Postgraduate Institute Of Medical Education And Research Research Articles

Super-specialty Medical Teleconsultations to Remote Areas of Ladakh, India via E-Sanjeevani under Hub-and-Spoke Model: A Pilot Study

Objectives: To assess the feasibility, spectrum, outcomes and challenges of delivering super-specialty consultations to remote areas of the Union Territory (UT) of Ladakh through telemedicine. Design: Prospective, observational (descriptive), pilot study Methodology: Super-specialty medical teleconsultations were provided to healthcare providers in UT Ladakh by specialists in the Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh from October 2021 to May 2022, employing the hub-and-spoke model of the Ayushman Bharat Digital Mission. Doctor-to-doctor teleconsultations were initiated by treating doctors at healthcare facilities in UT Ladakh on the eSanjeevani™ platform. Audio-video model was used for teleconsultation and digitally signed prescriptions were shared. Setting: India – Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh (hub) and healthcare providers in UT Ladakh (spokes) Participants: Healthcare providers in UT Ladakh and specialists in the Department of Telemedicine, PGIMER, Chandigarh Interventions: Super-specialty medical consultations using telemedicine (eSanjeevani™ platform) Main Outcome Measures: Demand and spectrum of superspecialty teleconsultations, outcome of consults (whether managed successfully at teleconsultation level, or required referral for in-person visits), and technical challenges faced. Results: A total of 26 super-specialty teleconsultations were provided; 14 (54%) were for women. Patient distribution was uniform across all age groups. The super-specialty-wise distribution of consultations was - 9 from endocrinology, 9 from neurology, 3 from hepatology, 2 from cardiology, and 3 from neonatology. Reasons for seeking consultation were assistance in diagnosis (3, 12%), optimization of therapy (10, 38%), or both diagnostic evaluation and treatment optimization (13, 50%). Five cases (19%) were referred for physical visits to a higher center for advanced diagnostic testing like liver biopsy, brain biopsy, upper GI endoscopy, etc.; other cases were managed remotely. Problems with audio-visual connectivity were encountered in three patients. Conclusion: This pilot study demonstrates that complex, super-specialty medical consultations can be effectively delivered to remote areas through telemedicine. Future research should focus on assessing long-term outcomes, patient satisfaction, and cost-effectiveness to better evaluate the impact of this model.

Role of Cerebroplacental Ratio in Predicting Perinatal Outcome.

Objective Doppler velocimetry provides a sensitive, non-invasive, and safe method of surveillance of fetal hemodynamics and fetomaternal circulation. Cerebroplacental ratio (CPR) is an indicator of placental function and fetal maladaptation to placental insufficiency. Cerebroplacental ratio (CPR) is becoming a significant indicator of unfavorable pregnancy outcomes, which has implications for the assessment of fetal well-being. This study aimedto determine the cut-off value of the cerebroplacental ratio (CPR) in appropriate for gestational age (AGA) fetuses in high-risk mothers to predict adverse perinatal outcomes. We also compared the efficacy of CPR, umbilical artery pulsatility index (UmA PI), and middle cerebral artery pulsatility index (MCA PI) for predicting adverse perinatal outcomes. Design and setting This was a prospective observational study conducted at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. Methods A total of 100 women with singleton high-risk pregnancies were included in this prospective observational study. Obstetric ultrasound was performed at the time of recruitment, and fetal weight and CPR were noted. Based on fetal weight, patients were divided into AGA and fetal growth restriction (FGR) groups; CPR was measured; patients were followed up fortnightly; and outcomes were noted. Main outcome The effectiveness of CPR, UmA PI, and MCA PI for predicting poor perinatal outcomes and identifying the cut-off value of CPR in appropriate for gestational age (AGA) fetuses in high-risk mothers was assessed. Result The values of MCA PI, UmA PI, and CPR were statistically significant between AGA and FGR (p-value =.023, .002 and .0001), respectively. The cut-off value for CPR-detecting adverse outcomes in AGA was 1.49. It has sensitivity, specificity, positive predictive value, and negative predictive value of 67.5%, 68%, 71.69%, and 70.21%, respectively. Conclusion Cerebroplacental ratio (CPR) reflects both circulatory insufficiency of the placenta and adaptive changes of the middle cerebral artery, indicating an important non-invasive surveillance modality.

