Tertiary Care Hospital In India Research Articles

Effect of Admission Day and Time on Patient Outcome: An Observational Study in Intensive Care Units of a Tertiary Care Hospital in India.

The current study aimed to assess any association between intensive care unit (ICU) and hospital outcomes with ICU admission timings of critically ill patients. Retrospective observational single-center study involving all adult admissions. Each patient admission was categorized in "after-hours" (08:00 p.m.-07:59 a.m.), or "normal-hours" (08:00 a.m.-07:59 p.m.), "Weekday" (Monday-Saturday), or "Weekend" (Sunday), "Same day" (admission directly to ICU) or "other day admission" (admission to ICU after a hospital stay of ≥24 hours). Intensive care unit and hospital mortality, length of stay (LOS), and ICU readmission were assessed for any association with different admission timings. Among 3,029 patients, 54.2% (1,668) were male, with mean age 66.49 (SD ± 15.69) years, mean acute physiology and chronic health evaluation-IV (APACHE-IV) score 55.5 (SD ± 26.3). Around 86.1% of admission occurred during weekdays, 13.9% on weekends, 57.4% normal-hours, 42.6% after-hours, 66.3% same day and 33.7% other day admission. Intensive care unit and hospital mortality were 10.8 and 14.2% respectively. Neither ICU nor hospital mortality were significantly different among patients admitted normal vs after-hours (p = 0.32, 0.23), and weekdays vs weekends (p = 0.09, 0.93), nor was ICU LOS (p = 0.21, 0.74). Intensive care unit and hospital mortality (p = 0.001), DORB (p = 0.001), hospital LOS (p = 0.001), and readmission to ICU (p = 0.001) were significantly higher in the other day admission group compared to same-day admission. In a multivariate regression analysis age, APACHE IV score along with other day admission to ICU did have a significant effect on both ICU and hospital mortality. Intensive care unit and hospital mortality and LOS did not differ significantly with hours or days of ICU admission though they were significantly higher in other day admission groups. Bhattacharyya M, Todi SK. Effect of Admission Day and Time on Patient Outcome: An Observational Study in Intensive Care Units of a Tertiary Care Hospital in India. Indian J Crit Care Med 2024;28(5):436-441.

Prevalence of HPV in Oral Squamous Cell Carcinoma Through p16 IHC: A Hospital-Based Study in Eastern India

Abstract Context: Oral squamous cell carcinoma (OSCC), the third most prevalent solid cancer in India with 45% incidence, is associated with 20%–50% of cases having human papillomavirus (HPV) infection; however, the current role of HPV in managing OSCC remains unclear, particularly in high-incidence areas such as Eastern India. Aim: The study aims to determine the prevalence of HPV in OSCC patients and evaluate its role as an independent risk factor in the progression of OSCC. Settings and Design: This cross-sectional study, conducted in an Eastern Indian tertiary care hospital, involved 140 identified and treated OSCC patients. Materials and Methods: Immunohistochemistry (IHC) was used to determine HPV immunoreactivity using the marker p16. The data were analyzed using SPSS version 27.0 with a significance level of P < 0.05. Results: Among 140 patients, 11 showed strong P16 positivity (>70%) for HPV, resulting in a prevalence rate of 7.86%. However, no statistically significant association of HPV (p16 positivity) with any groups was found. Interestingly, all P16-positive patients in our study had a history of tobacco use (9.5%), suggesting that HPV may not be considered an independent factor for oral cancer. Conclusion: In our cases, p16 positivity is seen in 7.85% of cases. This finding suggests that further sub-analysis concerning p16 as a prognostic marker and its therapeutic implication is further required in oral cancer. Correlation with PCR is also required to substantiate TNM staging of p16 by the IHC method.

A rare case of pneumococcal keratitis in a patient with Herpes Zoster Ophthalmicus and compromised immune status

Infectious keratitis is commonly encountered in the ophthalmology emergency department. Streptococcus pneumoniae causing bacterial keratitis is a cause of concern in developing countries, owing to its complication of irreversible corneal scarring. This is a rare case report of a 25-year-old immunocompromised patient who presented to the Ophthalmology Department in a tertiary care hospital in India with complaints of diminution of vision in the left eye with pain, redness and watering, along with a history of vesicular painful rashes involving the left side of the forehead, the tip of the nose and the supraciliary area. Gram-positive lanceolate diplococci and plenty of pus cells were seen on the Gram staining of the corneal abscess scrape. The clinical presentation of the patient led to a provisional clinical diagnosis of secondary bacterial infection in Herpes Zoster Opthalmicus (HZO), corneal abscess with herpetic keratitis. Quellung reaction yielded an 18C serotype of the isolated pneumococci. Prompt treatment was required to prevent rapidly progressive complications.

