Health Care Center In India Research Articles

PD-9 Three-arm phase II/III randomized controlled trial in patients with unresectable/metastatic gall bladder cancer with poor performance status: Erlotinib or capecitabine v/s best supportive care

Currently there is no standard of care for Eastern Cooperative Oncology Group (ECOG) poor performance status (PS) patients (PS-III) with unresectable/metastatic Gall Bladder Cancer (GBC). Being unfit for chemotherapy, these patients receive only best supportive care (BSC) resulting in a very dismal outcome. A report published from M.D. Anderson Cancer Centre stated median overall survival (OS) of only one month in patients with poor PS with GBC. This single centre, prospective randomized controlled phase II/III, open label trial was done at a tertiary health care centre in India. Patients (above 18 years) with histologically confirmed unresectable/ metastatic GBC with adequate organ function and ECOG PS-III were included. Patients with prior adjuvant chemotherapy/erlotinib/capecitabine in last 6 months, active malignancy other than GBC, lactating and pregnant women, and HIV-positive status were excluded. Random allocation (1:1:1) was done to one of the three arms - Erlotinib (150 mg OD) + BSC, Capecitabine + BSC or BSC alone using computer-generated sequence. The primary end point was median OS, defined as time from randomisation to death, in the intention-to-treat population. A sample size of 105 was estimated, assuming median OS in BSC, Erlotinib+BSC and Capecitabine+BSC as 2, 4 and 5 months respectively (taking two-sided alpha error as 0.05 and power as 80%). Between Dec 27, 2017 and January 18, 2021, 201 patients were screened, of which 105 were randomized to Erlotinib +BSC (n = 36), Capecitabine +BSC (n = 36) or BSC alone arm (n = 33). After a median follow up of 10 months (IQR 3.9- 11.5), there were 82 deaths in the whole cohort. The median OS in Erlotinib arm was significantly higher at 3.84 months (2.33- 4.67) compared to 1.77 months (1.18- 2.73) in BSC only arm, with hazard ratio (HR) of 0.50 (95% CI - 0.26 -0.95), p = 0.02. However, there was no statistically significant difference observed in survival between Capecitabine +BSC over BSC alone - median OS 2.46 months (1.67-3.58), HR - 0.70 (95% CI - 0.38- 1.2), p = 0.30. Compared to only 15.1% (5/33) in BSC arm, the disease control rate (complete response + partial response + stable disease) at 6-8 weeks was 58.3% (21/36) in Erlotinib arm (p = 0.004) and 47.2% (17/36) in Capecitabine arm (p = 0.04). Grade III/IV toxicities were reported in 12 patients (33.3%) in Erlotinib arm (skin rash and diarrhea being most common at 8% each) and in 5 patients (13.8%) in Capecitabine arm (anemia and fatigue most common at 6 % each). No treatment related deaths were reported in either group. Addition of Erlotinib to BSC significantly improves OS in patients with unresectable/metastatic GBC, otherwise unfit to receive chemotherapy, with acceptable toxicity profile.

Increased Rate of Hand Hygiene Compliance During COVID -19 Pandemic: Myths and Facts

