North Indian Hospital Research Articles

Prognostic significance of poison-related factors and consumption patterns in acute aluminum phosphide poisoning

OBJECTIVES: The prognosis of acute aluminum phosphide poisoning is usually based on toxidrome features, with little focus on poison-related factors. We aimed to study the prognostic significance of poison-related factors, consumption patterns, and time delays to treatment. METHODS: We performed a prospective cohort study in an academic hospital in North India in patients aged ≥ 13 with aluminum phosphide poisoning from July 2019 to December 2020. During data collection, a particular emphasis was made on the poison formulation, the ingested dose, the reconstitution of poison, vomiting, and time intervals to initiate various treatments. The primary outcome was inhospital mortality. RESULTS: Fifty-eight patients were enrolled (median age, 32 years; 37 males). The mean dose of the ingested poison was 6.56 (±5.42) g. The predominant formulation of poison was pellet (n = 41), followed by powder (n = 16). Twenty patients performed reconstitution of poison before consumption, and 13 stirred the poison while reconstituting. All patients but three developed vomiting after consumption. Inhospital mortality (n = 23, 39%) was significantly high with a higher ingested dose (P < 0.001), nonstirred reconstitution before consumption (P = 0.042), fewer vomiting episodes (P = 0.010), a delay in detection of the victim by someone (P = 0.001), and delayed initiation of intravenous fluids (P = 0.043). The secondary outcomes (shock and requirement of vasopressor or ventilation) remained unaffected by the stirring in the reconstitution group. CONCLUSIONS: Poison-related factors and time intervals determine early risk stratification at admission in aluminum phosphide poisoning.

Intermediate-term outcome of Aurolab aqueous drainage implant in refractory glaucoma.

The purpose of the study was to evaluate the intermediate-term outcomes of Aurolab aqueous drainage implant (AADI) in terms of intraocular pressure (IOP) lowering from baseline levels, the number antiglaucoma medications (AGMs) in the postoperative phase, and the rate of complications. It was a retrospective interventional case series. All patients who underwent AADI surgeries with sulcus fixation from March 2018 to September 2018 at a tertiary eye care hospital in North India with a minimum follow-up of 1 year were recruited for the study. A standard AADI technique was employed. The primary outcome measures were the postoperative IOP, the requirement of AGMs, and early and late postoperative complications. A total of 20 patients were recruited in the study. The mean follow-up period was 25.25 ± 3.76 months. The mean IOP reduced from 33.20 ± 7.95 mmHg to 19.45 ± 9.19 mmHg at day 1, 13.62 ± 3.92 mmHg at 6 months, 12.78 ± 3.36 mmHg at 1 year, and 13.0 ± 2.53 mmHg at 2 years postoperatively (P < 0.001). The mean number of AGMs also reduced from 3.7 ± 0.97 to 0.35 ± 0.81 at 6 months, 0.42 ± 0.83 at 1 year, and 0.26 ± 0.73 at 2 years postoperatively (P < 0.001). Early postoperative complications, such as hypotony and hyphema, were seen in 5 (25%) patients, although none of them was sight-threatening. Late postoperative complications, such as hypertensive phase and persistent fibrinous membrane, were also seen in five eyes. The study assessed the clinical outcomes, safety profile, and long-term AGM requirement with AADI and found it to be a good viable surgical option in refractory glaucoma.

A retrospective analysis of the effectual paucity of patient load in the period of the COVID-19 pandemic in the dermatology department of a tertiary care hospital in North India

Background: The COVID-19 pandemic, originating in China in December 2019, spread throughout the world like wildfire in a matter of months. With the health-care resources being reallocated toward the management of the patients found to be suffering from the severe acute respiratory syndrome coronavirus 2 infection, the routine health-care services in all walks of medicine have faced the fire. Aim and Objectives: This study was undertaken with the aim to compute the brunt suffered by the everyday services at the dermatology department of a tertiary care hospital at the behest of the pandemic. Materials and Methods: This was an observational study carried out retrospectively, wherein the hospital records of the patients visiting the outpatient, procedural, and inpatient dermatology department at a tertiary care center in North India were analyzed from June 2019 to May 2021. Results: A significant decrease of 51.33%, 75.53%, and 58.42% was found in the number of patients visiting the outpatient, procedural, and inpatient dermatology department, respectively, in June 2020–May 2021 as compared to June 2019–May 2020. Conclusions: Our study reveals that the regular services of the dermatology department were severely affected by the pandemic. We feel that it is safe to say that this observation holds true for the routine services offered by all the departments all over the world. Learning and adapting to the changing patterns of patient care needs and the redistribution of health-care resources is of paramount importance as the end of this pandemic is not yet visible in the foreseeable future and also to be ready for any other such calamities that the world might face in the upcoming times.