First Thousand Cases of Intracranial Radiosurgery Treated with Gamma Knife at a Tertiary Care Hospital in India

Abstract Purpose We present the profile of first 1,000 cases of intracranial radiosurgery (IRS) treated with Gamma Knife system at a government-funded tertiary care hospital in India. In addition to the information on the indications treated, this study provides an idea of the relevance of the Gamma Knife Radiosurgery (GKRS) for IRS in the fast-changing technological scenario. This study also shows the disease indications for which GKRS was the primary treatment preference. Materials and Methods Leksell Gamma Knife model 4C was used for GKRS. Leksell G-frame-based stereotactic localization was used for all patients. Axial magnetic resonance imaging scans were used for treatment planning with additional two-dimensional angiography images for patients treated for arteriovenus malformations (AVM). The patient population treated with GKRS at our center mainly comprised of patients referred from across the country. Results Acoustic schwannoma formed the largest group of patients (27%) followed by meningioma (21%), AVM (18%), pituitary adenoma (16%), brain metastasis (5.3%), trigeminal neuralgia (3%), cavernoma (2.4%), glomus jugulare (1.8%), craniopharyngioma (1.1%) and “others” (5%). Conclusion The case mix at our center is similar to the overall Indian case mix. However, it is different from the Asian data of 2018 but interestingly similar to the data from Middle East and Africa for 2018. Among the various categories of cranial disorders treated by us, pituitary adenoma tumors had minimum (14/161) and cavernoma tumors had maximum (24/24) proportion of cases managed with GKRS as primary treatment modality.

Association between migraine and pre-eclampsia among pregnant women: a single hospital-based case–control study in India

BackgroundPre-eclampsia and migraine share some similar aspects of pathophysiology such as vascular function, platelet activation, and enhanced clotting. A few observational studies from different demographics showed that pregnant women with a history of migraine were at higher risk of developing pre-eclampsia. However, there is no such evidence available from the Indian context. Hence, a hospital-based case–control study was conducted among Indian women to determine the association between migraine and pre-eclampsia.MethodIt was a single-centre case-control study in a tertiary care hospital in India. Cases were pregnant women with clinically diagnosed pre-eclampsia, and controls were normotensive pregnant women. Migraine was diagnosed with a questionnaire adapted from the “International Classification of Headache Disorders (ICHD), 3rd Edition” by the International Headache Society, (IHS). We performed logistic regression to explore the association between migraine and pre-eclampsia.ResultOne hundred sixty-four women (82 women per group) were enrolled. The mean age among the cases (24.5 years, standard deviation of 2.4 years) was slightly higher than the mean age of the controls (23.5 years, standard deviation of 2.5 years) with a p-value of 0.006. We found that women with a history of migraine were more likely to develop pre-eclampsia (Adjusted Odds Ratio 6.17; p-value < 0.001, 95% Confidence Interval of 2.85 to 13.62).ConclusionThe current findings suggest a significant association between migraine and pre-eclampsia aligning with previous study findings; nevertheless, larger follow-up studies including women from different states in India are needed.

Primary omental infarction – a benign cause of acute abdomen

Abstract Objectives Omental infarction (OI) is an uncommon cause of acute abdominal pain. A high index of clinical suspicion is required for diagnosis of OI as the incidence is less than 1 %, presenting with abdominal pain. We report primary OI’s clinical and radiological profile from a single tertiary care hospital in India. Methods In this retrospective cross-sectional study, the electronic medical and radiology records of patients with abdominal pain were reviewed over seven years (2015–2022). Variables were systematically collected and analyzed. Results A total of 22 patients diagnosed with primary OI were included in this study. Male preponderance (63.6 %) was noted with a mean age of 47.45 years (SD ± 13.84; range: 18–72 years). Most patients belonged to class I obesity (according to the Asia-Pacific body mass index classification) with a mean BMI of 26.56 kg/m2 (SD ± 3.21 kg/m2). All patients had abdominal pain as the primary symptom, with a mean duration of 8.64 days (SD ± 10.15; range: 1–42 days). The most common locations of pain were the right hypochondrium (27.3 %) and diffuse (27.3 %), followed by the right iliac fossa (18.1 %). Most (95.45 %, n=21/22) patients were treated conservatively, and only one required surgical intervention. Conclusions Primary OI is a rare and benign cause of acute abdomen. Obesity is a risk factor but does not correlate with the size or severity of OI. Radiological imaging, like a computed tomography (CT) scan, is essential for diagnosis. A conservative management line should be the first approach in treating primary OI before considering surgical options.

