Hospital-based Prospective Study Research Articles

Thrombocytopenia in Plasmodium vivax Malaria: A Report from a Sub-zonal Hospital in Western Rajasthan

Abstract Background: Malaria continues to be a major public health problem in India. Vivax malaria is being increasingly seen with thrombocytopenia. The reported prevalence of the same has been extremely variable and its significance is not well established. This study was conducted to ascertain the prevalence and severity of thrombocytopenia in vivax malaria and assess the outcome of cases with severe thrombocytopenia. A secondary objective was to compare the clinical and laboratory profile of cases of vivax malaria with falciparum malaria and mixed infection. Materials and Methods: This hospital-based prospective study was carried out in the department of general medicine at a sub-zonal hospital in Western Rajasthan in the year 2022. Consecutive febrile patients with a diagnosis of malaria were included in the study after ruling out coexistent alternate infections. Results: A total of 396 cases were enrolled. Ninety-nine percent of patients were male. The mean age of the study group was 32.1 years. A total of 328 (90.8%) out of 361 vivax malaria cases had thrombocytopenia (platelet count <150 × 103 μL) with 26.5% having severe thrombocytopenia (platelet count <50 × 103 μL). The mean defervescence duration was 44.4 h in vivax malaria. 3.4% of severe vivax malaria cases required intensive care unit care due to hypotension, respiratory distress, and multiorgan dysfunction, and none of them had any bleeding manifestations. All cases recovered well after standard treatment. There was a significant statistical difference between the mean platelet count among the three types of malaria: vivax, falciparum, and mixed (vivax + falciparum infections) (P = 0.03). Similarly, on applying Chi-square test, there was a significant difference in severe thrombocytopenia across the groups (P = 0.01). Conclusion: There is a high prevalence of thrombocytopenia in vivax malaria including severe thrombocytopenia. In the majority of cases, this thrombocytopenia does not result in any adverse event, and cases respond well to conventional treatment. Clinicians need to be aware of the extent and severity of thrombocytopenia in vivax malaria and rule out this treatable condition in endemic areas with a high prevalence of other coexistent infections causing thrombocytopenia.

Utilization of blood and blood components in the department of clinical hematology of a tertiary care hospital: A prospective hospital-based study

Background: To have proper utilization of blood and its components adherence to established guidelines is essential. Hence, periodic review of blood components is necessary to improve transfusion practices and decrease the inappropriateness of blood components. Aims and Objectives: Our study aims to assess the utilization and appropriateness of blood and blood components in the Department of Clinical Hematology SKIMS, Soura, Srinagar. Materials and Methods: This prospective observational study was conducted in the Department of Blood Transfusion and Immunohematology, SKIMS, Soura, Srinagar, over a period of 1 year from August 2020 to July 2021 on patients admitted in Clinical Hematology requiring transfusion therapy. The number of all blood and blood component units supplied over a period of 1 year was assessed. The usage of different types of blood component was recorded and correlated with the patient’s diagnosis and indications for transfusion. Results: A total of 250 patients were transfused with 2099 blood and blood components, among them 64.32% (1350) units were used appropriately and 35.68% (749) units were used inappropriately. Transfusions of packed red blood cells were found to be inappropriate in patients with asymptomatic chronic anemia with Hemoglobin >7 g/dL. Fresh frozen plasma was given inappropriately in cases of bleeding without derangement of coagulation tests. Inappropriate use of platelets was seen in patients who had received platelets prophylactically with platelet count above 10,000/μL. Conclusion: Proper implementation of guidelines for the use of various blood components would help reduce their inappropriateness.

A study of non-invasive predictors of esophageal varices in patients with cirrhosis of liver – A cross-sectional study

Background: Current guidelines advise that patients diagnosed with liver cirrhosis undergo screening through upper gastrointestinal endoscopy to detect esophageal varices (EV). Prophylactic measures should be taken for those with large varices on diagnosis and during follow-up. However, this poses a dual challenge, both social and medical, as the number of cirrhotic patients rises while the availability of endoscopy units remains limited. Aims and Objectives: In this study, we aim to evaluate the diagnostic accuracy of the non-invasive predictors such as spleen size, platelet count (PC), and PC/spleen diameter (PC/SD) ratio for the diagnosis of EV. Materials and Methods: This hospital-based prospective observational study was done in the SDM College of Medical Sciences and Hospital, Dharwad, among 50 patients with cirrhosis of liver. Results: Among the 50 patients studied males pre-dominated the study with 80%. Out of the study population, 70% of the patients had varices. For a cutoff point of PC/SD ratio 916, the sensitivity was 71.42% and specificity was 93.3%. For a cutoff value of PC of 1.32 lakhs, the sensitivity was 71.42%, and the specificity was 73.3%. For a cutoff value of the longest SD of 12.40 cm, the sensitivity was 94.30%, and specificity was 33.3%. Conclusion: These non-invasive predictors can be useful screening tools for the diagnosis of EV. These can be effective for the initiation of prophylactic treatment when the endoscopy facility is not available.

