Tertiary Care Centre In North India Research Articles

Impact of rituximab maintenance on survival of patients with mantle cell lymphoma: A north Indian tertiary care center experience.

e19047 Background: Mantle cell lymphoma (MCL) is an aggressive variant of non-Hodgkin lymphoma. Indian data is scarce owing to its rarity in south-east Asia. Till now, studies have not shown overall survival benefit with rituximab maintenance (RM). Our study aims to assess if RM improves overall survival of MCL patients. Methods: We retrospectively analysed clinicopathological data of 90 transplant-ineligible MCL patients treated between January’2013-December’2023 at Institute Rotary Cancer Hospital - All India Institute of Medical Sciences, New Delhi, India. Rituximab-based induction chemotherapy was used in all patients as per institutional protocol. RM was used in twenty-eight (31.0%) patients due to financial constraints. Primary outcome was overall survival (OS). Secondary outcomes were event free survival (EFS) and factors affecting OS, EFS. OS was defined as time from treatment initiation to demise from any cause or last follow-up. EFS was defined as time from treatment initiation to disease progression or relapse or demise from any cause. Response was assessed by modified Cheson’s lymphoma response evaluation criteria. STATA 13.0 was used to assess survival by Kaplan-Meier analysis and log rank test. Factors affecting survival were assessed by multivariate analysis (Cox proportional hazards model) and expressed as adjusted hazard ratio (aHR). p value < 0.05 defined statistical significance. Results: Median age was sixty years; male-female ratio 3:1. Thirty-five (39.0%) had one or more co-morbidities, 79(88.0%) generalised lymphadenopathy, 72(80.0%) extra-nodal involvement, 49(54.0%) B symptoms, 84(93.0%) advanced stage (III/IV), 49(54.0%) high risk MCL international prognostic index (MIPI). Clinical and tumor characteristics, response rates after initial induction were similar in both maintenance and non-maintenance groups. Overall, 52(58.0%) patients were alive with median follow-up of 63.0 months (inter-quartile range 37.0-90.0 months). Median OS was 37.5 months in non-maintenance group and did not reach in maintenance group. Estimated 1.0-, 2.0, 3.0-year OS were 100.0%, 91.0%, 81.0% vs 75.0%, 63.0%, 55.0% respectively in maintenance vs non-maintenance group. RM was significantly associated with better OS [aHR (95% confidence interval): 0.31 (0.13-0.75), p=0.01]. Advanced stage, Eastern Co-operative Oncology Group performance status (ECOG PS) ≥2 at presentation were also significant factors for poor OS. Median EFS was significantly lower in non-maintenance group [14.0 vs 42.5 months; aHR (95% confidence interval): 0.34 (0.18-0.64), p=0.001]. Advanced stage, anemia, high risk MIPI at presentation were also significant factors for poor EFS. Conclusions: This was the first study from south-east Asia demonstrating impact of rituximab maintenance in MCL. Rituximab maintenance significantly improved OS and EFS of MCL patients.

Integrated analysis of transcriptome and genome variations in pediatric T cell acute lymphoblastic leukemia: data from north Indian tertiary care center

IntroductionT-cell acute lymphoblastic leukemia (T-ALL) is a genetically heterogeneous disease with poor prognosis and inferior outcome. Although multiple studies have been perform on genomics of T-ALL, data from Indian sub-continent is scarce.MethodsIn the current study we aimed to identify the genetic variability of T-ALL in an Indian cohort of pediatric (age ≤ 12 years) T-ALL patients (n = 25) by whole transcriptome sequencing along with whole exome sequencing and correlated the findings with clinical characteristics and disease outcome.ResultsThe median age was 7 years (range 3 -12 years). RNA sequencing revealed a definitive fusion event in 14 cases (56%) (including a novel fusions) with STIL::TAL1 in 4 (16%), followed by NUP21::ABL1, TCF7::SPI1, ETV6::HDAC8, LMO1::RIC3, DIAPH1::JAK2, SETD2::CCDC12 and RCBTB2::LPAR6 in 1 (4%) case each. Significant aberrant expression was noted in RAG1 (64%), RAG2 (80%), MYCN (52%), NKX3-1 (52%), NKX3-2 (32%), TLX3 (28%), LMO1 (20%) and MYB (16%) genes. WES data showed frequent mutations in NOTCH1 (35%) followed by WT1 (23%), FBXW7 (12%), KRAS (12%), PHF6 (12%) and JAK3 (12%). Nearly 88.2% of cases showed a deletion of CDKN2A/CDKN2B/MTAP genes. Clinically significant association of a better EFS and OS (p=0.01) was noted with RAG2 over-expression at a median follow up of 22 months, while a poor EFS (p=0.041) and high relapse rate (p=0.045) was observed with MYB over-expression.ConclusionOverall, the present study demonstrates the frequencies of transcriptomic and genetic alterations from Indian cohort of pediatric T-ALL and is a salient addition to current genomics data sets available in T-ALL.