Retrospective Analysis of Spectrum of Infections and Antibiotic Resistance Pattern in Chronic Kidney Disease Patients on Maintenance Hemodialysis in a Tertiary Care Centre in North India.

Hemodialysis patients are at risk of infections. This study examines the spectrum of infections and antibiotic resistance patterns. We retrospectively reviewed the records of 586 hemodialysis patients from May 2018 to April 2020 in a tertiary care hospital in North India. The study identified 99 episodes of confirmed infections. Urinary tract infections were the most common type of infections (55.5%), followed by catheter-related bloodstream infections (CRBSI) (definitive 21.2%). Other infections were pneumonia (8.1%), tuberculosis (6.1%), skin and soft tissue infection (4.0%), dengue fever (3.03%), and empyema thoracis (1.0%). Overall, Escherichia coli (33.3%) was the most common organism isolated. The most frequent uropathogens recovered were Escherichia coli (54%). In confirmed CRBSI, P. aeruginosa (23.8%) and MSSA (23.8%) were the most common pathogen isolated. K. pneumonia (37.5%) was the most common pathogen in pneumonia. Uropathogens showed the highest resistance to fluoroquinolones (93.3%-100%). Pathogens isolated in CRBSI showed maximum resistance to ciprofloxacin (100%). In pneumonia, the highest resistance was seen to third-generation cephalosporins (75%-100%). Though the bacterial spectrum remains the same over time, antibiotic resistance is changing in uropathogens. There is a trend of predominance of Gram-negative bacterial infections in CRBSI. Tuberculosis incidence rate was much higher than the general population. There is a need for nationwide and worldwide continuous surveillance.

Awareness and Hesitancy of COVID-19 and other Vaccines among People Living with HIV/AIDS Attending Antiretroviral Therapy (ART) Center in North India.

Approximately 40 years have passed since we first learned about the human immunodeficiency virus (HIV), but several people living with HIV (PLHIV) in developing countries such as India cannot avail treatments. This makes preventive measures, such as vaccinations, critical in these persons to avoid vaccine preventable diseases (VPDs). However, little is known about the willingness and perceptions of PLHIV regarding these vaccines. Therefore, we explored vaccine awareness and hesitancy, especially during the recent COVID-19 pandemic. The primary objective was to determine the uptake of the Covid-19 vaccine and other VPD's among PLHIV and factors affecting the same in Antiretroviral therapy (ART) centers in a tertiary care hospital in North India. This was a cross-sectional study of HIV patients who attended our Antiretroviral Therapy center (ART). Clinical data were collected using a questionnaire on general profile, disease information, knowledge, attitude, and practice (KAP) regarding vaccinations, and vaccination status for different VPDs. We enrolled 300 subjects and found that 82% of the patients attending our ART center were aware of vaccinations, most of whom were aware of the polio vaccine (n=91, 30.33%), followed by tuberculosis (n=61, 20.33%), and the majority of them were not aware of vaccines indicated in PLHIV. We also found that the majority (n= 240, 80.23%) of patients had vaccine hesitancy, especially regarding the new COVID-19 vaccine. There is a need to create awareness among people about the benefits and uses of vaccination to achieve the greater goal of reduced morbidity and mortality among PLHIV. There is a need for free vaccination programs for VPDs in PLHIV patients.

Mental health of health care workers during the hour of crisis - A study from tertiary care hospital in North India.