CLINICAL PROFILE OF PATIENTS WITH MUSCULOSKELETAL TUBERCULOSIS VISITING A TERTIARY CARE CENTRE IN INDIA

Background: Musculoskeletal tuberculosis a major cause of mortality and morbidity in India and other developing countries. Musculoskeletal TB comprises around 10 to 30% of all EPTB cases. Even though skeletal tuberculosis is an important debilitating disease, the literature in statistical data regarding the socio-demographic distribution and clinical presentation of disease is very scarce. Objective: To study the socio- demographic and clinical profile of musculoskeletal tuberculosis patients reaching the Orthopaedics Department in a tertiary care hospital in India. Methodology: 186 patients with musculoskeletal tuberculosis who have completed treatment were called for a follow up and data regarding demographic, person and illness related factors affecting disease were collected and were tabulated and represented in various charts and diagrams, and analysed. Results: Almost equal sex distribution was seen. Maximum proportion (26%) of the patients were belonging to 40-49 age group, with a mean age of 49.6 years. Patients with age &lt;40 had less incidence compared to middle aged and elderly patients. Maximum number of patients were belonging to upper lower class (102 out of 186). Spine was the commonest site involved among the 138 cases. Spinal involvement was predominant in dorso- lumbar junction followed by thoracic spine and lumbar spine. 100% patients had pain as the presenting complaint and other complaints were not consistent. Only 16% of the patients had history of pulmonary tuberculosis and history of contact with tuberculosis case was present in 25% cases. 28% cases were diabetic and other comorbidities were less frequent. 19% of the cases had multi drug resistance. Conclusion: It was seen that Musculoskeletal tuberculosis is most frequently seen in middle age with majority of spine affected cases. The study reinforces the acquaintance of tuberculosis with low socioeconomic status and to some extend the debilitating diseases. It often has an atypical presentation leading to delay in diagnosis.

Clinico-radiologic Spectrum and Outcome of Pediatric Acquired Demyelinating Disorders of Central Nervous System: A Retrospective Indian Tertiary Care Hospital Cohort.

Pediatric acquired demyelinating syndrome (ADS) constitutes a group of treatable disorders with acute neurologic dysfunction. Neuroimaging has played a significant role in diagnosis of ADS. We describe clinico-radiologic spectrum, outcomes, and comparison of the groups: acute disseminated encephalomyelitis (ADEM), neuromyelitis optica spectrum disorder (NMOSD), clinically isolated syndrome (CIS), multiple sclerosis (MS), and myelin oligodendrocyte glycoprotein antibody-associated disorders (MOGAD). Retrospective review of 70 children with ADS at a tertiary care hospital over 15 years (2008-2023) was performed. Diagnosis was assigned as per International Pediatric Multiple Sclerosis Study Group criteria 2016. Fisher's exact and chi-square tests were applied. Thirty-nine boys and 31 girls aged 8.2 ± 4.0 years with CIS (n = 27), ADEM (n = 16), NMOSD (n = 13), MS (n = 1), and MOGAD (n = 13) were included. Clinical syndromes with positive significant association included polyfocal symptoms, encephalopathy in ADEM, optic neuritis (ON) in MOGAD, brainstem, area postrema syndrome in NMOSD. MOGAD presented with atypical presentations like prolonged fever (PF; 76.9%) and aseptic meningitis (23%). Seropositivity for myelin oligodendrocyte glycoprotein immunoglobulin-G was 62% and for NMO-IgG 2.6%. Neuroimaging of MOGAD showed lesions predominantly in basal ganglia/thalami (69.2%), optic nerve (46.2%), and cerebellum (46.2%). Imaging patterns between ADEM and MOGAD were comparable except for more ON (p = 0.004), spinal cord (p = 0.01), and cerebellar lesions (p = 0.03) in MOGAD. Area postrema lesion was unique to NMOSD. All patients received immunotherapy, of whom 91.4% (n = 64) had good recovery, 8.6% (n = 6) had functional limitation on modified Rankin scale at discharge, and 12 (17.1%) relapsed. The largest group was CIS. Seropositivity of MOG was high with atypical presentations like PF and aseptic meningitis. Specific neuroimaging patterns correlated with ADS categories. Short-term outcome with immunotherapy was favorable in spite of relapses.