Mode of Transport and Patient Status Upon Arrival at a Tertiary Pediatric Emergency Department in a Developing Country: A Prospective Observational Study.

Introduction In children with acute illness or injury, timely access to healthcare is crucial for optimal outcomes, including early identification, prompt stabilization, and appropriate referral. Prehospital transport practices often represent a weak link in the system and are frequently underreported. Enhancing these practices could greatly benefit pediatric care. This study aims to analyze the mode of transport and condition upon arrival of children at our hospital's pediatric emergency department. Methods This hospital-based prospective observational study was conducted from August 2019 to March 2020. Data on referral status, mode of transport, vital parameters at admission, and final outcomes in terms of survival were collected prospectively from patient admission records. Results Out of 1,658 children, 1,326 (80%) were referred from another health facility. Among these, only 10.8% received prior notification about their arrival. The most common mode of transport was a bus (39.3%), followed by locally available ambulances (24.4%), two-wheelers (15.6%), and cars (10.9%). In terms of medical conditions, 47.5% of the children had respiratory infections, 15.8% had renal ailments, and 14.1% had neurological complaints. Upon arrival, 1,214 (73.2%) were in stable condition, while 444 (26.8%) were unstable. Common alterations in vital parameters included hypothermia (16.6%), SpO2 <92% (9.9%), abnormal heart rate (32.5%), and abnormal respiratory rate (56%). Additionally, 111 (6.6%) children required CPR upon arrival. Conclusions The data highlights the need for improvements in our referral systems and the modes of transport for sick children within our population.

Evaluation of Diagnostic Methods and Rifampicin Resistance in Pulmonary Tuberculosis: A Hospital-Based Study.

Background Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis, predominantly affecting the lungs (pulmonary TB) and is a significant public health challenge in India. The study aims to analyze demographic, radiological, and clinical subgroups of pulmonary TB cases, examine the relationship between smear acid-fast bacillus (AFB examination) and cartridge-based nucleic acid amplification test (CBNAAT), evaluate CBNAAT sensitivity for Mycobacterium tuberculosis (MTB) in new and previously treated patients, and determine the proportion of rifampicin resistance. Methods This hospital-based prospective study was conducted among patients diagnosed with pulmonary TB at the Respiratory Medicine Department of a Government Hospital over 16 months (August 2019 to December 2020). The study included 150 diagnosed TB cases (new and previously treated). Data collection encompassed demographic details, clinical symptoms, comorbidities, radiological findings (chest X-ray), and microbiological results (smear AFB examination, CBNAAT). Sputum samples were subjected to Ziehl-Neelsen staining and CBNAAT for MTB detection and rifampicin resistance testing. Statistical analysis was performed using IBM SPSS Statistics version 21.0 (IBM Corp., Armonk, NY, USA). Results Of the 150 patients, 69.3% were male, and 48% were aged 21-40 years. The majority had a BMI of 18.5-24.9 kg/m² (50%) and resided in urban areas (63.3%). Common symptoms included cough (95.3%), fever (80%), and weight loss (74%). Cavitary lesions on chest X-ray were observed in 84% of patients. Smear microscopy detected MTB in 72.7% of cases, while CBNAAT detected MTB in 94% of cases. CBNAAT sensitivity for smear-positive and smear-negative samples was 93.97% and 94.12%, respectively. Rifampicin resistance was found in 3% of new cases and 6% of previously treated cases. The sensitivity of smear microscopy was 77.33%, and the sensitivity of CBNAAT was 94%. Conclusion The study underscores the high burden of pulmonary TB and the utility of CBNAAT in detecting MTB and rifampicin resistance, particularly in smear-negative samples. The findings highlight the necessity of universal drug susceptibility testing (DST) for effective TB management and the importance of addressing drug resistance to improve treatment outcomes.

The Role of 20% Ethanol in Enhancing Pterygium Surgery Outcomes: A Clinical Study.