Introduction: Hand Hygiene is the cheapest, easiest and the single most effective measure to reduce cross-transmission of infection from one patient to another and from the healthcare workers to patients and vice versa. Multiple studies have shown a decrease in healthcare-associated infections (HCAIs) rates after improvement in hand-hygiene compliance. Despite being the simplest procedure adherence to the hand hygiene recommendations remains well below 50% and healthcare workers repeatedly observed as being poor compliers. Objective: This study was planned to access the impact of covid-19 pandemic on the compliance of infection control practices at a tertiary health care centre in India. Methods: Institution-based cross-sectional study was used to assess the impact of covid-19 pandemic on attitude, knowledge and on the compliance of hand hygiene practices at a tertiary health care centre in India. Results: A marked difference was observed in the availability of resources for hand hygiene i.e., 48 (96%) locations and the display of instructions for hand hygiene 50 (100%). A significant difference was also observed among the knowledge of the steps of hand hygiene {2019: 16(32%; 2020: 33 (66%)} and of the moments of hand hygiene {2019: 27 (54%); 2020; 44 (88%)}. (ϰ2 = 79.2, df =1, p = 0). In 2020 (during COVID -19 pandemic) a significant increase in compliance was noted in most of the departments with highest compliance rate of ICUs (100%), followed by OTs (91.7%), paediatrics (95.8%) obstetrics and gynaecology (90.6%), surgery (86.5%), blood bank and laboratories (85.7%). However, unlike the other parameters, the compliance of hand hygiene during the previous year (2019) and during 2020 (COVID -19 pandemic, was poor with no significant difference in compliance of hand hygiene practices even during the pandemic. Of all the 5 moments suggested by WHO, maximum compliance (36% in 2019 and 60% in 2020 pandemic) was after body fluid exposure. Conclusions: Hand Hygiene should be made a national priority. Active involvement by healthcare administrators, national and local governments should be committed to make hand hygiene a mandate for patient safety. Accessibility to hand hygiene products like soap and water and/or alcohol-based hand rubs and written and verbal reminders to staff are essential to improve the compliance of hand hygiene. Thrust should also be given to hand hygiene as a research subject.

Increased Rate of Hand Hygiene Compliance During COVID -19 Pandemic: Myths and Facts

Introduction: Hand Hygiene is the cheapest, easiest and the single most effective measure to reduce cross-transmission of infection from one patient to another and from the healthcare workers to patients and vice versa. Multiple studies have shown a decrease in healthcare-associated infections (HCAIs) rates after improvement in hand-hygiene compliance. Despite being the simplest procedure adherence to the hand hygiene recommendations remains well below 50% and healthcare workers repeatedly observed as being poor compliers. Objective: This study was planned to access the impact of covid-19 pandemic on the compliance of infection control practices at a tertiary health care centre in India. Methods: Institution-based cross-sectional study was used to assess the impact of covid-19 pandemic on attitude, knowledge and on the compliance of hand hygiene practices at a tertiary health care centre in India. Results: A marked difference was observed in the availability of resources for hand hygiene i.e., 48 (96%) locations and the display of instructions for hand hygiene 50 (100%). A significant difference was also observed among the knowledge of the steps of hand hygiene {2019: 16(32%; 2020: 33 (66%)} and of the moments of hand hygiene {2019: 27 (54%); 2020; 44 (88%)}. (ϰ2 = 79.2, df =1, p = 0). In 2020 (during COVID -19 pandemic) a significant increase in compliance was noted in most of the departments with highest compliance rate of ICUs (100%), followed by OTs (91.7%), paediatrics (95.8%) obstetrics and gynaecology (90.6%), surgery (86.5%), blood bank and laboratories (85.7%). However, unlike the other parameters, the compliance of hand hygiene during the previous year (2019) and during 2020 (COVID -19 pandemic, was poor with no significant difference in compliance of hand hygiene practices even during the pandemic. Of all the 5 moments suggested by WHO, maximum compliance (36% in 2019 and 60% in 2020 pandemic) was after body fluid exposure. Conclusions: Hand Hygiene should be made a national priority. Active involvement by healthcare administrators, national and local governments should be committed to make hand hygiene a mandate for patient safety. Accessibility to hand hygiene products like soap and water and/or alcohol-based hand rubs and written and verbal reminders to staff are essential to improve the compliance of hand hygiene. Thrust should also be given to hand hygiene as a research subject.

Cost Optimization and Emission Control of a Grid Connected Hybrid PV-Wind System for a Health Care Centre in India

The essential component of development for a nation is health care to the citizens. The skilled human resource is produced by the development of the medical and paramedical institutions. The cost optimization of the electrical energy consumption and the emission control of energy generation is analyzed using Homerpro software well before the installation of the project. The analysis of a healthcare center in Tamilnadu is performed with Homerpro software. The annual energy production and the energy consumption are estimated, and it is found that the annual energy production is improved. The greenhouse gas emission is nullified to avoid the polluted environment.