Abstract PO1-13-06: Androgen Receptor Isoform V7 (AR-V7): A Promising Biomarker for Prognosticating Breast Cancer Aggressiveness

Abstract Androgen Receptor (AR) is an emerging endocrine therapy target in Breast Cancer (BrCa) with up to 80% expression in clinical cases. AR-V7 is a constitutively activated splice variant of AR having a truncated ligand-binding domain (LBD). This confers ligand-independent transcriptional activity to AR-V7 and makes it susceptible to nonsteroidal antiandrogens such as Bicalutamide or Enzalutamide which target the LBD of AR. Higher levels of AR-V7 in metastatic prostate cancer leads to therapeutic resistance and enhanced metastasis. We assessed AR-full length (AR-FL) and AR-V7 expression in BrCa cell lines of different molecular subtypes. This was extended for a clinical correlation of AR-FL and AR-V7 in validated treatment naïve BrCa patients undergoing surgical intervention at a tertiary care hospital in India. Transcriptomic and proteomic analysis was performed using qRT-PCR and Western Blotting. Immunocytochemistry and immunohistochemistry were used to examine protein expression and localisation in cells and tissues. AR-FL and AR-V7 were variably expressed in cell lines which got elevated with Dihydrotestosterone (DHT) treatment. Cell lines stimulated with Bicalutamide or Enzalutamide showed significant downregulation in AR-FL expression. From a cohort of 82 clinical cases, more than 50% originated from the urban setting, post-menopausal stage, and in the age groups of 61 to 70 years. ER, PR, HER2, and AR were positive in 65%, 55%, 24%, and 67% respectively. We were able to correlate aggressive clinical traits and higher pathological grades with increased expression of AR-V7 in the AR-positive BrCa fraction. This was consistent with the cell line-based preclinical research. This study affiliates AR-V7 as an important prognostic biomarker for predicting breast cancer aggressiveness. It can serve as a screening marker of poor clinical outcomes and aid in appropriate therapeutic intervention. These outcomes, however, seek extensive prospective validation. Citation Format: Tryambak Pratap Srivastava, Joyeeta Talukdar, Rohit Kumar Verma, Subhradip Karmakar. Androgen Receptor Isoform V7 (AR-V7): A Promising Biomarker for Prognosticating Breast Cancer Aggressiveness [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-13-06.

Estimation of serum Fetuin A and GALECTIN-3 levels in gestational diabetics in a tertiary care hospital in India: A pilot study

Estimation of serum Fetuin A and GALECTIN-3 levels in gestational diabetics in a tertiary care hospital in India: A pilot study

Comparison of the Outcomes of Enhanced Recovery After Surgery and Traditional Recovery Pathway in Robotic Hysterectomy for Benign Indications: A Randomized Controlled Trial

ObjectiveThe present study aimed to evaluate the impact of implementation of the ERAS program in patients undergoing robotic hysterectomy for benign indications in comparison with conventional management DesignRandomized controlled trial SettingNorth Indian tertiary care hospital ParticipantsPatients aged 40-60 years willing to sign the informed written consent were included while cases with contraindications for neuraxial anesthesia were excluded. 130 subjects undergoing robotic hysterectomy, divided into ERAS (N=65) and conventional (non-ERAS) (N=65) groups. InterventionsComponents of the ERAS protocol included preoperative counselling, carbohydrate loading, early removal of catheter, and early ambulation. Both groups underwent optimization of medical conditions, standardized anesthesia, and venous thromboembolism prophylaxis. ResultsOutcome measures included length of hospital stay (LOHS), time to tolerance of diet, postoperative complications, readmission rates, and quality of life assessed by WHO-QOL BREF. Baseline characteristics were comparable between groups. ERAS group showed significantly lower docking time (4.82±0.73 versus 5.31±0.92 minutes), faster tolerance of diet (0.14±0.35 versus 1.14±0.35 days), and earlier resumption of ambulation (0.42±0.5 versus 1.26±0.44 days). Time for 'fit for discharge' (1.43±0.61 versus 2.97±1.1 days) and LOHS (2.85±1.09 versus 3.78±1.29 days) were significantly lower in the ERAS group. Postoperative complications and readmission rates were comparable. Quality of life scores favoured the ERAS group at postoperative day 1 and 30. ConclusionThe combination of ERAS and robotic surgery improves patient outcomes, shortens hospital stay, and enhances postoperative recovery without increasing complications. This research serves as a pioneering effort in assessing ERAS impact on robotic hysterectomy for benign indications, providing valuable insights for future multicentric studies and supporting the integration of ERAS protocols to enhance patient outcomes and quality of life.Clinical trial registration: Clinical trial registry of India: https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NjczODM=&Enc=&userName=)

