Tertiary Care Hospital In North India Research Articles

Association of Epstein-Barr virus (EBV) with nasopharyngeal carcinoma: Experience from a North Indian tertiary care hospital

IntroductionNasopharyngeal carcinoma (NPC), arising from nasopharyngeal epithelium is caused by Epstein-Barr virus (EBV). It is common in South China, South East Asia and North East India. The aim and objectives of this study were to determine the prevalence of EBV in formalin-fixed paraffin-embedded (FFPE) tissue sections of clinically suspected NPC patients, correlate the results of polymerase chain reaction (PCR) with histopathology findings, and to determine the utility of tissue EBV DNA as a diagnostic bio-marker. Materials and methods31 FFPE tissue samples were collected from clinically suspected NPC patients from April 2018–December 2019. Histopathological diagnosis was done by examination of Hematoxylin and Eosin stained slides. Presence of EBV was detected by EBNA-1 PCR. IHC was performed using EBV Latent Membrane Protein 1. ResultsOf the 31 clinically suspected NPC cases, 15 (48.4 %) were histopathological confirmed NPC. Of these15, 13 (86.6 %) were non-keratinising undifferentiated NPC, and one each were keratinising NPC and non-keratinising differentiated NPC respectively.EBV EBNA1 PCR was positive in 35.5 % (11/31) of clinically suspected NPC cases. Of the 11 PCR positive cases, 9 (81.8 %) were histopathological confirmed NPC.Of the 31 clinically suspected NPC cases, IHC was indicated in 23 biopsies. Of which, 12 (52.2 %) were positive for LMP1 in the abnormal cells. Of the 12 IHC positive samples, 10 were NPC cases. ConclusionEBV DNA as an indicator towards NPC among clinically suspected cases had a sensitivity of 60 % and specificity of 87.5 %. In this study, addition of EBV DNA detection by PCR from FFPE tissue sections could confirm EBV association in 20 % of cases where it was not detected by EBV LMP1 IHC, thus helped in increasing the detection of EBV positivity in NPC cases. Early diagnosis of NPC will improve the cure rate and hence reduce the morbidity and mortality rates.

Efficacy of a low dose of antivenom for severe neuroparalysis in Bungarus caeruleus (common krait) envenomation: a pilot study.

Despite the widespread use of antivenom for the treatment of snakebite envenoming in the Indian subcontinent, the ideal dose of antivenom has been a point of contention. Low-dose regimens can economize on a scarce resource in low- and middle-income countries. This study assessed the effectiveness of a low-dose (10 vials) antivenom regimen compared to the usual 20 vials in patients with krait bite neuroparalysis requiring mechanical ventilation. This study was a prospective controlled pilot study conducted in a tertiary-care hospital in north India. Participants were eligible if they were ≥12years old, had krait bite neurotoxicity, showed severe paralysis requiring mechanical ventilation, and had access to antivenom therapy within 24h of the bite. The primary outcome was the duration of mechanical ventilation, and the secondary outcomes were the length of hospital stay and in-hospital survival. Fifteen patients received 10 vials of antivenom, and 25 received 20 vials. The two treatment groups had similar baseline demographics, clinical and laboratory features, snakebite severity scores, and median time from snakebite to initiation of antivenom therapy. The low-dose regimen was as effective as the standard dose concerning the median duration of mechanical ventilation (41h vs. 55h, P=0.094), the median length of stay (78h vs. 85.5h, P=0.360), and in-hospital deaths (1 vs. 3, P=1.000). The incidence of ventilator-associated pneumonia was similar between the two groups (1 vs 3, P=1.000). A low dose of antivenom effectively treats patients with severe krait bite neuroparalysis.