This cross-sectional study aimed to analyze the psychosocial, behavioral, and sleep impact of coronavirus disease-19 (COVID-19) pandemic on healthcare workers (HCWs) at a tertiary-care hospital in Northern India. An online questionnaire including three psychological scales - peritraumatic distress inventory (PDI), insomnia Severity Index (ISI), and Depression anxiety stress scale was circulated among the HCWs at a tertiary-care hospital in Northern India. Three hundred and ninety-six HCWs (Mean age standard deviation: 34.8 [8.1%] years; 181 females) responded. Place of posting was active COVID area (27.2%), reserve active COVID team (23.2%), trained reserve pool (29.5%), and non-COVID areas (19.9%). More than half of all the respondents (51%) had abnormal PDI score (>14) with a propensity to develop posttraumatic stress disorder. Furthermore, there was a significantly higher prevalence of abnormal PDI scores in those involved in active COVID care units (74%) versus non-COVID care unit (24%, P = 0.001). More than 60% of all the respondents had abnormal ISI score suggesting significant insomnia. Stress was seen in 71% of all the respondents while 82% were anxious and 77% participants had depressive symptoms. Hence, the psychological morbidity among the HCWs was high. Our study found a much higher prevalence of peritraumatic distress, insomnia, anxiety, stress, and depression among the HCWs, more so in those working in COVID areas. Factors indigenous to Indian population in terms of psychological health must be studied and addressed to reduce this psychological morbidity since the battle with COVID is long.

Medication Adherence and its Predictors among Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study.

Medication adherence is vital in managing noncommunicable diseases like diabetes. Illness perception and an individual's knowledge regarding the disease may influence medication adherence. The present study aimed to assess the prevalence and predictors of medication adherence among type 2 diabetic patients. A cross-sectional study was conducted among 400 diabetes mellitus patients attending an outdoor patient department (OPD) of a tertiary care hospital in North India. Brief Medication Questionnaire (BMQ) and Brief Illness Perception Questionnaire (B-IPQ) were used to study medication adherence and illness perception, respectively. Descriptive and analytic statistics were computed using Epi Info software for Windows (CDC, Atlanta, GA, USA). The prevalence of medication adherence was 79.5% (82/400). The odds of medication adherence increased with higher age (odds ratio [OR] = 1.8 [1.1-2.9]) and more duration of illness (OR = 1.8 [1.0-3.2]) Patients having good knowledge of diabetes were more likely to adhere to medications. [OR=1.8(1.1-3.1). Diabetes medicine-adherent patients had a higher perceived understanding of the disease, felt having lesser negative consequences, and were less concerned about the illness than their counterparts. A high proportion adhered to diabetes medication. The guiding factors to further improve medication adherence are age, duration of illness, illness perception, and knowledge regarding the disease.

Decoding stillbirths using relevant condition at death classification in a tertiary care hospital in North India

Objectives: The objective of the study is to know the stillbirth rate and causes of stillbirth using relevant condition at death (ReCoDe) classification. Methods: A hospital-based retrospective study. The medical records of women with stillbirth between January 1, 2022, and March 31, 2023, were retrieved and analyzed for the cause of stillbirth using ReCoDe classification. The study was approved by institutional ethics committee. Results: There were a total of 4520 deliveries during the study and of these 78 were stillbirths, a rate of 17.2/1000 births. Maternal factors such as Pregnancy induced hypertension (PIH), preeclampsia and eclampsia, and undiagnosed congenital anomalies were significantly more common in un-booked mothers in the study subjects. Using ReCoDe classification the cause could be assigned to 88% of stillbirths. The most common maternal causes were PIH and antepartum hemorrhage while the most common fetal causes were severe growth retardation and lethal congenital anomalies. Medical conditions associated with stillbirths were found in 41.2% (32) mothers. Conclusion: ReCoDe classification is a useful, easy-to-use tool and can assign a cause to majority of stillbirths.