IDF21-0427 Gender differences in age, new onset vs established diabetes in patients with Covid in an urban healthcare centre in India

Background: Diabetes and its association with poor outcomes in patients with COVID-19 is a well established fact. In this study, we are focusing on gender differences in age of occurrence of COVID 19, gender differences in patients with newly diagnosed diabetes vs established diabetes. Through this study, we are trying to focus on gender specific diabetes care in the background of the current pandemic.

Cloud vendor selection for the healthcare industry using a big data-driven decision model with probabilistic linguistic information.

The role of cloud services in the data-intensive industry is indispensable. Cision recently reported that the cloud market would grow to 55 billion USD, with an active contribution of the cloud to healthcare around 2025. Inspired by the report, cloud vendors expand their market and the quality of services to seek growth globally. The rapid growth of the cloud sector in the healthcare industry imposes a challenge: making a rational choice of a cloud vendor (CV) out of a diverse set of vendors. Typically, the healthcare industry 4.0 sees the issue as a large-scale group decision-making problem. Previous studies on a CV selection face certain challenges, such as (i) a lack of the ability to handle multiple users’ views, as well as experts’/users’ complex linguistic views; (ii) the confidence level associated with a view is not considered; (iii) the transformation of multiple users’ views into holistic data is lacking; and (iv) the systematic prioritization of CVs with minimum human intervention is a crucial task. Motivated by these challenges and circumventing them, a new big data-driven decision model is put forward in this paper. Initially, the data in the form of complex expressions are collected from multiple cloud users and are further transformed into a holistic decision matrix by adopting probabilistic linguistic information (PLI). PLI represents complex linguistic expressions along with the associated confidence levels. Later, a holistic decision matrix is formed with the missing values imputed by proposing an imputation algorithm. Furthermore, the criteria weights are determined by using a newly proposed mathematical model and partial information. Finally, the evaluation based on the distance from average solution (EDAS) approach is extended to PLI for the rational ranking of CVs. A real-time example of a CV selection for a healthcare center in India is exemplified so as to demonstrate the usefulness of the model, and the comparison reveals the merits and limitations of the model.

A Prospective Study to Find the Association of Astigmatism in Patients of Vernal Keratoconjunctivitis (VKC) in a Tertiary Health Care Centre in India (Vindhya Region MP)

Introduction: Vernal keratoconjunctivitis (VKC) /Spring catarrh is a chronic, bilateral, although it can occasionally present unilaterally1 at times asymmetrical, seasonally exacerbated, allergic inflammation of the ocular surface, involving the lids, conjunctiva (tarsal/bulbar), limbus and the cornea with periodic incidence of self-limited character mainly affecting patients in their first or second decade2 Aim: To conduct a prospective study to find the association of astigmatism in patients of vernal keratoconjunctivitis (VKC) in tertiary health care Centre. Material and Method: Hundred patients, age ranging between 5 and 20 years, with Vernal Keratoconjunctivitis (VKC) attending the ophthalmology out-patient department at tertiary health care centre, Rewa, M.P., India from January 2020 to June 2021 were included in the study. Detailed history including a record of age, sex, place of residence, age of onset of symptoms, seasonal variation, associated allergic or atopic history, best corrected visual acuity, refractive status and autorefractometry was noted, and each patient was thoroughly examined with slit lamp. Result: Vernal Keratoconjunctivitis (VKC) is found to affect young males76 (76%) more than females 24 (24%). Male: female 3:1. 80% patients were below 16 years of age, more in summer in the month of May and June. Itching was the commonest presentation 100 (100%). Palpebral 59 (59%) form of the VKC was predominant type of all three. Myopia 28 (28%) was the commonest refractive error followed by Hypermetropia 9 (9%) and Astigmatism 19 (19%). Amongst astigmatism maximum were having mixed type astigmatism, palpebral form was mostly associated with astigmatism. Conclusion: We found myopia to be the commonest refractive error in patients of Vernal Keratoconjunctivitis followed by hypermetropia and astigmatism. Chronic VKC was the commonest manifested stage. Palpebral Vernal Keratoconjunctivitis was the commonest clinical type.