Spectrum of Opportunistic Infections in People Living with HIV: A Tertiary Care Center Experience from North India

: Patients with human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) are proneto opportunistic infections (OIs) given their immunosuppressed state. OIs continue to cause morbidity and mortality in HIV/AIDS patients even after highly-active antiretroviral therapy (HAART); hence, attainment of the goals on health care programs,particularly in resource-poor countries, is hard to achieve. The prevalence of specific OIs varies in different countries and evenin different areas within the same country. Little information is available about the prevalence of OI in HIV patients fromdeveloping countries, especially India. Early diagnosis and prompt treatment contribute to increased life expectancy amonginfected patients delaying progression to AIDS. Hence, the present study was carried out to elucidate current frequencies andspectrum of OIs in HIV seropositive adult patients in Haryana and to evaluate the associated risk factors for OIs. Materialsand methods: This was a cross-sectional study carried out at the Dept. of General Medicine in a tertiary care hospital in NorthIndia. Basic demographic details, anthropometric measurements, symptoms of HIV/OI, clinical examination, biochemicalinvestigations and treatment details were recorded. Patients aged 18 to 70 years and HIV seropositive subjects were includedin the study. Results: The study found that about 53.21% of HIV/AIDS patients on ART had one or more OIs. Tuberculosis(TB) was the predominant OI identified, with a prevalence of 25.71%. Candidiasis and herpes zoster were the second and thethird most prevalent OIs at 13.8% (101/731) and 7.25% (53/731), respectively. Age (43.4 ± 10.7 years), low income, illiteracy,low socioeconomic status, initial 4 months since initiation of ART, CD4 count <200/mm3, body mass index of <18.5 kg/m², poorART adherence, hemoglobin, albumin were strongly associated with OIs. Conclusion: The present study shows that TB is thecommonest OI in adults and the overall population of people living with HIV (PLHIV) in Haryana and proves that OIs acrossdifferent patient groups vary significantly. Various factors like adherence to HAART, socioeconomic and education status ofpatients can influence the occurrence and outcome of these deadly infections.

Lipid Profile and Total Antioxidant Status in Major Depressive Disorder Patients in North Indian Tertiary Care Hospital: A Case Control Study

Lipid Profile and Total Antioxidant Status in Major Depressive Disorder Patients in North Indian Tertiary Care Hospital: A Case Control Study

Prevalence and socio-demographic causal factors associated with use of various psychoactive substances in patients seeking treatment from a deaddiction centre of a tertiary-care hospital in North India

Background: Substance abuse is a quiet, slowly expanding epidemic in any community. We sought to analyze the patterns among substance users seeking treatment from the community. Aim was to determine the sociodemographic causal factors and prevalence of substance use of those seeking treatment in the deaddiction centre of tertiary care hospital for one year. Methods: 670 patients of all age groups with substance dependence enrolling for treatment during 1 year period for the first time in a deaddiction centre of a tertiary-care hospital in north India were retrospectively evaluated. Data was coded and analyzed using SPSS 20. Results: Male subjects (97.3%) were predominant; with substance use being most prevalent among 31-40 years (31.6%). 43.9% subjects were educated upto higher secondary level. Tobacco (76.4%), alcohol (73.9%), cannabis (30%), opium (13.3%), volatile solvents (5.1%), and sedatives-hypnotics (4%) were the most prevalent substances used. 5.8% subjects were actively injecting drugs and had multiple high-risk behaviors. One-tenth subjects were found positive out of 9.4% that were screened for human immunodeficiency virus. Co-morbid mental illnesses like bipolar disorder (6.11%), Schizophrenia (5.8%), depression (2.8%), and somatoform disorder (2.8%) & medical illnesses like Hypertension (12.1%) and alcoholic liver disease (4.32%) were also seen. History of previous treatment and prior hospitalization for deaddiction was present in 26.3% and 11.6% subjects respectively. Conclusions: Among the at-risk population in the community, the parameters and causal factors associated with psychoactive substance users presenting to a deaddiction centre in tertiary care, need to be prioritized.