Left Main Rotablation: Case Series From a Tertiary Care Centre in North India

Background: Calcified left main (LM) disease is an important subset of coronary artery disease, associated with a high risk and procedural complexity. Advances in percutaneous coronary intervention (PCI) are making it a viable alternative to coronary artery bypass grafting. Methods: This was a retrospective study of patients aged ≥18 years who underwent rotational atherectomy (RA)-assisted PCI of LM disease at a tertiary-care centre in North India from August 2018 to May 2023. PCIs also involved use of intravascular ultrasound and adjuvant plaque-modifying therapies, such as cutting balloons, and intravascular lithotripsy, as indicated. Procedural details and clinical outcomes were analysed. Results: The study included 55 consecutive patients. A total of 52 patients (94.5%) were men, and the mean age was 64.7 ± 9.0 years. The mean follow-up was 16.3 ± 11.2 months. The mean ejection fraction was 52.7 ± 8.2%. On angiography, the mean SYNTAX score was 34.9 ± 7.7, and true bifurcation lesions (Medina class 1,1,1 or 1,1,0) were present in 22 patients (40%). Adjuvant plaque modification therapy included a cutting balloon in 25 patients (45.5%), and intravascular lithotripsy in nine (16.4%). Intravascular ultrasound guidance was used in 46 patients (83.6%). Supported PCI was performed in six cases (10.9%). Angiographic success was achieved in 100% of the patients. One patient (1.8%) died in hospital due to an upper gastrointestinal bleed. On follow-up, one patient died (1.8%), and target vessel revascularisation was needed for three patients (5.5%). Conclusion: Rotational atherectomy-assisted PCI for calcific LM disease can be performed safely, with judicious use of intravascular ultrasound and adjunct plaque modification therapies, providing satisfying short- to medium-term outcomes.

Impact of secondary infections on dengue presentation: A cross-sectional study in a tertiary care hospital in Uttar Pradesh, India

BackgroundRecently, a wide range variety of manifestations, including a self‑limiting to severe illness, has been increasingly reported in dengue. Few studies attract attention to severe dengue, mainly observed in secondary infection. With this background, this study aims to provide a comprehensive overview to differentiate primary from secondary dengue using serology (IgG) and the possible association of severity of illness in secondary dengue. MethodsPresent retrospective cross-sectional study was conducted at a North Indian tertiary care center from September 2021 to January 2022. Clinical data of confirmed dengue patients from the medicine department were collected and assigned as primary and secondary dengue. ResultsOf the 220 dengue patients, 22 (10 %) had secondary dengue infection. Hemorrhagic manifestations were reported in 58/220 (26.4 %) cases while 7/22 (31.8 %) in secondary dengue. Prevalent hemorrhagic manifestations in secondary dengue include purpura (27.3 %), vaginal bleeding (4.5 %), melaena (9.1 %), and epistaxis (4.5 %). In addition, 42 (19.1 %) patients had pancytopenia, and 8 (36.6 %) cases were of secondary dengue. Hepatic dysfunction was noted in 164 (74.5 %) cases. Notably, all secondary dengue cases (22;100 %) had hepatic dysfunction and severe in 9 (40.9 %) cases. In addition, in secondary dengue patients, evidence of plasma leakages such as hypoproteinemia 7 (31.8 %) and ascites (35 %) were statistically more frequent. Overall, two deaths (0.9 %) were reported, and were one in each group. ConclusionsMany parameters, including hemorrhagic manifestation (melaena), hematological characteristic (pancytopenia), evidence of plasma leakage (hypoproteinemia and ascites), gastrointestinal (GB wall thickening and hepatic dysfunction) and reduction in mean hemoglobin and platelet count were found to be statistically significant in secondary dengue infection. Additionally, early classification of secondary dengue may help to anticipate its severity and allow for early strategic intervention/management to lower morbidity and mortality.