Assessment of quality of life in patients with female pattern hair loss in a tertiary care hospital in India

Background: Female pattern hair loss (FPHL) is the most common cause of hair loss in women. Although it is a mild dermatological disorder, psychologists and dermatologists have observed that even clinically imperceptible hair loss is capable of damaging the quality of life (QoL) of patients due to the loss of self-image and diminished self-esteem. Methods: After obtaining consent from patients 66 females filling in inclusion criteria were selected for study. Data was collected from OPD case papers once and a fifteen-minute interview regarding the illness and symptoms was conducted as per the questionnaires (Hairdex, VAS, DLQI) to evaluate the QoL. Results: The QoL subscales results showed the younger age group (≤30 years) was more affected in all Hairdex subscales. They fared significantly poorly with higher scores than older patients (&gt;30 years) as far as symptom score and stigmatization were concerned (p&lt;0.05). Even DLQI scores was highest in patients less than 20 years of age. Mean dermatology life quality index (DQLI) score of younger subjects was significantly higher than older subjects (p&lt;0.05). Conclusions: Our study showed that there is statistically significant decrease in QoL in patients with FPHL more so in younger patients. Younger patients seem to be more stigmatized, have poor functioning and emotional stability.

Primary Small Cell Carcinoma of Hypopharynx-A Case Report of a Rare Tumor from a Tertiary Care Hospital in India

Introduction. Primary hypopharynx involvement of small cell carcinoma is very rare and very few cases have been reported in the texts. Here, we report a case of primary small cell carcinoma of hypopharynx with metastases to left humerus in a female patient of north india. Case Report. A 54 year old woman presented with a 4month history of shortness of breath and neck swelling in the left side. Fibreoptic laryngoscopy and biopsy revealed small cell carcinoma of the hypopharynx. Discussion. Small cell carcinoma of the hypopharynx still does not have any clear modality of treatment due to being a rare entity. Systemic chemotherapy and radiotherapy should be preferred over other treatment modalities.

Determinants of Conception and Adverse Pregnancy Outcomes in Women with Endometriosis: A Longitudinal Study.

Endometriosis, affecting approximately 10% of reproductive-aged women globally, poses significant challenges, including chronic pelvic pain, dysmenorrhea, and infertility. In low- and middle-income countries like India, accessibility to affordable infertility care remains a concern. This multicenter prospective cohort study, conducted across six tertiary care hospitals in India from 2017 to 2022, aims to explore the natural progression of conception and pregnancy outcomes in women with endometriosis. Of the 257 participants, 19.1% conceived during the study, revealing significant geographic and income-based variations (p < 0.001, p = 0.01). Dysmenorrhea (p < 0.001) and dyspareunia (p=0.027) were correlated with conception, while no such associations were found with chronic pelvic pain or menstrual factors. Lesion type, number, and severity showed no conclusive link with conception. Natural conception occurred in 70% of cases, with an average post-surgery conception time of 282.1 days. Live birth rate was 85.7%, while complications included placenta previa (16.4%), preeclampsia (4.1%), and preterm births (4.1%). This study, one of the first in India on endometriosis-related fertility progression, emphasizes the need for comprehensive understanding and management of conception and pregnancy outcomes. Considering India's substantial endometriosis burden, the study recommends prioritizing larger multicenter investigations for a better understanding and effective strategies for infertility management.