Antimicrobial Susceptibility Pattern and Prevalence of the Emerging Nosocomial Pathogen Achromobacter xylosoxidans in a North Indian Tertiary Care Hospital

Achromobacter xylosoxidans is an emerging nosocomial pathogen which is commonly found in the environment. In hospital settings, especially in ICU, it can be a cause of nosocomial infection. It is commonly found in the humidifiers in ICU settings and it is also commonly associated with the immunocompromised state of patient having comorbidities. The objective of the study was to study the prevalence of Achromobacter xylosoxidans and its antimicrobial sensitivity pattern. The Retrospective analysis was done of the culture reports positive for Achromobacter xylosoxidans by VITEK 2 method and its Antimicrobial sensitivity pattern was analysed from the period of September 2021 to February 2023.The maximum (54.54%) infection was seen in the age group >50 years. The maximum number (66.2%) of Achromobacter xylosoxidans were isolated from Suction tip, followed by blood (8%) and Tracheal Tip (5%). Surgical ICU contributed to the maximum number of infections i.e. 40.2%, followed by Respiratory ICU (22.1%). Maximum sensitivity was seen for Cotrimoxazole and Meropenem (around 80%), followed by Cefoperazone-Sulbactam (74%), Imipenem, Levofloxacin, Ceftazidime (around 65%). The sensitivity was minimal for Ceftriaxone (0%), Aztreonam (1.3%), and Gentamicin (5.2%). The most common risk factors/ comorbidities associated with Achromobacter infections was recent ICU admission (87.01%). The antibiotic sensitivity trends to all the antibiotics used, declined from 2021 to 2022. The antibiotic of choice to our conclusion is Cotrimoxazole, followed by Piperacillin-Tazobactam. Colistin should be kept as a reserve drug for the last resort treatment. The bacteria should not be ignored as it can lead to various opportunistic infections in immunocompromised patients, causing hindrance in the treatment.

Pulmonary Function in HIV-Infected Children at a Tertiary Care Hospital in North India: A Prospective Cross-Sectional Study.

Background The global burden of HIV remains significant, particularly in India. Antiretroviral therapy (ART) has improved outcomes for children with HIV, yet understanding the virus's impact on respiratory health is essential. Pulmonary complications, common in HIV-infected adults, are poorly understood in children. Despite India's high HIV prevalence, data on pediatric lung function are lacking. This study aims to evaluate spirometry-based pulmonary function in perinatally HIV-infected children, exploring associations with disease severity, immune status, and other factors. Methods This prospective cross-sectional study conducted in a North Indian tertiary care hospital aimed to assess pulmonary function using spirometry in children (6-18 years) with HIV infection. Ethical approval and informed consent were secured. Data on demographics, clinical history, CD4+ T-cell counts, and viral load were collected. Certified respiratory therapists performed spirometry using standardized protocols. Descriptive statistics were computed, and differences in pulmonary function based on CD4+ T-cell counts, viral load, and opportunistic infection were analyzed. The study adhered to ethical guidelines and maintained participants' confidentiality. Results This cross-sectional study enrolled 57 children (mean age 13.6±3.2 years) with HIV infection. Age distribution was <9 years (24.6%), 9-11 years (28.1%), and >11 years (47.4%). Males constituted 56.1%. The mean BMI was 15.92±2.78 kg/m². HIV viral load (87.23±56.28 copies/μL) and CD4 count (1146.32±103.98 cells/mm³) were recorded. ART duration averaged 6.21±1.36 years. Viral load groups were <1 (52.6%), 1-1000 (26.3%), and >1000 copies/μL (21.1%). CD4 categories were >500 cells/mm³ (47.4%), 200-499 (42.1%), and <200 cells/mm³ (10.5%). Spirometry showed 71.9% normal and 28.1% abnormal (mild/moderate obstruction: 18.8%, mild/moderate restriction: 81.3%). No significant spirometric differences were observed among CD4 or viral load groups (p>0.05), nor with opportunistic infections (p>0.05). Conclusion This study reveals complex associations between spirometric parameters and CD4 count, viral load, and opportunistic infections in children with HIV. Further research, including longitudinal studies, is needed to unravel the intricate interplay and improve management strategies for this population.