A Prospective Observational Study on the Outcome Assessment of Conservative Management Versus Intercostal Drainage (ICD) in Blunt Chest Injury Patients With ≤3 Rib Fractures in a North Indian Tertiary Care Center.

Introduction Trauma is the third most common cause of death in all age groups. One out of four trauma patients die due to thoracic injury or its complications. Seventy percent of thoracic traumas are due to blunt injury. This indicates the importance of chest trauma among all traumas. Quick and precise assessment bears paramount importance in deciding life-saving and definitive management. Often, the initial management in blunt injury patients is based on subjective assessment by the attending clinician. A scoring system that provides early identification of the patients at the greatest risk for respiratory failure and more likely to require mechanical ventilation and require prolonged care, as well as those with a higher mortality risk, may allow the early institution of intervention to improve outcomes. Thoracic Trauma Severity Score (TTSS) poses to be a precise tool in directing the management modality to be employed. Methodology This was an observational study including 112 patients of age >12 years, with blunt chest injury, sustaining ≤3 ribfractures, and with a stable chest wall. The patients with penetrating injury, those with blunt chest injury having flail segment, patients in the pediatricage group (<12 years), or polytrauma patients were excluded from our study. Of the 112 patients, 56 had been managed by intercostal drainage (ICD), and the rest (56) had been managed conservatively. Result Road traffic accidents (RTA) were the most common mode of injury in both groups. The percentage of the patients with one, two, and three ribfractures was57.14%, 32.14%, and 10.71%, respectively, in the ICD groupand 85.71%, 7.14%, and 7.14%, respectively, in the conservative management group (p = 0.124). The mean TTSS score was significantly more in the ICD group as compared to the conservative management group in the single rib fracture patients (p = 0.001*), as well as all patients of any number of rib fractures (p < 0.01*) (significance was defined as a value of p less than 0.05 {indicated by an asterisk}). The mean hospital stay was significantly lower in the conservative group as compared to the ICD group (p < 0.01*). The mean SF-36 (outcome) was significantly more in the conservative management group as compared to the ICD group (p = 0.020*). The mean cost of treatment was significantly more in the ICD groupas compared to the conservative management group (p < 0.001*). Conclusion In our study, a TTSS (as measured by the primary care surgeon) of >7, across any number of rib fractures, was preferably predictive of management by ICD, while a <7 value was favorable for conservative management. TTSS can be used as an important tool to predict the management modality in blunt chest injury patients with ≤3 ribfractures.

E079 Preliminary analysis of autoantibody profiles of autoimmune inflammatory myopathies: study from a single North Indian tertiary care centre

Abstract Background/Aims Studies in autoimmune inflammatory myositis (AIM) have shown a strong role of autoantibodies in the diagnosis and prognosis of patients with myositis. This ongoing study shares the preliminary data of 139 patients with AIM from a North Indian tertiary care centre. This prospective, observational study was conducted at a 1250-bedded hospital to assess the prevalence of myositis-specific antibodies (MSA) and myositis-associated antibodies (MAA) in patients from the Indian subcontinent with AIM and the correlation of these antibodies with clinical features. Methods From November 2016 to September 2022, patients with AIM (satisfying the Bohan and Peter criteria of 1975) attending the Rheumatology and Clinical Immunology Department of Medanta Hospital were included after taking their informed consent, and divided into subgroups as dermatomyositis (DM), polymyositis (PM), CTD-associated myositis (CTD-M), cancer-associated myositis (CAM), and juvenile myositis (JM). The Institutional Ethics Committee approved the study. Clinical data and sera from patients were collected and analysed. Results The study included 139 individuals with a mean age of 45.4 years. Fifty-two had DM, 49 had PM, 25 had CTD-M, 6 had CAM, and 7 had JM. ANA positivity was found in 67.70%, MSA in 22.3%, MAA in 25.4%, and both in 12.3%. Antibodies against Mi-2 were identified in 13 (28.9%) patients, Jo-1 in 14 (32.50%), PL-7 in 3 (6.7%), PL-12 in 4 (8.9%), SRP in 9 (20%), and MDA-5 and NXP2 in 1 (2.2%) patient each. Antibodies against Ro were found in 28 (57.1%) of the patients, RNP in 8 (16.3%), and PM-Scl in 9 (18.4%). Mi-2 antibodies were mostly identified in DM patients and were significantly associated with skin rash. SRP positivity was mostly found mainly in PM. Raynaud's and ILD were linked to the presence of Jo-1 and Ro antibodies. Malignancy screening was negative in NXP2 and TIF1γ antibody-positive patients. Conclusion MSA was found in 22.3% of cases and MAA in 25.4%. Mi-2 antibodies were linked to rash, but none had ILD, whereas Jo-1 antibodies were linked to mechanic hands, arthritis, and ILD. We aim to gather more strong results in the future as additional patients are recruited in this continuing trial. Disclosure S. Dhuria: None. P. Khatri: None. N. Negalur: None. K. Telang: None. S. Ghosh: None. D. Yadavalli: None. V. Singal: None. R. Gupta: None.