The Clinical Diagnostic Utility of Array CGH in Children with Syndromic Microcephaly.

A prospective study using array CGH in children with Syndromic microcephaly from a tertiary pediatric healthcare centre in India. To identify the copy number variations causative of microcephaly detected through chromosomal array CGH. Of the 60 patients, 33 (55%) males and 27 (45%) females who consulted the Rare Disease Clinic at Department of Pediatrics, SMS Medical College, Jaipur, with developmental delay/facial dysmorphism/congenital anomalies in combination with microcephaly were included. Children with acquired or non-genetic causes of microcephaly, craniosynostosis, metabolic diseases, known chromosomal aneuploidy such as trisomy 21, 13, and 18 and abnormal karyotype were excluded. The cohort was analyzed by array CGH in order to identify potentially pathogenic copy number variants (CNVs). Clinically relevant pathogenic or likely pathogenic copy number variations (CNVs) were identified in 20/60 (33.3%) patients, variant of uncertain significance (VOUS) in 4/60 (6.6%) cases and benign CNVs in 3/60 (5%) of total cases. Out of 20 cases with pathogenic CNVs, 12 (60%) patients detected with a deletion, five (25%) patients with duplication and three (15%) patients resulted with a complex chromosomal rearrangement. Twelve cases present CNVs containing genes known to be implicated in microcephaly etiology. This research highlights the contribution of submicroscopic chromosomal changes in the etiology of microcephaly in combination with developmental delay/facial dysmorphism/congenital anomalies (syndromic microcephaly). Our studies provide more insights into the benefits derived by using array CGH analysis in patients with syndromic microcephaly.

Impact of topical moxifloxacin prophylaxis and povidone iodine on conjunctival bacterial flora in patients receiving intravitreal injections in a tertiary healthcare center in India.

To assess the efficacy of 3 days of topical moxifloxacin in combination with povidone-iodine (PVI) versus moxifloxacin/PVI alone in eliminating conjunctival bacterial flora in patients scheduled to undergo intravitreal injections (IVI). A prospective randomized comparative study in which 120 patients scheduled to undergo IVI at a tertiary care hospital in New Delhi were selected. Study patients were randomized into two groups. Both the groups received self-administration of moxifloxacin for 3 days prior to injection, except in Group B where it was preceded by PVI. Cultures were obtained at different time intervals, such as in Group A before and after applying moxifloxacin (for 3 days) and once again after applying PVI just before the procedure in the operating room, whereas in Group B first two samples were taken before and after applying PVI and the last sample was taken on the day of the procedure after 3 days of moxifloxacin application. A statistical significance was seen between moxifloxacin prophylaxis and resistant coagulase-negative Staphylococcus (CoNS) (P = 0.0001), which implies that frequent use of antibiotic prophylaxis will ultimately lead to the formation of resistant organisms in the conjunctival flora, especially when repeated IVI are given. We could not establish any additional benefits of topical moxifloxacin prophylaxis with regard to a reduction in conjunctival flora when compared with PVI 5%. PVI can be used as an efficient monotherapy in patients undergoing repeated IVI.

Pilot study on burden of fungal contamination in face masks: need for better mask hygiene in the COVID-19 era.