Radiotherapy for Geriatric Cancer Patients: Five-year Experience at a North Indian Tertiary Care Hospital

Background: The incidence of malignancy in elderly population in India has risen due to increased life expectancy, health awareness, and access to tertiary health care. Radiotherapy is the primary treatment modality in elderly cancer patients due to morbidity of surgery. We reviewed and analyzed clinical, disease and treatment profiles of geriatric population treated with conventional radiotherapy at our institute. Methodology: The clinical records of patients aged 70 years or more, treated from January 2015 to December 2019 were analyzed for patient characteristics (age, sex &amp; co-morbidities), disease characteristics (site, histology &amp; stage) and treatment characteristics (modality &amp; intent of treatment, radiation dose). Results: A total of 289 patients aged 70 years and above were treated during the study period. 69% were treated with curative intent, of which, 72.4% received definitive, 24.6% received adjuvant, and 3% received neoadjuvant radiotherapy. 31% were given palliative radiotherapy. The median age was 74.6 years with male: female ratio of 4.25:1. 21.4% of the study patients had co-morbidities. 14% patients were of early stage, 57% locally advanced and 29% had metastatic disease. 51% of the study population received concurrent chemotherapy along with Radiotherapy. 87.1% of those treated with curative intent &amp; 93.3% of patients treated with palliative intent, completed the planned radiotherapy regimen. Out of total 200 patients treated at our institute with Radiotherapy, 187 were prescribed concurrent chemotherapy, while it was exhibited to only 103 patients due to various factors like old age, poor performance status and co-morbidities. Conclusion: Our study showed a high degree of compliance amongst geriatric patients receiving radiotherapy treatment. Toxicity rates in geriatric population were not significantly higher than the overall population treated at our centre. Various factors like disease biology and stage and patient’s performance status, co-morbidities and life expectancy affect the decision making in deciding radiotherapy intent and schedules in cancer patients of geriatric age group. Combined decision making between patients, caregivers and oncologists is crucial in geriatric age group keeping in mind above mentioned factors.

Real-world data on renal transplantations from a tertiary-care hospital in North India, in context of Indian regulatory act-transplantation of human organs and tissues act (THOTA): A retrospective analysis

IntroductionRenal transplantation is the treatment of choice for patients suffering from end stage renal disease (ESRD). Indian regulations defined under Transplantation of Human Organs and Tissues Act (THOTA), 2014 restricts organ donations to near-related living donors to curb any malpractices like ‘paid donors’ in living-donor kidney transplantation (LDKT). The aim of our study was to look at real-world data of donor-recipient pairs and to identify relationship of donors (with their respective patients) and the common (or uncommon) DNA profiling methods used for supporting “claimed relationship” in accordance with the regulations. Material and methodsThe donors were categorized and grouped into near-related donor, donors other than near-related donors, swap donors and deceased donors. Claimed relationship was confirmed, commonly by HLA typing, using SSOP method. In few cases, which were uncommon (and infrequent), autosomal DNA analysis, mitochondrial DNA analysis and Y-STR DNA analysis were performed to support the claimed relationship. Data collected included age, gender, relationship, DNA profiling test method. ResultsAmong the 514 donor-recipient pairs evaluated, numbers of female donors out-numbered male donors. The decreasing order of relationships in near-related donor group were wife>mother>father>sister>son>brother>husband> daughter>grandmother. 11.9% of donors were in the category of donors other than near-related donors. In 97.86% cases, the claimed relationship was supported by HLA typing and in just 2.1% cases autosomal DNA analysis>mitochondrial DNA analysis> Y-STR DNA analysis, in this order, were performed to establish relationship. ConclusionThis study brought out gender disparity with women out-numbering men as donors. Among recipients, access to renal transplant was largely restricted to men. As far as relationship of donors to recipients was concerned, mostly near-related family members, like wife, were donors and claimed relationship was almost always (99%) was corroborated by HLA typing.