Is the Rule of Halves Still Relevant today? A Study from a Tertiary Care Hospital in India

Introduction: Hypertension significantly increases the risk of heart disease, stroke and kidney failure. It impacts approximately one-third of adults in Southeast Asia, yet a considerable number remain unaware or lack access to adequate treatment. Introduced by Wilber and Barrow in 1972, the ‘rule of halves’ governs the prevalence of hypertension. The study aimed to re-evaluate the rule of halves and suggest measures for early detection and treatment compliance. Materials and Methods: A hospital-based study was conducted from (August, 2023 to October, 2023) involving 1518 employed individuals selected through non-probability sampling, excluding those seriously ill or absent. Data were gathered through a semi-structured questionnaire. Results: Out of all 1518 study subjects, 206 (14%) were diagnosed with hypertension. Among them, (42) 20% were aware and within this aware group, 81% received treatment. Of those receiving treatment (25), 73% received treatment adequately. Conclusion: The findings suggest that, although the proportion of diagnosed hypertension was lower, the rates of treatment and adherence amongst individuals with diagnosed hypertension were higher. There is a need to revisit the rule of halves for India.

Diagnostic Efficacy Study Comparing Tzanakis Scoring System With Alvarado Scoring System in Effective Diagnosis of Acute Appendicitis.

Objective Among the common causes of abdominal emergencies, acute appendicitis ranks at the top, particularly in the young population. While negative appendectomy is not uncommon, the risk of appendicular perforation is substantial if the diagnosis is missed or delayed. This study evaluated the diagnostic efficacy of the Tzanakis scoring system for acute appendicitis, comparing it with the Alvarado scoring system, considering the histopathological finding as the gold standard. Materials and methods This prospective observational study, conducted in the General Surgery department in a tertiary care hospital in India, included clinically diagnosed acute appendicitis cases posted for open or laparoscopic appendicectomy. Results The mean age for the 60 participants included in the study was30.97±13.44, and the median was 24.5 yrs. The sensitivity ofultrasonography (USG)in diagnosing histopathological positive acute appendicitis was 89%, and the specificity was 50%. The sensitivity, specificity, positive, and negative predictive values of the Tzanakis score were 87%, 50%, 96%, and 22%, respectively, and those of the Alvarado score were 54%, 75%, 96%, and 10%, respectively. Conclusion The receiver operator characteristic (ROC) curve for the Alvarado and Tzanakis scores showed that the area under the curve (AUC) was greater for the Tzanakis scoring system (0.670) than for the Alvarado scoring system (0.598). Differences between the AUCs were not statistically significant. Although the Tzanakis scoring system is more sensitive than the Alvarado scoring system in diagnosing acute appendicitis, studies with larger samples are needed to show the superiority of this scoring system over the Alvarado scoring system.

Study of Immature Platelet Fraction, Mean Platelet Volume and Interleukin-6 in Acute Coronary Syndrome: A Study at a Tertiary Care Hospital in India

Background: In the pathophysiology of acute coronary syndrome (ACS), platelets play a key role. The immature platelet fraction (IPF) is thought to be a possible indicator of activation of platelets and turnover processes. Younger platelets have a higher thrombotic potential and combine with collagen faster, which might compromise their ability to maintain hemostasis and lead to the development of thrombus. MPV measurements show platelet activation. IL-6 plasma levels seem to indicate the degree of latent plaque inflammation and, thus, may indicate susceptibility to plaque rupture. Aims and Objectives: To estimate the levels of IPF, MPV and IL-6 in ACS and to find out the association and correlation of IPF, MPV and IL-6 with ACS. Material and Method: Seventy patients of ACS fitting the Universal criteria of Myocardial infarction as cases and 70 healthy controls were included in the study. MPV, IPF, and IL6 were analyzed in all the cases and controls using various statistical tools. Result: MPV (fl) was the best predictor among all parameters at a cutoff point of &gt;4.2, with an AUC of 0.855 for correctly predicting STEMI. IPF came out to be a reasonably good marker for predicting STEMI, with a mean of 8.71 ± 5.39. IL-6 in NSTEMI was significantly higher than in controls ( P = .004) and was comparable with UA ( P = .09). Conclusion: The current study’s findings seem to confirm that elevated MPV and IPF are important ancillary indicators in the assessment of ACS.