SDH-B, INSM1, and GATA3 expression in cauda equina neuroendocrine tumors: report on 21 cases from a North indian tertiary care center

Primary neuroendocrine tumors (NETs) of the central nervous system are rare, primarily seen in the cauda equina region, known as cauda equina NETs. This study was carried out to evaluate the morphological and immunohistochemical characteristics of cauda equina NETs. All cases of histologically proven NETs that originated within the spinal cord from 2010 to 2021 were retrieved from the surgical pathology electronic database. For each case, the clinical presentation, site, radiological features, functional status, and preoperative diagnosis were recorded. Immunohistochemical stains for GFAP, synaptophysin, chromogranin A, cytokeratin 8/18, INSM1, Ki-67, GATA3, and SDH-B were performed for every case using an automated immunostainer. GATA3 immunohistochemistry was repeated manually. A retrospective probe of records revealed 21 cases of NETs having a mean age of 44 years and slight male dominance (M:F ratio: 1.2:1). Cauda equina was the most prevalent site of involvement (19, 90.5%). The most typical presentation was lower backache and weakness of bilateral lower limbs. The histopathological features were similar to NETs seen at other sites. Reactivity for at least one neuroendocrine marker was seen in all cases while GFAP was negative. Cytokeratin 8/18 was expressed in the majority (88.9%) of cases. INSM1 and GATA3 expression was seen in 20 (95.2%) and 3 (14.3%) cases, respectively. All cases retained SDH-B cytoplasmic staining. Higher Ki-67 index (≥3%) was associated with a higher risk of recurrence. Cauda equina NETs rarely express GATA3 and are unlikely to be associated with SDH mutations. Recurrent cases may be negative for synaptophysin, chromogranin, and cytokeratin; thus, INSM1 immunohistochemistry is helpful.

Comparison of orthopedic trauma patterns in geriatric patients during COVID-19 pandemic led lockdown and non-lockdown periods

Background: Lockdown had hindered persons’ ability to engage in regular physical activity. Our study analysed bone trauma patients who visited the orthopedic department based on the mode of injury, kind of extremity involved, and the bone implicated. Methods: This was a retrospective cross-sectional study of patients visiting the orthopedic surgery department of a North Indian tertiary health care centre. Patient data was recorded from the case sheets. Results: A total of 792 patients’ data was collected, out of which 250 patients were those of during lockdown, and 542 patients were of non-lockdown phase. During the lockdown phase, the patients who have undergone RTA were 37 (14.8%), those admitted for domestic trauma were 128 (51.2%), and those for miscellaneous causes were 85 (34%). During the non-lockdown phase, RTA were 145 (26.739%), domestic were 318 (58.608%) and miscellaneous were 79 (14.652%). During lockdown, the site of injury was upper limb in 59 patients, lower limb in 154 patients, vertebrae in 37 patients. In the non-lockdown phase, the upper limb was injured in 95 patients, lower limb in 377 patients, vertebrae in 52 patients and hip bone in 17 patients. Femur was the most affected bone. Conclusions: There was a decrease in the number of instances during the lockdown. During both the periods, the majority of geriatric patients were from rural areas. Domestic trauma cases were most prevalent in the older age range, and the most common extremity implicated appeared to be the lower limb, with the femur being the most involved bone in both stages.

Prevalence and Complications of Subclinical and Overt Hypothyroidism in Pregnancy at North Indian Tertiary Care Center.