Mental health outcome in hospitalized COVID-19 patients: An observational analysis from North Indian tertiary care hospital

AimThe study investigate the severity of perceived stress and wide domains of psychiatric symptoms reported on initial screening in hospitalized patients of COVID-19 with a second aim to determine the role of sociodemographic factors and coping styles in the hospitalized patients of COVID-19. MethodTotal 224 patients of COVID-19 infection, hospitalized in various isolation facilities were assessed via web-based self-reported questionnaires on perceived stress scale, brief cope inventory, and DSM-5 crosscutting level-1 questionnaire. ResultsMajority of the patients reported moderate level of stress followed by mild and severe. Depression and Anxiety symptoms were most common psychopathologies though the patients have reported greater severity in various domains of psychiatric symptoms. Coping styles explains most of variance (64.8%) of the perceived stress. Similarly total PSS scores, coping styles, COVID-19 status and sociodemographic factors contributed significantly to the variance of all psychiatric symptoms. ConclusionFactors like female gender, being married, belonging to nuclear families, service class and urban domicile are the significant factors determining higher risk of stress and developing more psychopathologies. Furthermore, coping styles used by the patients have a greater moderating effect on mental health symptoms and their perceived stress which can be a major area for interventions to reduce the mental health morbidities.

A clinicoepidemiological study on topical steroid misuse in a tertiary-care hospital in North India and the role of dermoscopy as a non-invasive diagnostic modality

Background: Topical corticosteroids (TCs) are one of the most frequently prescribed medications by dermatologists, yet may lead to an array of side effects due to prolonged and improper use. Because of the easy availability of topical corticosteroids as over-the-counter medications in India, these drugs are misused and abused. Objective: The objective was to determine the extent and the side effect profile of topical corticosteroid misuse/abuse in patients attending the OPD, to determine the demographic data and the reason and source of procuring TCs, and to characterize the dermoscopic findings of TSDF. Materials and Methods: This was a prospective, cross-sectional, clinical study conducted over a period of two years in which a predesigned, questionnaire-based proforma was employed. Patients above the age of fifteen reporting to the OPD giving a history of the application of a steroid cream continuously or intermittently for the minimum duration of four weeks were included in the study. A total of two hundred patients who met the clinical criteria were subjected to dermoscopic examination with a handheld dermoscope (DermLite DL4; 3Gen, U.S.; 10×). Results: A total of 2400 patients (fifteen-year-old or older) were enrolled in the study, in which 65% of the patients were females while 35% were males. Mostly, the patients procured these medicines from the pharmacist or paramedic, followed by general practitioners. The most common indications for which topical preparations were used included acne, followed by photodermatoses and ephelides. Most of the patients used combination creams, followed by potent steroids such as clobetasol propionate and betamethasone valerate. The most common side effects were erythema (74%), followed by photosensitivity (49%), hypertrichosis (47%), telangiectasia (42%), acneiform eruption (33%), contact dermatitis (21%), wrinkles (23.50%), etc. The main findings noticed on dermoscopy were irregularly dilated, branching, tortuous vessels almost interconnecting with each other in 79.78%, followed by hypertrichosis in 56.34%, white structureless areas representing atrophy in 42.33%, red dots in 7.22%, and a reddish background in 92.20%. Conclusion: The rampant use of TCs by patients for a prolonged period of time leads to a variety of side effects. Due to the topographical location, the climate of the valley, and the lighter skin type of the local population, the indications for which TCs were employed in our study group and the side effect profile were unique from the rest of the country. Dermoscopy may play a vital role in improving the diagnostic accuracy of TSDF and help us to differentiate it from close mimics.

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

Fetal nasal bone length at 11-28 weeks in Indian fetuses

Objective: To establish the reference range of fetal NBL for Indian population and study the ethnic variation in fetal Nasal Bone Length.Methods: Prospective Observational Cohort Study was conducted at a North Indian tertiary care Hospital in fetuses at 11-28 weeks. Fetal Nasal Bone Length was measured in mid-sagittal section of the face using electronic callipers. Gestational age was calculated based on Last Menstrual Period (LMP) or first trimester scan when LMP was not known. A total of 250 fetuses were scanned followed by post-natal follow up clinical examination to rule out aneuploidies. Results: The NBL values showed positive linear correlation with gestational age. The median NBL values increased from 1.9 mm at 11-12 weeks till 8.0mm at 27-28 weeks. The NBLs in Indian fetuses were significantly shorter as compared to Western populations.Conclusion: An indigenous reference range for fetal NBLs at 11-28 weeks better suited to be used in Indian population.