Development and Validation of a Treatment Compliance Assessment Scale for Clients with Mental Illnesses

Background: Treatment compliance improves mental health and facilitates the resolution of the underlying illness. An accurate assessment of treatment compliance is necessary for effective and efficient treatment planning and for ensuring that changes in health outcomes can be attributed to the recommended regimen. Aim: This study aimed to develop a treatment compliance assessment scale for clients with mental illnesses and to evaluate its psychometric properties. Methodology: The initial questionnaire was developed through the Delphi expert consultation, pilot study, and semistructured interview. The instrument was applied to 130 clients attending the outpatient services of a tertiary care hospital in North India. Results: A seven-item clinician-rated questionnaire was formed in which exploratory factor analyses yielded two factors, including medication compliance and attitude toward current treatment. The instrument was found to have a good internal consistency (Chronbach’s alpha was 0.932), split-half reliability (Guttman’s split-half coefficient − 0.838), and test–retest reliability (0.882). The concurrent validity of demonstrated a significant correlation with the 12-item Medication Adherence Rating Scale at P ≤ 0.01. Conclusion: The clinician-rated treatment compliance assessment scale was found to be a valid instrument for assessing treatment compliance among patients with mental illnesses with adequate psychometric properties.

Descriptive study of physical activity and sitting time among medical students from North India

Background: A physically active lifestyle is the cornerstone of good health. A sedentary lifestyle is emerging as a global threat to public health and physical activity is being recommended as an important intervention for the prevention and control of non-communicable diseases. Aim and Objectives: The present study aims to assess the level of physical activity and duration of sitting time among medical undergraduates to guide the formulation of strategies for healthy lifestyles. Material and Methods: A cross-sectional study was conducted among medical undergraduate students of a teaching hospital in North India. Data were collected using a structured questionnaire regarding the demographic profile, anthropometric parameters, physical activity, and sitting time. The level of physical activity and time spent sitting was assessed using International Physical Activity Questionnaire. R software was used for data analysis. Results: A total of 250 medical students were included with a response rate of 83.3%. Overall, 67.6% of students engaged in moderate levels of physical activity, 21.2% engaged in high levels, and 11.2% engaged in low levels of physical activity. The mean time spent sitting was 8.8 hours/day (males: 8.5 and females: 9.1). It showed a significant association between physical activity and body mass index, with the low prevalence of obesity among students engaged in moderate and high levels of physical activity. Conclusion: The study highlights prolonged sitting as an emerging public health problem where three-fourths of students were spending more than 7 hours/day sitting. However, the majority of students were engaged in moderate to high levels of physical activity.

Prevalence of genital Chlamydia trachomatis at a Tertiary Care Hospital in North India: A 10-year observational study.

Prevalence of genital Chlamydia trachomatis at a Tertiary Care Hospital in North India: A 10-year observational study.

A comparative study of psychiatric comorbidities in patients of head-and-neck cancer at tertiary care hospital in North India

A comparative study of psychiatric comorbidities in patients of head-and-neck cancer at tertiary care hospital in North India

Severe acute respiratory syndrome coronavirus 2 Omicron variant and psychological distress among frontline nurses in a major COVID-19 center: Implications for supporting psychological well-being

Background: Coronavirus outbreak severely affected the psychological health of frontline health-care workers, including nurses. Nurses relatively face many more psychological problems compared to other health-care workers. This study aimed to assess nurses' fear, stress, and anxiety status during the Omicron, a new variant of the severe acute respiratory syndrome coronavirus 2, outbreak in India. Materials and Methods: This questionnaire survey included 350 frontline nurses working at a tertiary care teaching hospital in North India. The information was collected using the Coronavirus Anxiety Scale, Impact of Event Scale-Revised, and Fear of COVID-19 Scale. Nurses working in the hospital since COVID-19 outbreak were included in the study. Appropriate descriptive and inferential statistics were applied to compute the results. Results: Nurses hospitalized after contracting an infection (odds ratio [OR] – 3.492, 95% confidence interval – 1.644–9.442, P < 0.002) and attended training on COVID-19 (OR – 2.644, 95% CI – 1.191–5.870, P < 0.017) reported high distress than their counterparts. Likewise, nurses hospitalized after contracting an infection (β = 3.862, P < 0.001 vs. β = 2.179, P < 0.001) and have no training exposure on COVID-19 management and care (β = 2.536, P = 0.001 vs. β = 0.670, P = 0.039) reported higher fear and anxiety, respectively. Likewise, married participants (β = 1.438, P < 0.036) who lost their friends and colleagues in the pandemic (β = 0.986, P = 0.020) reported being more frightened and anxious. Conclusions: Participants reported experiencing psychological burdens, especially nurses hospitalized after contracting an infection and who lost their friends and colleagues to COVID-19. High psychological distress may be a potential indicator of future psychiatric morbidity. Authors recommend a variant-specific training to improve nurses' mental health to combat the pandemic.