Thyroid disorders are one of the commonest endocrine problems among pregnant women. It is often argued that it is not only overt, but subclinical thyroid dysfunction also has similar adverse effects on maternal and fetal outcomes. There is a huge deficiency of data from the Indian population to assess the prevalence of thyroid dysfunction in pregnancy. This study aimed to determine the prevalence of thyroid disorders in pregnancy and their impact on obstetrical outcomes in the Indian population. The study also had the objective of finding a correlation between maternal and fetal thyroid-stimulating hormone (TSH) levels in hypothyroid pregnancies. Around 1055 pregnant women in the first and second trimesters were enrolled in the study. A detailed history was noted and general examinations were done. Apart from routine obstetrical investigations, TSH level estimation was done. If the TSH level was deranged, then free T4 (fT4) and free T3 (fT3) levels were also estimated. Furthermore, 50 hypothyroid and euthyroid pregnant women from the same cohort were followed till delivery. Their obstetrical and perinatal outcomes were noted. The prevalence of thyroid dysfunction was 36.5% in this study, which was quite high in the population. Moreover, hypothyroid groups were prone to have pregnancy-induced hypertension (P = 0.03), intrauterine growth restriction (P = 0.05), and preterm delivery (P = 0.04) as compared to control. Cesarean section rate for fetal distress was significantly higher among pregnant hypothyroid women (P = 0.05). Neonatal respiratory distress and low appearance, pulse, grimace, activity, and respiration (APGAR) () scores were significantly more in the hyperthyroidism group (P = 0.04 and P = 0.02, respectively). Maternal TSH was significantly correlated with hemoglobin levels, HbA1c, and systolic blood pressure. Significant adverse effects on maternal and fetal outcomes were seen emphasizing the importance of routine antenatal thyroid screening.

Detecting medication non-adherence in schizophrenia: A comparison of different methods among outpatients from a North Indian center.

The rates of medication non-adherence among Indian patients with schizophrenia are high, and its detection poses problems. Comparisons of suitable measures to detect medication non-adherence in schizophrenia from Indian outpatient settings are scarce. This study compared simple and inexpensive methods of detecting medication non-adherence in schizophrenia among outpatients from a tertiary-care center in North India. A longitudinal comparison of two self-reports, the Morisky Medication Adherence Questionnaire and the Drug Attitude Inventory-10, clinicians' ratings employing the Compliance Rating Scale, and clinic-based pill counts was conducted among 70 outpatients with schizophrenia. The rates and detection of medication non-adherence, associations with determinants of treatment non-adherence, and agreement between measures were examined at intake and after six months of follow-up (n = 53). The self-reports had greater ability to detect medication adherence (specificity 41-65%; positive predictive values 25-51%; negative likelihood ratios 0.86-1.14) and moderate ability to detect medication non-adherence (sensitivity 27-65%; negative predictive values 49-69%; positive likelihood ratios 0.78-1.10). They yielded higher medication non-adherence rates, detected changes in medication non-adherence over time, and were associated with the other measures and the well-known correlates of medication non-adherence. Clinicians' ratings and pill counts had high sensitivity (56-90%) but low specificity (35-49%) to detect medication non-adherence. Self-reports are comparatively better screening options for detecting medication non-adherence among Indian outpatients with schizophrenia. However, the sequential use of different measures could lead to better recognition of medication non-adherence.

Colistin Resistant Gram-Negative Bacteria Isolated from Various Clinical Samples in North Indian Tertiary Care Center

&gt;Background: Antibiotic resistance and their mischaracterization often lead to treatment failure. In the present scenario, resistance to colistin is emerging. Poor testing methods for colistin resistance detection can increase the risk of treatment failures and even mortality. In this study, we analyzed the burden of multidrug-resistant (MDR), Extensively drug-resistant (XDR), pandrug resistant (PDR), and colistin resistant Gram-negative bacteria and also evaluated Vitek-2 compact and Broth Microdilution (BMD) for the detection of colistin resistance at North Indian Tertiary-Care Hospital. Methods: A total of 11237 samples were processed in which 1822 (16.21%) were gram-negative bacilli (GNB). All GNB after identification by Vitek-2 compact, were subjected to antibiotic sensitivity testing by Vitek-2 and characterized as MDR, XDR, and PDR as per guidelines of Centers for Disease Control and Prevention US (CDC) and European Centre for Disease Prevention and Control (ECDC). Identification of colistin resistance in Enterobacteriaceae family, Pseudomonas aeruginosa, Acinetobacter baumannii was made by broth microdilution (BMD) method. BMD was used as a standard gold method for colistin resistance. Results: A total of 43.57% MDR, 9.49% XDR, and 3.5% PDR gram-negative bacteria was isolated from various departments and from various sites. Vitek-2 compact detected 47 (2.75%) and MBD method detected 38 (2.23%) colistin-resistant gram-negative bacilli. Vitek-2 compact failed to detect nine colistin-resistant organisms. The highest resistance towards colistin was seen in A. baumannii (6%), followed by P. aeruginosa (5%), Escherichia coli (1.07%), Klebsiella pneumonia (1%). Conclusions: There is a need for quick and efficient antibiotic resistance management efforts against colistin resistance. Vitek-2 compact gives unsatisfactory and inaccurate results in the detection of colistin susceptibility

Translation, Adaptation, and Validation of Hindi version of Quality of Life of the Infant (QUALIN) for Use in Infants and Toddlers.