Introduction Pterygium is an ocular surface disorder characterized by a hyperplastic growth of conjunctiva encroaching over the cornea. It causes redness, watering, and foreign body sensation. Surgical excision is the preferred mode of treatment when there is encroachment over the visual axis, chronic irritation, restricted ocular motility, and cosmetic concerns. Various surgical methods have been adopted for the treatment and to prevent recurrences. This study assessed the effectiveness and safety of 20% ethanol as an adjuvant in pterygium excision with conjunctival autograft implantation, evaluating surgical outcomes. Methods A prospective hospital-based interventional study was conducted among 30 patients with pterygium from August 2022 to December 2023. Patients were evaluated preoperatively for anterior segment, posterior segment, visual acuity, and corneal astigmatism. Pterygium was excised using 20% ethanol as an adjuvant, and conjunctival autograft was placed over the bare sclera without sutures. Patients were evaluated on postoperative days 1, 8, 30, and 90 for graft condition, visual acuity, corneal astigmatism, and associated complications. Results After three months of follow-up, the mean visual acuity improved to LogMAR 0.46±0.35 (p=0.001), which was statistically significant, and the average corneal astigmatism decreased from 3.36±2.87 to 0.87±0.57 (p=0.0001). No recurrence was noted among the participants. Conclusion This study has shown that using 20% ethanol as an adjuvant for pterygium excision facilitated clean dissection of a pterygium from the underlying cornea and the pterygium-induced corneal astigmatism has significantly decreased, which led to progress in vision.

Diagnostic accuracy of cerebroplacental ratio in anticipating adverse perinatal outcome in uncomplicated appropriate for gestational age pregnancies at term

Abstract Introduction: Anticipating which babies are in danger of experiencing poor outcomes during the perinatal period in uncomplicated appropriate for gestational age (AGA) pregnancies at term is difficult in obstetric practice. Cerebroplacental ratio (CPR) is emerging as a significant indicator of negative perinatal results. The current study sought to establish how effective CPR is in predicting negative perinatal outcomes in term uncomplicated AGA pregnancies. Materials and Methods: This study was a hospital-based prospective observational cohort study conducted at a single center. Patients were chosen depending on different criteria for inclusion and exclusion. A prenatal ultrasound with a color Doppler scan was carried out to calculate CPR. Patients were grouped according to their last CPR measurement before delivery into either normal CPR or pathological CPR categories. Doppler results did not impact clinical decisions and delivery followed institutional protocols. After childbirth, data on the outcome of the perinatal period were obtained from the patients’ medical records. Negative perinatal outcomes were assessed through the delivery method, APGAR score, perinatal morbidity, and perinatal mortality. These outcomes were correlated with CPR. Results: The research included 605 women, separated into normal and pathological CPR groups. Of these, 153 (25.3%) were classified in the pathological CPR category, whereas 452 (74.7%) exhibited normal CPR. In our study, there were 138 patients who experienced adverse perinatal outcomes in the pathological CPR group, whereas 44 patients had such outcomes in the normal CPR group. The diagnostic accuracy of pathological CPR to predict any negative perinatal result was 90.25%. Conclusions: CPR shows potential in detecting fetuses at risk in full-term uncomplicated AGA pregnancies.

Efficacy of Low-Molecular-Weight Heparin in the Treatment of Severe Acute Pancreatitis: A Comparative Study at a Tertiary Health Center.

Introduction Acute pancreatitis is caused by multiple factors. The disease can progress to severe acute pancreatitis (SAP) rapidly, which is a fatal condition. SAP is associated with systemic inflammatory response and disturbances in microcirculation, which are responsible for the high rate of mortality. Low-molecular-weight heparin (LMWH), apart from preventing thrombus formation, also has a property of reducing the release of cytokines and inflammatory mediators. This aids in the improvement of microcirculation of the pancreas. Materials and methods A prospective hospital-based study was conducted on 60 patients diagnosed with SAP. Patients were randomly divided into two groups: conventional treatment group (C group consisting of 30 patients) and LMWH in addition to conventional treatment (L group, consisting of 30 patients). Clinical and laboratory parameters and computed tomography (CT) scores of pancreatic necrosis (CTSPN) were compared in the two study groups. Results No significant difference (p > 0.05) was observed in the clinical and laboratory parameters and CTSPN among the two study groups at the time of admission. On initiation of treatment, the rate of improvement in symptoms and laboratory parameters were significantly higher in the L group compared with the C group (p < 0.05). Acute physiology and chronic health evaluation (APACHE) II score and development of complications were significantly lower in the L group compared with the C group (p< 0.05). CTSPN was found to be very low in the L group compared with the C group (p < 0.05). After two weeks of treatment, the recovery rate in response to treatment was observed to be higher in the L group compared to the C group, and the mortality rate was very low in the L group (p <0.05, significant). Conclusion The addition of LMWH to conventional treatment in SAP augments the effect and improves the clinical response, improving the recovery rate and decreasing mortality. LMWH is highly effective for the treatment of SAP, with a good safety profile and easy availability and without high financial burden.