Are we moving from symptomatic to asymptomatic syphilis: A retrospective analysis.

Syphilis remains a global health problem with recent reports of resurgence from various parts of the world. We undertook this study to analyze the current epidemiological and clinical trends of syphilis in our part of the country. To analyze the changing trends in clinical presentation of syphilis and the current status of HIV/AIDS-syphilis co-infection in our area. This is a hospital-based retrospective analysis of records of sexually transmitted disease (STD) patients enrolled in "Suraksha clinic" in the department of Skin and VD at a Tertiary Care Hospital in North India. Patient records were analyzed from January 2018 to December 2021. The demographic, clinical, and serological profiles of patients were assessed to study the percentage of syphilis patients attending the STD clinic and their clinical presentations. A total of 7153 patients were enrolled in the"Suraksha clinic" from January 2018 to December 2021, these included the venereal disease patients (3137) and nonvenereal disease patients (4016) who were registered for HIV and venereal disease research laboratory (VDRL) screening from the dermatology outpatient department. Out of 3137 sexually transmitted infection (STI) patients, 139 patients tested positive for VDRL. Treponema pallidum hemagglutination was found positive in 137 patients and negative in two patients. Hence, 137 patients were confirmed syphilis cases, constituting 4.36% of total STD cases in our STI clinic in 4 years. Out of 137 patients, 2 (1.45%) presented with primary chancre, 6 (4.37%) with lesions of secondary syphilis and 129 (94.16%) were found serologically reactive without any symptoms or clinical signs, i.e., in latent syphilis. Our records also showed 14 (10.21%) cases of HIV and syphilis co-infection. In our study, a remarkable rise in the number of patients in the latent syphilis stage is observed over primary and secondary syphilis stage. This signifies the persistence of syphilis in subclinical phase in the community and unfortunately, it goes unnoticed. These could be "warning signs" for changing disease pattern of syphilis in India and points toward hidden resurgence of syphilis as being reported in various parts of the world. To actively look for these "hidden cases," there is a need to strengthen "Suraksha clinics." VDRL testing should be mandatory along with routine testing in all patients visiting the hospital irrespective of their disease. We also propose for the central registration of syphilis patients on lines of HIV-infected patients' registry.

Clinical spectrum and outcomes of patients with anti-jo1 positive antisynthetase syndrome seen at a single tertiary care hospital in North India

Clinical spectrum and outcomes of patients with anti-jo1 positive antisynthetase syndrome seen at a single tertiary care hospital in North India

Evaluation of serum adipokines (omentin-1 and visfatin) in coronary artery disease at a North Indian hospital.

Objective. Adipose tissue is considered to be an endocrine organ that secretes bioactive substances known as adipokines that contribute to the pathophysiology of metabolic and coronary diseases related to obesity. In this study, various novel biomarkers, such as inflammatory markers that are pro-inflammatory (visfatin) and anti-inflammatory (omentin-1), as prognostic indicators for people with coronary artery disease (CAD) were investigated. Methods. In this study, 30 diabetic patients with CAD, 30 diabetic patients without CAD, and 30 healthy control counterparts were included. Serum omentin and visfatin concentrations were evaluated by solid-phase enzyme linked immunosorbent assay (ELISA) kit. Patients with established diagnosis of CAD based on angiography, ECG, and elevated cardiac marker level were included into the study. Patients with cardioembolic stroke, cerebral venous sinus thrombosis, CNS vasculitis, and hemorrhage due to trauma, tumor, vascular malformation, and coagulopathy were excluded. Results. The serum omentin-1 levels were significantly higher in the healthy controls in comparison with the diabetic group (p<0.0001) and serum visfatin levels were significantly higher in the diabetic group in comparison with the healthy controls (p<0.0001). The serum omentin levels were significantly higher in the diabetic group in comparison with the cardio-diabetic group (p<0.0001) and serum visfatin levels were significantly higher in the cardio-diabetic group in comparison with the diabetic group (p<0.0001). The serum omentin-1 showed negative correlation with the serum visfatin in the cardio-diabetic group. Conclusion. The adipokines, such as omentin and visfatin, may be good therapeutic candidates in preventing or ameliorating CAD.