To translate Quality of Life of the Infant (QUALIN), cross-culturally adapt the Hindi version of QUALIN (Hi-QUALIN), and evaluate its psychometric properties in children. This cross-sectional study was performed at the tertiary-care center in North India over 21 mo (April 2019 to January 2021). Healthy children (aged 3 to 36 mo) visiting the hospital for vaccination, minor ailments, routine health checkup, and accompanying an ill sibling were included. Children with infantile spasms in same age group were also included. Hindi translations were carried out by bilingual translators who could fluently communicate and write in Hindi and English. Standard Hindi was used to avoid the misinterpretation or misunderstanding. Discriminant and Construct validity was determined utilizing the known-groups method and factor analysis. Reliability was analysed as internal consistency and test-retest reliability. Four hundred and sixty-four children were recruited through opportunity sample selection method with statistically significant difference between healthy and unhealthy children in total score ofHi-QUALIN (3-12 mo) and (13-36 mo). Finally, Hi-QUALIN (3-12 mo and 13-36 mo) consisted of 29 and 30 items constituting the five extracted factors respectively. Overall internal consistency was excellent (α = 0.92 and 0.88, respectively). Intra-class correlation coefficients (ICC) were 0.84 (95% CI: 0.78-0.89; p <0.0001) and 0.94 (95% CI: 0.93-0.96; p <0.0001) indicating excellent test-retest reliability. Hi-QUALIN has good psychometric properties and can be used for health-related quality of life (HRQoL) measurement in young children.

COVID-19 in Children with West Syndrome: An Ambispective Study.

ObjectivesTo study the course of West syndrome (WS) and coronavirus disease-19 (COVID-19) in children with WS who contracted SARS-CoV-2 infection.MethodsThis ambispective study was conducted at a tertiary-care center in North India between December 2020 and August 2021 after approval from the Institute Ethics Committee. Five children with WS, positive for COVID-19 based on RT-PCR, fulfilled the inclusion criteria.ResultsOne child with COVID-19 during the first wave was retrospectively included while four children (of the 70 children screened) were prospectively enrolled. The median age at onset of epileptic spasms was 7 mo (2 boys), and that at presentation with COVID-19 was 18.5 mo. Three had underlying acquired structural etiology. Three were in remission following standard therapy, while two had ongoing spasms at the time of COVID-19 illness. During the illness, two of those in remission continued to be in remission while one child had a relapse. The children with ongoing epileptic spasms had variable course [one had persistent spasms and other had transient cessation lasting 3 wk from day 2 of COVID-19 illness, but electroencephalography (on day 8 of COVID-19 illness) continued to show hypsarrhythmia]. Fever was the most typical symptom (and sometimes the only symptom) of COVID-19, with a duration ranging from 1–8 d. Two children had moderate COVID-19 illness requiring hospitalization, while the rest had a mild illness. All the affected children had complete recovery from COVID-19.ConclusionThe severity of COVID-19 illness in children with WS is often mild, while the subsequent course of WS is variable.

Quantitative real-time PCR for the analysis of viral load among Hepatitis C Virus positive patients attending the medical Out Patient Department at a north Indian tertiary care centre

The present study aimed towards the determination of seroprevalence and viral load among hepatitis C virus (HCV) patients attending the Medicine Out Patient Department (OPD) of Government Medical College (GMC), Jammu over a period of two years and five months i.e. from May 2016 to September 2018. About 16315 patients were screened for anti-HCV antibodies using third-generation ELISA, among which 142 were reported to be positive amounting to seropositivity of 0.8%. Viral RNA was extracted and quantified from the positive samples and viral load analysis was done. The viral RNA was detected in 37 patients stating an active infection in 26% of positive patients. Among the 37 HCV RNA positive patients, the average age was reported to be 44 years with male preponderance (2.4:1). 23 patients were categorised under high viral load while 14 under low viral load. The major cause of HCV transmission appeared to be surgery and intravenous drug use (IVDU).