Prevalence of iron deficiency anaemia in patients of cholelithiasis undergoing laparoscopic cholecystectomy

Background: Gallstone disease (GSD) is a very common condition worldwide and the key event in the cholesterol stone formation is the supersaturation of bile with cholesterol. The role of trace elements like iron, calcium has been suggested in the pathogenesis of gallstones. Both iron deficiency and GSD are more prevalent in India. With this background, we studied the frequency of iron deficiency anaemia in GSD patients.Methods: This prospective observational study enrolled 150 adult patients undergoing laparoscopic cholecystectomy for symptomatic GSD in a north-Indian tertiary care hospital. Complete hemogram, serum ferritin, iron and unbound iron-binding capacity (TIBC) were performed in all patients. To simplify interpretation, anaemia was defined as Hb &lt;12 gm/dl; iron deficiency was defined as either ferritin value lower than the reference range, or, if the ferritin was within the reference range, reduced % transferrin saturation with normal-or-high TIBC.Results: Anaemia was present in 66% and 77.3% were having iron deficiency; of which 84.5% were females. Iron deficiency with anaemia was present in 85.3%; therefore remaining patients had latent iron deficiency. Serum ferritin was normal or raised in 52 (68.1%) patients with iron deficiency, indicating that it is insensitive as a stand-alone test for iron deficiency.Conclusions: At a public health level, our results may suggest that addressing the problem of endemic iron deficiency may also reduce the possible development of GSD in the community. Thus, pre-operative assessment of iron status appears to be a cautious choice in all patients planned for cholecystectomy as indirectly it will address the problem of anaemia in the population.

Acquired demyelinating disorders of central nervous system: A pediatric cohort

<b>Objective</b>: This is a retrospective chart review of consecutive children with acquired demyelinating disorders presenting to a north Indian tertiary care hospital over 4 years. The aim of this review is to describe all the patients (with single event as well as those with recurrences) with detailed description of those who recurred. <b>Materials and Methods:</b> Overall 35 cases were reviewed and their clinical presentations, diagnosis, management, and follow-up are being presented. <b>Results</b>: Out of 35 cases, 24 did not show any recurrences (seven acute disseminated encephalomyelitis (ADEM) and 17 clinically isolated syndromes). Amongst the 11 patients with recurrent demyelination, majority were multiple sclerosis (8/11, 72.7%) followed by neuromyelitis optica (NMO; 2/11), and multiphasic ADEM (1/11). The median disease duration and follow-up since onset for those with recurrent episodes is 4 years (2.5-4.5 years). Steroids caused significant improvement in acute episodes of demyelination. However, recurrent demyelinating disorders like multiple sclerosis and NMO required long-term immunomodulation. Azathioprine currently is the most favored long-term immunomodulator used in NMO. Interferon-β and glatiramer acetate are currently recommended for multiple sclerosis. However, azathioprine may be a suitable alternative in a resource-limited setting. <b>Conclusion</b>: The consensus definitions for these groups of disorders need further validation in the pediatric age group. Studies with larger population size are required to characterize features that predict future recurrences.

Trends in Blood Stream Infections of Adolescents the Forthcoming Challenges in a North Indian Tertiary Care Hospital IGMC Shimla, India

Trends in Blood Stream Infections of Adolescents the Forthcoming Challenges in a North Indian Tertiary Care Hospital IGMC Shimla, India

Assessment of medication adherence among type-2 diabetes mellitus in a tertiary care hospital of North India.