Risk factors which led to the outbreak of COVID-19 associated Mucormycosis still remains elusive. Face masks can become contaminated by fungal spores that are present ubiquitously in the environment. However the exact burden of such contamination is not known. Fifty masks of patients who attended the Employees Health Scheme COVID-19 facility of a tertiary healthcare centre in India were sampled by direct impression smears on Sabouraud Dextrose Agar. Agar plates were screened for any growth within five days after incubation. Growth was identified by microscopy on the Lactophenol Cotton Blue mount. Mask hygiene practices of participants was assessed using a pre-designed proforma. Out of 50 masks, fungal contamination was seen in 35/50 (70%) masks, with Aspergillus sp. being isolated from 26/50 (52%) masks and Mucorales being isolated from 9/50 (18%) of the masks. Aspergillus niger, Rhizopus a rrhizus and Syncephalastrum sp. were the most common species isolated. Same mask was worn for a median duration of 8 days (2-30 days) at a stretch with or without washing. Thirty one patients washed and re-wore their masks, with median time duration since last wash being 12 hours (4-72 hours). None of the factors assessed for mask hygiene were associated with fungal contamination. High rates of fungal contamination observed in our study emphasizes the need for better mask hygiene in the COVID-19 era.

Leukocyte morphological changes in COVID-19, a peripheral smear study and analysis at a tertiary health care centre in India

Context: Coronavirus disease 2019 (COVID-19) as the name depicts, a contagious disease caused by the coronavirus that emerged in the year 2019 December, at the Wuhan province in China. The knowledge on the pathogenesis of the disease at the cellular level to correlate with the clinical severity is still evolving. Various clinicopathological features and nature of the disease were gradually identified from those who were affected by the disease. Apart from the clinical presentation, certain investigations played a major role in diagnosing and assessing the severity of the disease. Morphological impact on blood cells was also caused by the severe acute respiratory syndrome-CoV-2 virus. Aim: Morphological analysis of leukocytes on blood samples of COVID19 patients. Settings and Design: Peripheral smear study of blood samples of COVID19 patients admitted at our tertiary care center. Subjects and Methods: Microscopic peripheral smear examination of leukocyte morphology on study samples. Statistical Analysis Used: All the data were recorded and analyzed statistically using Ms-Excel. Results: Our study demonstrated certain acquired pathogenic abnormalities of the leukocytes, that are acquired neutrophilic nuclear projections (ANNP), plasmacytoid lymphocytes, acquired Pelger-Huet anomaly (APHA), myeloid left shift, neutrophils with toxic granules and cytoplasmic vacuoles, and apoptotic cells. Conclusion: To summarize, in our study we observed similar features that were recorded in few studies earlier, such as APHA and plasmacytoid lymphocytes in convincing percentages among the COVID-19 patients in our population. Adding to these ANNP was one more prominent feature we encountered in majority of COVID-19 cases.

Factors responsible for difficult to treat superficial fungal infections: A study from a tertiary healthcare centre in India.

Recurrent and clinically unresponsive dermatophytosis is being increasingly observed in India. However, there is little information regarding the extent of the problem and the factors responsible for these difficult to treat superficial fungal infections. To identify factors contributing to difficult to treat recurrent superficial fungal infections. This prospective cross-sectional study enrolled 105 patients of all age groups presenting with either recurrent or long-standing dermatophyte infection attending the outpatient department of Dermatology, Venerology and Leprosy of Bharati Hospital, Pune, India, between September 2018 and March 2020. Patients were clinically examined, clinical history was taken and questions were asked regarding their current complaints and recorded in a proforma. Data were analysed using the SPSS software package. The males outnumbered females (74.3% vs 25.7%). A strong association was observed between the presence of past history and duration of disease (p=.007). The association of use of topical steroids or keratolytic agents with the duration of disease was statistically significant (p=.022). There was a statistically significant inverse association of duration of disease with dermatologist consultation (p<.001). The association between consultation with non-dermatologist and the duration of disease was statistically significant (p=.035). Hyperhidrosis, obesity, positive family history, tight clothing and chronic diseases may be considered important factors in acquiring dermatophytic infection. However, when it comes to difficult to treat tinea infections, irrational usage of topical steroids, treatment from non-dermatologists and a past history of tinea appear to be more critical causative factors. Treatment of dermatophytosis by dermatologists/ trained physicians and increasing general awareness of the public regarding the current situation about tinea in the country would help to alleviate the current crisis.

Providers' perspectives on the performance of primary healthcare centres in India: The missing link.