‘FLT3-ITD Mutation Does Not Influence Survival Outcome in Adult Acute Promyelocytic Leukemia Patients Treated With ATO and ATRA-Based Therapeutic Regimen: Experience From a North Indian Tertiary Care Centre’

IntroductionNPM1 and FLT3-ITD are frequently mutated genes in acute myeloid leukemia. We studied clinico-hematological profile and survival outcome of adult acute promyelocytic leukemia (APL) patients harboring these mutations. Materials and MethodsDe novo APL cases (> 12 years), enrolled between January 2019 and June 2020, were evaluated for FLT3-ITD and NPM1 mutations (A, B, D mutations) by conventional and real-time qualitative PCR respectively. ResultsFLT3-ITD mutation was detected in 12 of 36 (33.3%) de novo APLs cases while NPM1 mutation was not detected. FLT3-ITD was more frequently associated with Sanz high-risk category as compared to the intermediate-risk category (75% vs. 29%, P = .02), with BCR3 transcript type (P = .08) and higher median WBC count [22.7 × 109/L)(range 1.3-184), P = .018]. One and half-years overall survival (OS) and event-free survival (EFS) were not significantly altered by the presence/absence of FLT3-ITD mutation (OS 86% vs. 70%, P = .32; EFS 86% vs. 70%, P = .33), between genders (OS, EFS both 89% in males vs. 69% in females, P = .15) and between adolescent and younger adults (AYA) (≤ 30 years) and older adult APL cases (> 30 years) (OS 86% vs. 78%, P = .55; EFS 85% vs. 77%, P = .55), however were significantly lower with BCR3 transcript as compared to BCR1 transcript (OS 56% vs. 91%, P = .019; EFS 56% vs. 91%, P = .016) in univariate analysis, although not in multivariate analysis. One and half-year OS and EFS was 57% (6/14, P = .009 for each) in high-risk APL. ConclusionFLT3-ITD mutation did not influence survival outcome in adult APL treated with ATO and ATRA-based therapeutic regimen.

FETOMATERNAL OUTCOME IN ADOLESCENT AND YOUNG ADULT PRIMIGRAVIDAS: A HOSPITAL-BASED CASE-CONTROL STUDY

Adolescent pregnancies are considered high-risk, and create an enormous negative socioeconomic impact at an individual level, as well as on the society. According to WHO, 'adolescent pregnancy' refers to pregnancy between 10 and 19 years of age. The purpose of this study was to compare the fetomaternal outcome in adolescent and young adult primigravidas. The study was conducted at a tertiary care centre in India over a period of two years. Adolescent and young adult (20-25 years) primigravidas who delivered at our institution during that period were randomly selected for the study and compared using the chi-square test. Aim- To study and compare fetomaternal outcomes in adolescent (10-19 years of age) and young adult (20-25 years of age) primigravidas in a tertiary care centre in North-India over a period of two years ObjectivesŸ To assess and compare antepartum, intrapartum and postpartum complications, in adolescent and young adult primigravidas. Ÿ To asses and compare fetal outcomes in adolescent and young adult primigravidas

Profile of Pathogenic Mutations and Evaluation of Germline Genetic Testing Criteria in Consecutive Breast Cancer Patients Treated at a North Indian Tertiary Care Center.

BackgroundThe burden of hereditary breast cancer in India is not well defined. Moreover, genetic testing criteria (National Comprehensive Cancer Network [NCCN] and Mainstreaming Cancer Genetics [MCG] Plus) have never been validated in the Indian population.MethodsAll new female breast cancer patients from 1st March 2019 to 28th February 2020 were screened. Those providing informed consent and without previous genetic testing were recruited. Multigene panel testing (107 genes) by next-generation sequencing was performed for all patients. The frequency of pathogenic/likely pathogenic (P/LP) mutations between patients qualifying and not qualifying the testing criteria was compared and their sensitivity was computed.ResultsOverall, 275 breast cancer patients were screened and 236 patients were included (median age 45 years); 30 patients did not consent and 9 patients previously underwent genetic testing. Thirty-four (14%) women had a positive family history and 35% had triple-negative breast cancer. P/LP mutations were found in 44/236 (18.64%) women; mutations in BRCA1 (22/47, 46.8%) and BRCA2 (9/47, 19.1%) were the most common, with 34% of mutations present in non-BRCA genes. Patients qualifying the testing criteria had a higher risk of having a P/LP mutation (NCCN: 23.6% vs. 7.04%, p = 0.03; MCG plus: 24.8% vs. 7.2%, p = 0.01). The sensitivity of the NCCN criteria was 88.6% (75.4–96.2) and 86.36% (72.65–94.83) for MCG plus. More than 95% sensitivity was achieved if all women up to 60 years of age were tested. Cascade testing was performed in 31 previous (16/44 families), with 23 testing positive.ConclusionsThe frequency of P/LP mutations in India is high, with significant contribution of non-BRCA genes. Testing criteria need modification to expand access to testing.Supplementary InformationThe online version contains supplementary material available at 10.1245/s10434-021-10870-w.