Natural course and predictors of consciousness recovery in children with prolonged disorder of consciousness

Prolonged disorder of consciousness (DoC) is a rising challenge. Pediatric data on diagnosis and prognosis of prolonged DoC were too limited and heterogeneous, making it difficult to define the natural course and evaluate the prognosis. The present study explored the emergence from the Minimally Conscious State (eMCS) incidence at different months postinjury drawing the natural course, and detected the predictors of the incidence in children with prolonged DoC. A hospital-based prospective cohort study was conducted. Kaplan–Meier curves, as well as univariate and multivariate COX regression analysis, were performed. The study enrolled 383 pediatric DoC individuals, including 220 males (57.4%), with an average age of 3.9 (1.9–7.3) years. The median duration between onset and rehabilitation is 30.0 (21.0–46.0) days. At enrollment, the ratio of vegetative state/unresponsive wakefulness syndrome (VS/WUS) to MCS is 78.9%–21.1%. Traumatic brain injury and infection are the major etiologies (36.8% and 37.1%, respectively), followed by hypoxia cerebral injury (12.3%). For children with prolonged DoC, the cumulative incidence of eMCS at months 3, 6, 12, and 24 was 0.510, 0.652, 0.731, 0.784 VS 0.290, 0.418, 0.539, 0.603 in the traumatic VS non-traumatic subgroup, respectively. For children in a persistent vegetative state (PVS), the cumulative incidence of emergence at months in 3, 6, 12, 24, 36 and 48 was testified as 0.439, 0.591, 0.683, 0.724, 0.743 and 0.743 in the traumatic subgroup, and 0.204, 0.349, 0.469, 0.534, 0.589 and 0.620 in the non-traumatic subgroup. Participants who exhibit any of the following four demographical and/or clinical characteristics—namely, older than 4 years at onset, accepted rehabilitation within 28 days of onset, remained MCS at enrollment, or with etiology of traumatic brain injuries—had a significantly positive outcome of consciousness recovery (eMCS). Moreover, both prolongation of the central somatosensory conductive time (CCT) (level 2) and absence of N20 (level 3) independently predict a negative outcome. In children with prolonged DoC, we found that 12 months postinjury was critical to eMCS, and a preferred timepoint to define chronic vegetative state (VS). The characteristics including age, etiology, time before rehabilitation, consciousness state, and SEP results were useful predictors of conscious recovery.Trial registration Registered 06/11/2018, the registration number is chiCTR1800019330 (chictr.org.cn). Registered prospectively.

Neonatal sepsis-a peek into our findings in Northwest Nigeria: a prospective study

BackgroundNeonatal sepsis is still a global health concern as it contributes to a high burden of neonatal morbidity and mortality especially in developing countries. The aim of the study is to give an insight into neonatal sepsis: risk factors, sepsis types, clinical features, pathogen burden with their antibiotic sensitivities, and outcome of admission in our facility. The study was a prospective hospital-based study conducted over 10 months, October 2018–July 2019.ResultOf the 248 term neonates with features of sepsis enrolled in the study 94 (37.9%) were confirmed to have sepsis. Late-onset sepsis LOS (68%) was found to be the most common, and most of the neonates were delivered elsewhere. Clinical features were non-specific for both early-onset (EOS) and LOS and include fever, jaundice, poor suck, and depressed primitive reflexes. Infections were mostly caused by gram-negative bacteria, and while Staphylococcus aureus was the single most common isolate for both EOS and LOS. Antibiotic sensitivity was highest with ciprofloxacin for both EOS and LOS. Mortality was high at 14.9% and was mostly contributed to by Staphylococcus aureus infection.ConclusionNeonatal sepsis is still a burden with mostly non-specific clinical features. The local prevalent organisms were Staphylococcus aureus, Enterobacter agglomerans and Klebsiella pneumonia with good antibiotic susceptibility to ciprofloxacin. Most presented with late-onset sepsis and therefore infection is likely to be community-acquired which to a great extent can be prevented with robust public health interventions.