BackgroundPrimary healthcare centres (PHCs) form the foundation of the Indian public health system, and thus their effective functioning is paramount in ensuring the population's health. The World Health Organisation (WHO) has set six aspects of performance assessment for general health systems, which are hardly applicable to the PHC setup in a low‐ and middle‐income country. The Primary Health Care Performance Initiative (PHCPI) has prescribed a framework with five domains consisting of 36 indicators for primary healthcare performance assessment from a policy point of view. For the assessment to be realistic, it should include inputs from stakeholders involved in care delivery, so this study examines the perspectives of healthcare providers at PHCs in India.MethodologyThe authors used qualitative research methodology in the form of responsive evaluations of healthcare provider's interviews to understand the indicators of PHC performance.Results and ConclusionThe study results showed that healthcare providers considered efficient teamwork, opportunities for enhancing provider skills and knowledge, job satisfaction, effective PHC administration, and good community relationship as PHC performance assessment. These domains of performance could be considered the ‘missing link’ in PHC assessment, since they are deemed important by providers and did not coincide with the WHO aspects and the PHCPI performance assessment framework.

Machine learning–based heart disease prediction system for Indian population: An exploratory study done in South India

BackgroundIn India, huge mortality occurs due to cardiovascular diseases (CVDs) as these diseases are not diagnosed in early stages. Machine learning (ML) algorithms can be used to build efficient and economical prediction system for early diagnosis of CVDs in India. MethodsA total of 1670 anonymized medical records were collected from a tertiary hospital in South India. Seventy percent of the collected data were used to train the prediction system. Five state-of-the-art ML algorithms (k-Nearest Neighbours, Naïve Bayes, Logistic Regression, AdaBoost and Random Forest [RF]) were applied using Python programming language to develop the prediction system. The performance was evaluated over remaining 30% of data. The prediction system was later deployed in the cloud for easy accessibility via Internet. ResultsML effectively predicted the risk of heart disease. The best performing (RF) prediction system correctly classified 470 out of 501 medical records thus attaining a diagnostic accuracy of 93.8%. Sensitivity and specificity were observed to be 92.8% and 94.6%, respectively. The prediction system attained positive predictive value of 94% and negative predictive value of 93.6%. The prediction model developed in this study can be accessed at http://das.southeastasia.cloudapp.azure.com/predict/ ConclusionsML-based prediction system developed in this study performs well in early diagnosis of CVDs and can be accessed via Internet. This study offers promising results suggesting potential use of ML-based heart disease prediction system as a screening tool to diagnose heart diseases in primary healthcare centres in India, which would otherwise get undetected.

Cutaneous Sarcoidosis: A Retrospective Clinico-Pathological Study from the Indian Subcontinent in Patients Attending a Tertiary Health Care Centre.

Context:Sarcoidosis is a systemic disorder characterized histologically by noncaseating granulomas. There is paucity of Indian data on cutaneous sarcoidosis.Aims:To describe the clinical, histopathological findings, and extracutaneous involvement in cutaneous sarcoidosis.Materials and Methods:A retrospective study was done in patients of cutaneous sarcoidosis who had attended the dermatology clinic of a tertiary health care center in India from May 2009 to April 2015. The clinical details, histopathological findings, treatment, and response were reviewed.Results:There were 38 patients with cutaneous sarcoidosis. Mean age was 48 ± 13 years; 58% were female. Median duration of disease was 11 months (IQR 4–48 months). More than one morphology was seen in 28.9%, commonest being plaques (65.7%), and papules (50%). Erythema nodosum was rare. More than one site was involved in 55.3%, most commonly trunk (52.6%). Six patients had isolated cutaneous sarcoidosis. Commonest extracutaneous organs involved were lung (73.7%) and lymph nodes (68.4%). Histopathologically, classical naked sarcoidal granulomas were found in only 55.3%. Angiotensin converting enzyme (ACE) levels were elevated in 74.3% (26/35) with significant association with extracutaneous disease. Treatment included topical and/or systemic corticosteroids, hydroxychloroquine, and tacrolimus.Statistics:Pearson's Chi-square test was done to analyze associations between the skin lesions, ACE levels, and systemic involvement; P < 0.05 was considered significant.Conclusions:Cutaneous manifestations of sarcoidosis are varied, commonest being erythematous plaques. Even though most patients had systemic involvement, we found no significant association of the type and number of skin lesions with extracutaneous involvement or prognosis. Elevated ACE levels were significantly associated with systemic involvement.