Predictors of Mortality among Non Traumatic Non COVID Emergencies during Early COVID-19 Outbreak: An Observational Study on Clinical Profile and Outcome of Patients in North India

Context: Severe acute respiratory distress corona virus 2 (SARS COV 2) unleashed an unprecedented medical emergency and led to exemplary global containment response to limit the Corona Virus disease (COVID-19). These responses began in the initial phase of the pandemic itself and came at the cost of non-COVID hospital services. Aims: The aim of this study was to highlight the profile of patients, their outcomes and predictors of mortality in non-traumatic emergencies presenting to the non-Covid section of a north Indian tertiary care center during the early phase of COVID outbreak. Settings and Design: Single center observational study. Methods: After obtaining Institute ethics committee approval, data of patients presenting in emergency from February 1, 2020 to April 30, 2020 were obtained retrospectively. Patients coming with trauma related emergencies were excluded. Statistical analysis used: The data was categorized as survivors and non-survivors. Student t test/Mann Whitney test was used to compare continuous variables and Chi square test was used to compare categorical data. Univariate and multivariate binary logistic regression analysis were used to identify the predictors of non-survival. Results: Out of 800 patients admitted in emergency, 2 were found to be SARS COV2 positive. Of the remaining 798 patients, 27 (3.4%) patients expired. On multivariate analysis, greater age, hemoptysis, oxygen or ventilatory requirement and need of vasopressors at admission were predictors of non-survival. Conclusions: Greater age, need for oxygen, ventilator and vasopressors at time of admission are harbingers of mortality among non-Covid patients presenting in emergency.

155P Profile of pathogenic mutations and evaluation of germline genetic testing criteria in consecutive breast cancer patients treated at a North Indian tertiary care center

155P Profile of pathogenic mutations and evaluation of germline genetic testing criteria in consecutive breast cancer patients treated at a North Indian tertiary care center

Platelet Indices and Their Kinetics Predict Mortality in Patients of Sepsis.

Platelet indices are inexpensive, easily accessible parameters and potentially useful prognostic indicators in sepsis. In this study we explore the differences in platelet indices and their kinetics between sepsis survivors and non-survivors. A retrospective cohort-study of 97 cases of culture-positive sepsis at a tertiary-care center in North India. Demographics, clinical and laboratory parameters at admission were assessed. Platelet count (PLT), mean-platelet-volume (MPV), platelet-distribution-width (PDW) and plateletcrit (PCT) on admission, and third, fifth and last days of hospitalization were analyzed. Fractional change in platelet indices (ΔMPV72h, ΔPDW72h, ΔPCT72h, and ΔPLT72h) by day-3 were calculated. Unpaired and paired t-tests were used to compare survivors with non-survivors, and to study the change in platelet indices with time. Logistic regression was used for multivariate analysis. ROC-curves and optimum cut-offs to predict mortality were obtained. There were 64 survivors. Non-survivors had significantly higher ΔMPV72h, ΔPDW72h, day-1 MPV and PDW, and lower ΔPLT72h. MPV and PDW increased, and PLT decreased with time among non-survivors. Trends were reversed in survivors. Only MPV and PDW showed significant change by day-3. Both were independent predictors of mortality on multivariate analysis, alongside ΔMPV72h and ΔPLT72h. On ROC analysis, MPV, PDW, ΔMPV72h, ΔPDW72h and ΔPLT72h effectively predicted mortality. Cut-off for MPV was 10.25 fL (sensitivity = 93.9%, specificity = 60.9%), and PDW, 12.6% (sensitivity = 84.8%, specificity = 51.6%). A rise in MPV and a fall in PLT was associated with mortality in this study. MPV and PDW values at admission are effective predictors of mortality and may be used in conjunction with traditional parameters.