Microbiological Profile of Blood Stream Infections in a Tertiary Care Hospital, J&amp;K. India

Background: Worldwide, bacteremia is one of the serious infections that cause significant morbidity and mortality in hospitalized patients. A wide range of microorganisms have been implicated in the etiology of BSIs. Early detection of these pathogens along with the determination of antimicrobial susceptibility patterns have been shown to improve treatment outcomes. The present study aimed to determine the microbiological profile of BSIs in a major tertiary care hospital in North India.&#x0D; Materials and Methods: This is a cross-sectional study conducted in the Department of Microbiology Government Medical College Srinagar. Blood samples submitted in brain heart infusion (BHI) broth for culture and sensitivity over a period of one year from September 2021 to 30th August 2022 were included in the study and processed per standard laboratory protocol techniques for isolating and identifying pathogens causing BSI. The antimicrobial susceptibility of bacterial isolates was determined by the disc diffusion method as per Clinical and Laboratory Standards Institute (CLSI) guidelines.&#x0D; Results: Out of 4260 blood samples, 1204(28.26%) isolates were obtained. Of these isolates, 575(47.75%) were Gram‑positive bacteria and 468 (38.87%) were Gram‑negative bacteria. Candida species were isolated from 161(13.7%) positive samples and 32 showed contamination. The most commonly identified organism was Coagulase‑negative Staphylococcus (CoNS) (22.59%) followed by Staphylococcus aureus(17.69%), Acinetobacter spp. (13.70%), Klebsiella spp (10.13%) and Escherichia coli (6.47%). Among the gram-positive bacteria, maximum resistance was seen with methicillin and azithromycin. No resistance was seen with vancomycin and linezolid. Most of the gram-negative bacilli were multidrug-resistant. Maximum resistance was seen with ampicillin(91.7%), amoxiclav (86.5%), ceftriaxone (88.5%), and gentamicin (60.9%). Higher prevalence of resistance was observed in Gram‑negative bacteria when compared with Gram‑positive bacteria.&#x0D; Conclusion: Hence, empirical treatment of BSIs should be based on the current knowledge of bacterial resistance profiles as provided by microbiology laboratory reports. The results of this study warrant continuous monitoring of antimicrobial patterns for the clinicians along with judicious antibiotic policy to mandate antimicrobial sensitivity testing against the BSIs in the hospital setup so that appropriate therapeutic measures should be taken at the earliest.

Correlation between the Clinical, Etiological, Radiological, and Histopathological Pattern in Patients of Interstitial Lung Disease

Abstract Background and Objective: Interstitial lung diseases (ILDs) include a large number of conditions that primarily involve space between the alveolar epithelium, the capillary endothelium, and adjoining structures such as alveoli and small airways. This study has been conceived to generate the data on the clinical, etiological, radiological, and histopathological pattern of patients of ILD. Methods: This prospective study was conducted from January 1, 2018 to October 31, 2019 enrolling 43 patients of ILD who presented as outpatient/in patients to a tertiary care hospital in North India. Based on the clinical presentation and chest X-ray, the suspected patients were subjected to high-resolution computerised tomography (HRCT) chest and pulmonary function test for confirmation. The confirmed cases were then subjected to bronchoscopy and histopathological study. Results: There were 26 (60%) male patients and 17 (40%) female patients in the study population. The mean (±standard deviation) age was 56.9 ± 13.02 years. A diagnosis of ILD was made based on the history and clinical findings in 35 (81.5%) cases. The most common finding on chest radiography was reticular opacities in 20 (46%). Usual interstitial pneumonia pattern 20 (46%) was the most common abnormality on HRCT. Etiological profile was mainly found to be idiopathic pulmonary fibrosis in 19 (45%). Clinicoradiological correlation was seen in 35 cases, clinicohistological in 23 cases, and historadiological in 28 cases. Overall correlation between all the three modalities was established in 20 (46%) cases. Conclusion: The clinical suspicion of ILD is very important due to the varied etiologies and diseases with similar clinical presentations. Given the limitations of chest radiography, HRCT chest is the best noninvasive modality, while bronchoscopy is the most useful minimally invasive investigation tool to establish a diagnosis. Hence, multidisciplinary correlation is the best approach to evaluate a case of interstitial lung disease.