A Prospective Study to Evaluate BISAP Score in Acute Pancreatitis

Introduction: Acute Pancreatitis (AP) is among leading cause of acute abdomen in the study institution. There is a need of simple criteria to stratify patients in Emergency Department. The Bedside Index for Severity in Acute Pancreatitis (BISAP) score is one such score. Aim: This study evaluates the BISAP score to predict organ failure, pancreatic necrosis and moderately severe/severe AP in tertiary health care center in India and promote its use. Materials and Methods: This prospective observational study was conducted on 50 consecutive patients diagnosed as AP from May 2019 to April 2020 and admitted in Emergency Department of DMC Hospital, Ludhiana, India. BISAP score was calculated based on data obtained within 24 hours of hospitalisation. Severity of AP was defined according to the Revised Atlanta Classification, 2012. Organ failure was defined using the Modified Marshall scoring system. Data was expressed in terms of median, frequencies (number of cases) and relative frequencies (percentages); range; mean±Standard Deviation (±SD). All statistical calculations were done in Microsoft Windows Statistical Package for the Social Science (SPSS) version 21.0. Results: The leading cause of AP in present study is gall stones, with maximum 26 (52%) cases. Second most common cause is alcohol with 11 (22%) cases. Systemic Inflammatory Response Syndrome (SIRS) is the most common component of BISAP score, present in 47 (94%) cases. Pancreatic necrosis present in 12 (24%) cases. Incidence of pancreatic necrosis rises at score ≥3 which is statistically significant (p-value- 0.008). Transient organ failure was present in 14 (28%) cases, persistent organ failure was present in 9 (18%) cases and 27 (54%) cases had no organ failure. At score ≥3, there is increased risk of organ failure and it is statistically significant (p-value ≤0.001). There are 27 (54%) mild, 14 (28%) moderately severe and 9 (18%) severe cases of AP. At score ≥3, there is increased risk of moderately severe and severe pancreatitis and it is statistically significant (p-value ≤0.001). Conclusion: There is statistically significant trend of increasing incidence of organ failure, pancreatic necrosis and moderately severe/severe AP at BISAP score ≥3. Thus, BISAP score is simple yet accurate scoring system to improve early risk stratification in AP.

A clinico-epidemiological study of hearing loss in adult patients presenting to a tertiary healthcare center in India

Background: The objectives of the study are: 1. To determine the profile of patients presenting with hearing loss. 2. To determine the causes of hearing loss in adult patients of various age groups. The cases for the study comprised of adult patients aged &gt;/=20years, presenting to the ENT Out-patient Department with complaint of hearing loss. Detailed history thorough ENT examination including Examination of the ear, nose and throat with Bull’s eye lamp, Otoscopic/Otomicroscopic/Otoendoscopic examination with photo-documentation of the ear status when required, tuning fork tests, and a battery of audiological tests including pure-tone audiometry, impedance audiometry and Brain-stem Evoked Response audiometry (when required) were conducted and the reports of the same were enclosed with the Pro forma of the patients. Results and Discussion: Hearing loss is more common in old age and more male patients presented with hearing loss. The most common symptom seen with hearing loss was tinnitus which was commonly ringing type and this was commonly seen in older patients associated with sensori-neural hearing loss. The most common type of hearing loss was sensori-neural hearing loss seen more commonly in older patients and associated with tinnitus. The definitive diagnosis for patients with sensori-neural hearing loss was difficult to specify with the most common diagnosis being presbyacusis, followed by noise induced hearing loss. The second common diagnosis was Chronic Otitis Media(COM).