Study was conductedutilizing a confirmed medication adherence scale to measure the socio-demographic profile, self-care, and medication adherence among Type-2 Diabetes Mellitus (T2DM) patients. The Fisher exact test was used to calculate the level of significance (P) using SPSS (Statistical Package for Social Sciences) Version 21.0. The research presented in this paper uses statistical evidence to assess the numerous aspects that may be linked to medication adherence. A prospective observational study was undertaken on participants visiting the outpatient department for 6months at a North Indian tertiary care hospital to investigate the pattern and quality of life associated with T2DM. The study examined those who had T2DM for more than 2years. At the time of the visit, subjects were interviewed using socio demographic information and a structured verified questionnaire. Fisher exact test was used to identify the parameters that were linked to medication adherence, with P0.05 being regarded statistically significant. A total of 350 T2DM outpatients were followed up on, with a male-to-female ratio of 1:0.95. A 13-item medication adherence scale was created and tested, revealing that approximately 32% of participants demonstrated high adherence to anti-diabetic drugs (score = 13). The P value was obtained using Fisher exact test for educational status, occupation, marital status, and the quantity and kind of anti-diabetic drugs was found to be 0.05. Only 32% of the respondents took their diabetes medication as prescribed, indicating the need to improve adherence among T2DM patients. The quantity and kind of anti-diabetic drugs, as well as the patients' educational status, occupation, and marital status, all demonstrated a statistically significant relationship with medication adherence.

Diagnostic accuracy and feasibility of portable sleep monitoring in patients with obstructive sleep apnea: Re-exploring the utility in the current COVID-19 pandemic.

Portable sleep monitoring (PSM) is a promising alternative diagnostic tool for Obstructive Sleep Apnea (OSA) especially in high burden resource limited settings. We aimed to determine the diagnostic accuracy and feasibility of PSM device-based studies in patients presenting for evaluation of OSA at a tertiary care hospital in North-India. PSM studies (using a Type-III PSM device) were compared for technical reliability and diagnostic accuracy with the standard laboratory-based Type-I polysomnography (PSG). Patients were also interviewed about their experience on undergoing an unsupervised PSM studies. Fifty patients (68% males) were enrolled in the study, of which only 30% patients expressed their concerns about undergoing unsupervised PSM studies which included safety issues, ease of use, diagnostic accuracy, etc. Technical acceptability criteria were easily met by the PSM studies with signal loss in 12% studies (complete data loss and inaccessible data in 6% studies), warranting repetition sleep studies in four patients. The overall sensitivity of PSM device (AHI ≥5) was 93.5% (area under curve; AUC: 0.87). The diagnostic accuracy was 68.5%, 80%, and 91.4% for mild, moderate, and severe cases of OSA, respectively. An overall strong correlation was observed between PSM-AHI (apnoea-hypopnoea index) and PSG (r>0.85, p≤0.001), especially in severe OSA. The observed sensitivity was >90% for AHI>20 (clinically significant OSA), with high specificity of 91% for severe OSA (AUC: 0.94, 0.97 for AHI>20, AHI>30 respectively). The overall Bland-Altman concordance analysis also demonstrated only a small dispersion for PSM studies with a Cronbach's coefficient of 0.95.Therefore, there is good diagnostic accuracy as well as feasibility of home-based portable sleep studies in Indian patients. It can be promoted for widespread use in high burden countries like India for diagnosing and managing appropriately selected stable patients with high clinical probability of OSA, especially during the ongoing crises of COVID-19 pandemic.

Occurrence of blaampC and blaESBLs in clinical bacterial isolates from a North Indian Tertiary Care Hospital

Occurrence of blaampC and blaESBLs in clinical bacterial isolates from a North Indian Tertiary Care Hospital

Bacteriological Profile & Antibiotic Sensitivity Patterns of Catheter Associated Urinary Tract Infection Isolates in a North Indian Tertiary Care Hospital –A Pilot Study

Bacteriological Profile & Antibiotic Sensitivity Patterns of Catheter Associated Urinary Tract Infection Isolates in a North Indian Tertiary Care Hospital –A Pilot Study