Comparative analysis of computed tomography severity indices in predicting the severity and clinical outcome in patients with acute pancreatitis.

Background: Acute pancreatitis (AP) has unpredictable severity. Its management is based on initial assessment of disease severity. It ranges from mild interstitial to severe necrotic form; the latter is associated with poor prognosis. Contrast-enhanced computed tomography (CT) of the abdomen is the gold standard in early detection of pancreatic necrosis and inassessing the severity ofAP. Two CTgrading systems exist to assess theseverity of AP: CT severity Index (CSI) and modified CSI (MCSI). This study compares the usefulness of these two systems in predicting theseverity and clinical outcome in AP in comparisonwith Ranson's criteria and clinical outcome parameters. Methods: This is a prospective hospital-based screening study of 80 patients aged >12 years with clinical diagnosis of AP who underwent contrast-enhanced CT study of the abdomen. Comparative analysis between MCSI and CSI with Ranson's criteria and clinical outcome parameters was assessed by Chi-Squared test. Results: The accuracy ofCSI and MCSI in predicting the requirement of critical care, superadded infection, multiple organ dysfunction syndrome (MODS) and requirement of intervention were 73.0%, 64.5%, 69.8% 60.9% and 77.2%, 76.0%, 74.4% & 56.6% respectively. Area under the curve for MCSI score was significantly higher (AUC: 0.861; 95% CI: 0.736-0.986) than CSI score (AUC:0.815;95% CI:0.749-0.941). MCSI and CSI showed significant correlation with Ranson's criteria; however, MCSI correlation was better (r:0.53; p<0.01) than CSI (r:0.35;p:0.04). Conclusion: CSI and MCSI are better predictors of severity, clinical outcome and mortality compared with Ranson's criteria, with MCSI being more accurate and better predictor than CSI. The accuracy of MCSI is better than CSI for prediction of requirement of critical care, development of superadded infection and development of MODS in AP. However, CSI and MCSI have low accuracy in predicting intervention in AP.

Periconceptional maternal supplement intake and human embryonic growth, development, and birth outcomes: the Rotterdam Periconception Cohort.

Is periconceptional multiple-micronutrient supplement (MMS) use including folic acid (FA) compared to FA use only associated with increased embryonic growth, development, and birth weight in a high-risk population? Women with MMS intake show no significant differences in first-trimester morphological embryo development, but increased first-trimester embryonic growth trajectories and fewer neonates born small for gestational age (SGA), less than the 3rd percentile (<p3), compared to women using only FA. Periconceptional maternal FA intake in the general population is associated with increased embryonic and fetal growth, and reduced risks of neural tube defects, other congenital malformations, low birth weight, and neonates born SGA. A prospective tertiary hospital-based cohort study (the Rotterdam Periconceptional Cohort) was conducted from January 2010 to December 2020. We included 1076 women from the Rotterdam Periconceptional Cohort, before 10 weeks of pregnancy with follow-up until delivery. Embryonic growth was assessed by measurement of crown-rump length (CRL) and embryonic volume (EV), and embryonic morphology was described by Carnegie stages using longitudinal three-dimensional ultrasound scans and virtual reality techniques. Birth outcomes were extracted from medical records. General characteristics and supplement use were extracted from research questionnaires. This study showed increased embryonic growth trajectories (adjusted models, CRL: β = 0.052, 95% CI 0.012-0.090, EV: β = 0.022, 95% CI 0.002-0.042) in women using MMS compared to those using only FA. Moreover, a 45% reduced risk of a neonate-born SGA (<p3) was shown in women using MMS compared to FA users (adjusted OR = 0.546, 95% CI 0.308, 0.969). Embryonic morphological development (Carnegie stages) and the occurrence of miscarriages did not differ between women using MMS or solely FA. Following the heterogeneity of the composition and dose of MMS preparations, it is unclear which specific micronutrient, combination, or dose explains the increased embryonic growth trajectory and reduction in risk for SGA. This also hampers the possibility of differentiating between the effects of FA alone or as a component of MMS. Our findings emphasize the importance of periconceptional maternal MMS use as a potential preventative intervention against reduced embryonic growth and neonates born SGA. Therefore, we recommend the periconceptional use of MMS in women at risk of inadequate micronutrient intake. However, awareness of potentially harmful side effects of high doses and combinations of micronutrients is essential, therefore the optimal composition and dose need to be investigated, and careful surveillance is recommended. This research was funded by the Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands, and the ZonMw grant Open Competition 2018 (09120011910046). The authors declare that they have no conflict of interest. NTR4356.