Novel Staging Protocol for Management of Post Covid Mucor Mycosis

Introduction: There is an upsurge of Mucor Mycosis infection following Covid -19 pandemic. Disordered immune system due to covid19 infection coupled with indiscriminate use of steroids is believed to be responsible for this upsurge.Objectives: This study is aimed at analysing the preliminary epidemiological data of Mucormycosis patientsadmitted in a single tertiary care centre, stage them at presentation and to devise a treatment protocol according to their stage . To study the various surgical interventions, postoperative follow-up and treatment outcomes in terms of recovery rate and recurrence.Patients and Methods: This is a prospective longitudinal study, one of the largest of its kind involving around1841 patients diagnosed as Mucormycosis and admitted in a tertiary care hospital in India. A detailed case history, Diagnostic nasal endoscopy, CECT scan and MRI Scan were done. A novel staging was devised and patients were managed medically and surgically as per the stage. Debrided tissue was sent for microbiological and histopathological confirmation. Patients were followed-up and their recovery rates were analysed.Results: Among 1841 patients of mucor mycosis studied, 1288 were Rhino orbital and 78 were Rhino cerebraltype. 1229 patients under went surgical debridement according to the stage of disease, and rest were managed conservatively. Recovery rates fell from 90% to 26% from stage I to stage IV due to in volvement of CNS and Orbits. The mortality was as low as 17%. Re -do surgeries were done in only 12% of cases.Conclusion: Staging of mucor at presentation helps in planning, assessing response of treatment and prognosis.

IJCM_154A: Feasibility and Adherence of the Multimodal Oncology Rehabilitation Exercise (MORE) program amongst head and neck cancer survivors in a tertiary care hospital in India – A Cross Sectional Study

Background: Owing to the improvements in the diagnostic and treatment modalities, survivorship outcomes have improved drastically among cancer survivors across the globe. A mounting body of evidence states that exercise can significantly benefit physical and mental health during the various stages of anti-cancer treatment. A frequently used outcome measure used to determine exercise adherence rates and the causes for adherence and non-adherence is the Exercise Adherence Rating Scale (EARS). Objective: To assess the adherence of a tailored home Multimodal Oncology Rehabilitation Exercise (MORE) program amongst head and neck cancer survivors in a tertiary care hospital in India using the Exercise Adherence Rating Scale (EARS). Methodology: The EARS tool was provided to a sample of 22 head and neck cancer (HNC) survivors with stages III to IVb during the 3rd month follow-up. The home exercise program consisted of a template provided to the survivors on the day of discharge. The program consisted of tailored exercises i.e., cognitive motor strategies, a physical exercise program and relaxation strategies. Additionally, the participants were provided with an activity log to record the time, duration and any adverse events occurring during the exercise program. Results: The 6-item EARS tool was administered to the 22 HNC survivors. 45.5% of the 22 survivors regarded ‘lack of time’ as a barrier to exercising regularly. 18% of the survivors claimed to often forget exercising on a regular basis as recommended by the therapist. However, 50% of the survivors performed most or all of the exercises on a regular basis. Conclusion: Lack of time, forgetting to exercise and not fitting the exercises into regular routine can be regarded as essential barriers to adherence to the exercise regimen. The participants did not report any adverse events during the course of the exercise routine.

Unravelling Neurodevelopment: A Comprehensive Neuroimaging Exploration of Paediatric Disorders in a Tertiary Care Setting

Background: Paediatric neurodevelopmental disorders, including autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), intellectual disability (ID), and specific learning disabilities (SLD), present a growing healthcare challenge globally. This study, conducted at a tertiary care hospital in India, aims to explore the utility of neuroimaging techniques in understanding the structural and functional abnormalities associated with these disorders, considering the unique demographic and healthcare landscape of India. Methods: A multidisciplinary team collaborated in a cross-sectional observational study involving paediatric patients diagnosed with neurodevelopmental disorders. State-of-the-art magnetic resonance imaging (MRI) and functional MRI (fMRI) were employed. Participants underwent clinical assessments, and neuroimaging data were analyzed for structural and functional abnormalities. Advanced techniques such as diffusion tensor imaging (DTI) were utilized to explore microstructural changes in white matter tracts. Results: Distinct neuroimaging patterns were observed in different neurodevelopmental disorders. Structural abnormalities were prominent in ASD and ID, with nuanced variations in gray and white matter volumes. Functional connectivity abnormalities in ADHD were highlighted, emphasizing the involvement of attention and executive function networks. DTI revealed microstructural changes in white matter tracts, particularly in the prefrontal-striatal circuitry in ADHD and disruptions in interhemispheric communication in ASD. Conclusion: Our study contributes valuable insights into the neurobiological underpinnings of paediatric neurodevelopmental disorders, emphasizing the importance of neuroimaging for tailored diagnostic and therapeutic approaches.