical tests. Out of the 30 samples, 9 (30%) patients yielded growth; among them, 66.6% were found to be Staphylococcus aureus and 33.3% were Klebsiella pneumoniae. Median procalcitonin (PCT) levels in positive blood culture subjects were significantly higher than those with negative blood culture. We observed blood culture positivity in 30% of the patients of DM with sepsis, predominance of Gram-positive bacteria, and significantly higher PCT levels in blood culture-positive patients.

Study of serum transforming growth factor-beta 1 (TGF-?1) levels in type 2 diabetes mellitus patients with nephropathy

Background: Diabetic nephropathy (DN) is a major micro-vascular complication of diabetes mellitus (DM) and it is the leading cause of end stage renal disease (ESRD) worldwide. The present study was carried out to estimate the serum TGF-β1 levels in T2DM patients with nephropathy. Methodology: All study subjects (n=75) were enrolled in 3 groups. Group 1: (n=25) healthy controls, group 2: (n=25) T2DM patients without nephropathy, group 3: (n=25) T2DM patients with nephropathy. Patients were recruited from diabetic and nephrology clinic at University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India. Morning spot urine samples were collected for urine albumin and creatinine test. Serum and urine creatinine were estimated by alkaline picrate Jaffe´s kinetic method. Urine albumin was estimated by turbidometric method. Albumin/creatinine ratio (ACR) was expressed in mg/g creatinine. Serum TGF-β1 level was measured by ELISA kit. Results: A statistically significant difference was found in the levels of urinary ACR between the study groups I and III, II and III (p=0.000), but no statistically significant difference was found between groups I and II (p=0.460). There was a statistically significant difference observed in the serum TGF-β1 levels between the study groups I and II, I and III and II and III (p=0.000). Serum TGF-β1 showed significant positive correlation with HbA1c, fasting plasma glucose, post prandial plasma glucose, serum creatinine and urinary ACR. However, a negative correlation was found between serum TGF-β1 and eGFR. Conclusions: Serum TGF-β1 levels were found higher in patients with T2DM and were significantly elevated in T2DM patients with nephropathy. Serum TGF-β1 levels in diabetic patients were dependent on the glycemic control and degree of renal dysfunction however, its levels were not dependent on the duration of diabetes.