Clinical Study and Management of Epistaxis.

Epistaxis is the most common emergency in otorhinolaryngology affecting up to 60% of the population in their lifetime. There are various local and systemic cause and includes both medical and surgical management. This study has been undertaken to study various etiopathogenesis and management of epistaxis. This is a prospective hospital-based study conducted on 100 patients of all age groups and both genders presenting with epistaxis to the Department of Otorhinolaryngology both on outpatient and inpatient basis. A detailed history taking with clinical examination is done. Data is entered in a structured performa, master chart prepared and is subjected to statistical analysis by SPSS software version 23. The most common age group was first decade (26%) followed by fourth decade (15%) with male (71%) predominance. Anterior epistaxis (87%) and bilateral nasal cavity involvement (65%) was predominantly seen. Most common causes for epistaxis are trauma (20%) followed by nasal infections (18%) and hypertension (17%). Majority of the patients underwent medical line of treatment (80%) followed by anterior nasal packing (12%), surgical intervention (7%), posterior nasal packing (1%). Epistaxis needs immediate restoration of hemodynamic parameters with first aid, airway assessment and control of bleeding. Majority of the cases were managed conservatively which is safe and cost effective method. Patients should be advised to avoid strenuous activity, nose picking and vigorous nose blowing. Severe recurrent epistaxis needed invasive interventions like nasal packing and blood transfusion.

Cleft Lip Surgery in Sudan: Clinical Presentations, Early Outcomes, and Patient and Professional Satisfaction: A sub-Saharan African experience

BackgroundCleft lip and palate are the most common congenital craniofacial anomalies. They account for approximately 13% of all congenital anomalies. ObjectivesTo study the presentation of cleft lip and the early results of surgical repair among patients who presented to our centers. MethodsThis was a hospital-based prospective cohort study of 72 patients who underwent cleft lip repair in Sudan. ResultsThe commonest age group was between 10–18 months. The male-to-female ratio was 2:1, and a family history of cleft lip was found in 2.8% of patients. The cleft lip was complete in 81.9%, incomplete in 12.5%, and hybrid in 5.6% of patients. Associated cleft palate was observed in 54 patients. Associated syndromes were found in 10 patients. The surgery was carried out in most patients at 9 months or less; in 4 patients, it was more than 18 months. Achievement of reasonable lip repair was moderate (50% collectively). High achievement was observed for criteria, such as accurate union (90.3%), and sub-moderate achievement in even vermillion border and cupid's bow (44%), low nose symmetry (30.6%), and quality of scar (18.1%). Early complications were reported at the rate of 13.9%. Patient satisfaction was 59.7%; however, the professionals showed higher satisfaction levels (66.7%). The anthropometric measurements of normal infants were moderately similar to those of the infants who underwent surgery. ConclusionThe patients with cleft lip showed early presentation, with a predominance of the male gender and left side pattern. The preliminary outcome of cleft lip repair was moderate, with variations in different criteria. Patient and professional satisfaction were above average.

Clinico-microbiological evaluation of post-cesarean surgical site infections

Objectives: With increasing rates of cesarean section (CS), the incidence of post-operative complications is bound to increase, which includes surgical site infections (SSIs), being one of the common and distressing complication. This study was aimed to evaluate the various determinants of post-CS SSI, their clinical spectrum, prevalent microbiology, and their susceptibility and resistance patterns. Materials and Methods: This was a prospective longitudinal hospital-based study undertaken in Government Medical College and Hospital (GMCH), Chandigarh. Six hundred and eighty-eight patients were included from April, 2021, to September, 2022, and were followed up till 42nd day post-procedure. Results: The incidence of SSI in the study was 3.49%. The risk factors identified were gestational diabetes mellitus (GDM), thrombocytopenia, chorioamnionitis, prolonged labor, multiple per vaginum examinations, prolonged surgery, post-partum hemorrhage, and blood and blood product transfusions. Most patients presented on or after day 8 of surgery with discharge from the wound site being the most common presentation. Staphylococcus aureus emerged as the most prevalent organism and out of five patients having S. aureus, three had methicillin-resistant S. aureus. Linezolid was found to be the most susceptible antibiotic, whereas ciprofloxacin was mostly resistant among the prevalent isolates. Conclusion: Some of these determinants are modifiable such as GDM and thrombocytopenia and if detected and managed early may help in reducing the risk of developing SSI. Linezolid must be used empirically for treatment of SSI until the reporting of culture and sensitivity is done because routine antibiotics used for antibiotic prophylaxis in CS were found to be highly resistant. Periodic analysis of clinical spectrum and culture and sensitivity patterns is imperative for the early diagnosis and appropriate empirical management of SSI.