Vitamin D Toxicity Presenting as Altered Mental Status in Elderly Patients.

Background and objective Around 25-30% of elderly patients present toemergency departments (ED) with altered mental status (AMS), with hypercalcemia being one of the metabolic causes. Elderly patients, due to their multiple vulnerability factors and relative homeostenosis, are susceptible to alterations in mental state at even milder grades of hypercalcemia. There is a trend of overzealous prescription of higher doses of vitamin D in elderly patients for various ailments, which often exceeds the requirements of the patients.In this study, we aimed to establish vitamin D toxicity (VDT) as an underlying cause of AMS in elderly patients presenting to the hospital. Methods This was a descriptive case study conducted at a tertiary care university hospital in North India, from January 2015 to March 2020 for a total duration of five years. Elderly patients (aged ≥60 years) who were admitted with VDT as a cause for underlying hypercalcemia were included. The evaluation included patient history regarding the dosage of vitamin D received, route of administration, and biochemical parameters, such as serum calcium, intact parathyroid hormone (iPTH), 25-hydroxy vitamin D [25(OH)D], and albumin. All other potential causes for hypercalcemia and AMS were ruled out concurrently. Results A total of 19 patients were enrolled in the study, with a mean age of 72.3 years (range: 62-86 years). All patients had received injectable vitamin D formulation. The meanserum calcium among the patients was 12.52 ± 1.12 mg/dL (range: 11.2-15.7 mg/dL), whereas the mean 25(OH)D was 196.34 ± 70.44 ng/mL (range: 107-356 ng/mL). The mean cumulative vitamin D supplement intake was 2.594 ± 0.841 million IU (range: 1.2 million-4.2 million IU). While six patients had mild hypercalcemia, 12 had moderate, and one person had severe hypercalcemia, with altered sensorium (85%) being the most commoncomplaint for presenting to ED, followed by generalized weakness (15%). Conclusion VDT can manifest with AMS as an initial presenting complaint. The geriatric population, due to various underlying vulnerability factors, is more susceptible than their younger counterparts. We strongly recommend thatin elderly patients, higher doses of vitamin D should be prescribed only after checking their serum levels, and frequent monitoring of vitamin D should be performed.

IgG4-related hypophysitis: A monocentric experience from North India.

Immunoglobulin (Ig)G4-related disease is a systemic fibroinflammatory disease characterized by dense infiltration of IgG4-positive plasma cells in the affected tissue(s) with or without elevated plasma levels of IgG4. Hypophysitis itself is a very rare disease with reported prevalence in the operative specimens are around 0.2-0.88%. IgG4-related hypophysitis (IgG4-RH) may account for a substantial percentage of cases previously regarded as idiopathic hypophysitis. This study is a registry-based, retrospective, and cohort study from a tertiary care hospital in North India. The medical records and clinical data of biopsy-proven and suspected IgG4-RH patients registered were retrospectively analyzed. Treatment outcome of cases was also explored during this analysis. Two thousand and six sellar area space-occupying lesions have been operated-on since 2006, among them only four patients had IgG4-RH on histopathological specimen. One case was diagnosed on clinical suspicion. Mean age of the patients was 31.8 ± 6.32 years. Most frequent presenting complaint was headaches. Extracranial manifestations were present in four patients. The most common pituitary dysfunction was cortisol deficiency. 18 F-fluorodeoxyglucose positron emission tomography (18F FDG PET) was helpful in three cases for diagnosis of hypophysitis and other organ involvement. Classical histological findings with storiform fibrosis, obliterative phlebitis seen in two cases, and IgG4-positive plasma cell infiltration were positive in four cases. Surgery was the primary modality of treatment in all four cases. Only one patient received steroids as a primary therapeutic modality. IgG4-RH is rare. High index of suspicion is required to diagnosis the case precisely. FDG PET is helpful in diagnosing hypophysitis and extrapituitary lesions.