Antipsychotic Drug Induced Tardive Dyskinesia

A typical antipsychotics are at a lower risk of developing extra-pyramidal symptoms (EPS). But now, atypical antipsychotics are increasingly being associated with neurological side effects such as tardive dyskinesia, tardive dystonia, akinesia, parkinsonism, akathisia, bradykinesia, tremor etc. in which one of the major cases reported is Olanzapine induced tardive dyskinesia (TD). Schooler and Kane criteria is used for diagnosing tardive dyskinesia. Many cases have been published on this particular drug-induced side effect. In many instances tardive dyskinesia is misdiagnosed as tardive dystonia. Here we report the case of tardive dyskinesia associated with the use of antipsychotic drugs in a 50-year-old adult male suffering from persistent delusional disorder in a tertiary health care centre in India. The patient was on Olanzapine therapy for more than 2 years. Upon recurrent episodes of somatic delusions, Olanzapine dose was increased. When the patient developed symptoms of TD, the dose of Olanzapine was de-escalated. Even though the drug dose was reduced, the symptoms persisted which lead to the diagnosis of olanzapine induced TD. Based on this, Olanzapine was stopped and Clozapine treatment was initiated. On follow up, the patient was found to be relieved of the symptoms and complete recovery was achieved after 2 months of clozapine treatment.

Risk Stratification as a Tool to Rationalize Quarantine of Health Care Workers Exposed to COVID-19 Cases: Evidence From a Tertiary Health Care Center in India.

Quarantine of health care workers (HCWs) exposed to COVID-19-confirmed cases is a well-known strategy for limiting the transmission of infection. However, during a pandemic situation in a resource-constraint setting, we require an evidence-based guideline for quarantining HCWs. We developed an algorithm for exposure-based risk stratification and quarantine of HCWs. We did contact tracing and risk stratification of 3853 HCWs, of whom 560 (14.5%) were categorized as high-risk contacts. High-risk contacts were quarantined for 14 days and underwent testing for COVID-19, while low-risk contacts continued their work with adherence to physical distancing, hand hygiene, appropriate use of personal protective equipment, and self-monitoring of symptoms. Overall, 118 (3.1%) contacts tested positive for COVID-19. The positivity rate among high-risk contacts was 7.1% (95% confidence interval = 5.2-9.6). Our strategy of risk stratification prevented 3215 HCWs from being quarantined and thus saved 45 010 person-days of health workforce in the institution.

Quantitative assessment of crural closure for laparoscopic anti-reflux surgeries: A novel technique to reduce post-operative dysphagia.

Background:Long-term dysphagia is a known complication of laparoscopic anti-reflux surgery (LARS). Of the several factors, inadequate hiatal closure is one of the major reasons for its occurrence. The aim of this study is to develop a technique for the quantitative assessment of crural closure during LARS to reduce dysphagia.Materials and Methods:It is an analysis of prospectively collected data of 109 patients who underwent LARS at a tertiary healthcare centre in India. To identify the adequacy of hiatal closure intraoperatively, a 7 French Fogarty catheter was used, and its balloon was inflated with 1 cc air at the repaired hiatus. This inflated balloon in the repaired hiatus following cruroplasty gives an accurate quantitative assessment of the adequate closure and adequate space for food bolus to pass without causing mechanical obstruction after hiatus repair. Pre- and post-operative 12 months’ DeMeester scores and lower oesophageal sphincter (LES) pressures were calculated.Results:The patients had a significant reduction in DeMeester scores postoperatively from a mean of 68.5–12.3 (P < 0.0001). None of the patients had long-term dysphagia or the need for long-term proton-pump inhibitors. The mean LES pressures on post-operative manometry showed increase to 15.1 mmHg from a mean of 6.4 mmHg, which was statistically significant (P = 0.0001). None of the patients had a recurrence of hiatus hernia.Conclusion:Quantitative assessment of adequacy for crural closure during LARS using a 7 French Fogarty catheter balloon is a novel technique which may decrease the incidence of post-operative dysphagia or intrathoracic wrap migration or recurrence of hiatus hernia.