A Cohort Study to Evaluate the Effect of Nutritional Intervention on Severe Acute Malnutrition Children Admitted to A Nutritional Rehabilitation Centre in A Tertiary Care Hospital in Central Gujarat, India

Background: Undernutrition is one of the most concerning health and development issues in India as well as in the world. Nutritional rehabilitation centres (NRC) were started by Government of India to control severe acute malnutrition. The aim is to assess the effect of nutrition interventional measures for severe acute malnutrition (SAM) children admitted at NRC through selected anthropometric indicators. Methodology: A hospital-based prospective cohort study was conducted at NRC of SSG Hospital, Vadodara, Gujarat from April to September 2022, all children of 6-60 months of age admitted during this period were observed during their stay with three follow-ups after discharge at 15 days interval. The data was entered in Microsoft Excel and was analysed using Medcalc Software. Results: A total of 76 children were analysed for anthropometric indicators. A statistically significant difference was obtained between the weight of children at admission, discharge and 3 follow-ups (ANOVA=141, p&lt;0.001); difference of mid upper arm circumference (MUAC) (ANOVA=84.2, p&lt;0.001) and difference of height (ANOVA=43.3. p&lt;0.001) at admission, discharge and follow-up were also statistically significant. Conclusions: NRCs have had a positive impact on the selected anthropometric indicators of severe malnourished children but lag behind proper follow-up visits.

Correlative Study of Central Corneal Thickness and Intraocular Pressure with Optic Disc Changes in Primary Open-Angle Glaucoma

Abstract Background: Primary open-angle glaucoma (POAG) is characterised by open angles, raised intraocular pressure (IOP) and optic disc changes. Undetected glaucoma is the third leading cause of blindness. The study aims to correlate central corneal thickness and IOP with optic disc changes in POAG and to aid in the early detection and timely management of glaucoma to prevent advanced damage and vision loss. Methods: In this hospital-based prospective observational study, 50 cases (100 eyes) of POAG were selected after applying the inclusion and exclusion criteria. Detailed history, ocular examination, visual acuity testing, slit-lamp examination, gonioscopy, ultrasound pachymetry for central corneal thickness (CCT), IOP with Goldmann Applanation Tonometry (GAT), fundus examination with +90D lens and visual fields on Humphrey’s automated field analyser were performed for all patients. Results: There was a statistically highly significant positive correlation between IOP and CCT in the right and left eyes (P &lt; 0.01). There was a statistically very highly significant difference between mean IOP and mean corrected IOP in the right eye and left eye also (P &lt; 0.001). There was a statistically very highly significant difference in IOP, CCT and fundus cup-to-disc ratio (CDR) with HAP staging (P &lt; 0.001). Conclusions: IOP was positively related to CCT. Thinner CCT &lt;510μm eyes are at greater risk for more advanced disc cupping. Disc cupping increased proportionately with the rise in IOP. Thinner corneal readings should alarm the ophthalmologist to evaluate the patient thoroughly for glaucoma and monitor follow-up to keep a check on possible progression.

An Extensive Analysis and Comparison of Bone Marrow Aspiration and Bone Marrow Trephine Biopsy at a Tertiary Care Hospital in Jharkhand for Various Hematological and Non-hematological Illnesses.

Background Bone marrow examination (BME) is an indispensable diagnostic tool to evaluate various hematological and non-hematological disorders. Bone marrow aspirate cytology and bone marrow trephine biopsy, even though performed simultaneously, are assessed at different points in time due to different processing methods. Aims and objective This study aims to assess and compare the role of bone marrow aspiration and trephine biopsy to formulate an effective and rapid method for diagnosing a wide spectrum ofvarious hematological and non-hematological disorders. Materials and methods The approach of our study was a hospital-based prospective study conducted on 200 patients over a period of 1 year. The role of bone marrow aspiration and a trephine biopsy is to formulate an effective and rapid method for diagnosing a wide spectrum of hematological and non-hematological disorders. Results In our study, a total of 200 cases were studied, of whom 119 patients were male and 81 were female. The most common finding was erythroid hyperplasia, comprising 40 (20%) cases, followed by hypoplastic marrow, comprising 28 (14%) cases. Subsequently, there were 19 (9.5%) cases of acute leukemia, while 15 (7.5%) cases of chronic myeloid leukemia (CML) in the chronic phase were found. In our study, bone marrow aspirate and bone marrow trephine biopsy were found to positively correlate in 137 (68.5%) of the cases. Conclusion Bone marrow aspiration alone is sufficient for the diagnosis of megaloblastic anemia and most of the hematological malignancies. Bone marrow trephine biopsy is more appropriate for the detection of disorders of focal marrow involvement such as lymphoproliferative disorders and staging of lymphomas, metastatic cancers, granulomatous lesions, and hypoplastic marrow. However, it is strongly recommended that both procedures should be done simultaneously to ensure maximum diagnostic accuracy.

Ocular biometric characteristics of Han ethnicity in Tianjin and Uyghur ethnicity in Xinjiang undergoing cataract surgery.

To analyze and compare the differences among ocular biometric parameters in Han and Uyghur populations undergoing cataract surgery. In this hospital-based prospective study, 410 patients undergoing cataract surgery (226 Han patients in Tianjin and 184 Uyghur patients in Xinjiang) were enrolled. The differences in axial length (AL), anterior chamber depth (ACD), keratometry [steep K (Ks) and flat K (Kf)], and corneal astigmatism (CA) measured using IOL Master 700 were compared between Han and Uyghur patients. The average age of Han patients was higher than that of Uyghur patients (70.22±8.54 vs 63.04±9.56y, P<0.001). After adjusting for age factors, Han patients had longer AL (23.51±1.05 vs 22.86±0.92 mm, P<0.001), deeper ACD (3.06±0.44 vs 2.97±0.37 mm, P=0.001), greater Kf (43.95±1.40 vs 43.42±1.69 D, P=0.001), steeper Ks (45.00±1.47 vs 44.26±1.71 D, P=0.001), and higher CA (1.04±0.68 vs 0.79±0.65, P=0.025) than Uyghur patients. Intra-ethnic male patients had longer AL, deeper ACD, and lower keratometry than female patients; however, CA between the sexes was almost similar. In the correlation analysis, we observed a positive correlation between AL and ACD in patients of both ethnicities (rHan =0.48, rUyghur =0.44, P<0.001), while AL was negatively correlated with Kf (rHan =-0.42, rUyghur =-0.64, P<0.001) and Ks (rHan =-0.38, rUyghur =-0.66, P<0.001). Additionally, Kf was positively correlated with Ks (rHan =0.89, rUyghur =0.93, P<0.001). There are differences in ocular biometric parameters between individuals of Han ethnicity in Tianjin and those of Uyghur ethnicity in Xinjiang undergoing cataract surgery. These ethnic variances can enhance our understanding of ocular diseases related to these parameters and provide guidance for surgical procedures.

Enhancing participant understanding and ethical considerations in clinical trial biospecimen research: Insights from an oncology setting in India

This study explores the KAP of clinical trial participants on the use of surplus biospecimens for future research in Indian oncology trials. A hospital-based prospective study was conducted among 112 oncology clinical trial participants. Non-probability purposive sampling technique was used to recruit the participants. This study captured their socio-demographic information and pre and post-KAP assessment by using self-administered questionnaires and its highlights ethical concerns and the lack of global guidelines. The main goal is to understand participants’ understanding and opinions on sample collection, utilization, and storage, as well as the ethical implications. SPSS software used for statistical analysis to evaluate pre and post-intervention KAP scores using frequency, percentage, mean difference, standard deviation, and applied paired t-test and Wilcoxon signed ranks test to assess Different KAP Levels. The study analyzed knowledge, attitude, and practice levels among oncology clinical trial participants using statistical tests. Pre-test to post-test comparisons showed significant increases in knowledge (p &lt; 0.001, Wilcoxon Signed Ranks Test), attitude (p &lt; 0.001, paired-samples t-test), and practice (p &lt; 0.001), highlighting the intervention’s effectiveness. This study highlights the effectiveness of interventions in improving the knowledge, attitude, and practice (KAP) of oncology clinical trial participants in India regarding the use of surplus biospecimens, emphasizing the importance of standardized guidelines in global oncology trials.