Three-PointUltrasonography for Confirmation of Endotracheal Tube Position in Children (TRUCE Study).

To investigate the diagnostic accuracy of three-point ultrasonography for confirmation of endotracheal tube (ETT) position among children undergoing endotracheal intubation (ETI) with chest radiograph as reference standard. This prospective observational study was conducted from January 2021 through December 2021 (12 mo) in the pediatric emergency room (PER) and pediatric intensive care unit (PICU), Division of Pediatric Critical Care, Advanced Pediatrics Centre (APC), Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. Children aged 3 mo to 12 y, undergoing ETI in PER or PICU were included. Three-point ultrasonography (suprasternal notch and bilateral anterior chest) was done following ETI for confirmation of correct ETT position. Chest radiograph was used as a reference standard. Interobserver agreement between two investigators (IG and SKA) (kappa statistic) was determined for three-point ultrasonography to confirm the correct ETT position. One hundred fifty-five children with median (IQR) age of 4.5 (1-7) y were enrolled; 60% (n = 94) were males. On neck ultrasound, bilaminar sign was present in 100% of children. On lung ultrasound, bilateral and unilateral pleural sliding were present in 97.4% and 2.6% children, respectively. Three-point ultrasonography identified the correct position of ETT in 97.4% children as compared to 83.2% on chest radiograph. Sensitivity of three-point ultrasonography to identify the correct position of ETT was 98%. The interobserver agreement between two examiners was 96.8% (kappa of 0.53, p = 0.000). Three-point ultrasonography is an effective, sensitive, safe, and reproducible bedside method for identification of correct placement of ETT in children admitted to PER and PICU.

Segmentation of retinal blood vessels by a novel hybrid technique- Principal Component Analysis (PCA) and Contrast Limited Adaptive Histogram Equalization (CLAHE).

Diabetic Retinopathy is a persistent disease of eyes that may lead to permanent loss of sight. In this paper, methodology is proposed to segment region of interest (ROI) i.e. new blood vessels in fundus images of retina of Diabetic Retinopathy (DR). The database of 50 fundus retinal images of healthy subjects and DR patients is fetched from Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. The experimental set up consists of three set of experiments for the disease. For DR, in the first stage of automated blood vessel segmentation, gray-scale image is produced from the colored image using Principal Component Analysis (PCA) in the preprocessing step. The contrast enhancement by the Contrast Limited Adaptive Histogram Equalization (CLAHE) highlights the retinal blood vessels in the gray-scale image i.e. it unsheathed newly formed retinal blood vessels whereas PCA preserved their texture and color discrimination in DR images. The expert ophthalmologist(s) scrutiny on both internet repository and real time data acted as the gold standard for further analysis and formation of the proposed method. Further, ophthalmologists ascertained the forming of new blood vessels only on the disc region and divulging them, which were impossible with the naked eye. These operations help in extracting retinal blood vessels present on the disc and non-disc region of the image. The comparison of the results are done with the state of art methods like watershed transform. It is observed from the results that the new blood vessels are better segmented by the proposed methodology and are marked by the experienced ophthalmologist for validation. Further, for quantitative analysis, the features are extracted from new blood vessels as they are crucial for scientific interpretation. The results of the features lie in permissible limits such as no. of segments vary from 2 to 5 and length of segments varies from 49 to 164 pixels. Similarly, other features such as gray level of new blood vessels lie in 0.296-0.935 normalized range, coefficient with variations in gray level in the range of 0.658-10.10 and distance from vessel origin lie in the range of 56-82 pixels respectively. Both quantitative and qualitative results show that the methodologies proposed boosted the ophthalmic and clinical diagnosis. The developed method further handled the false detection of vessels near the optic disk boundary, under-segmentation of thin vessels, detection of pathological anomalies such as exudates, micro-aneurysms and cotton wool spots. From the numerical analysis, ophthalmologist extracted the information of number of vessels formed, length of the new vessels, observation that the new vessels appearing are less homogenous than the normal vessels. Also about the new vessels, whether they lie on the centre of disc region or towards its edges. These parameters lie as per the findings of the ophthalmologists on retinal images and automated detection helped in monitoring and comprehensive patient assessment. The experimental results show case that the proposed method has higher sensitivity, specificity and accuracy as compared to state of art methods i.e. 0.9023, 0.9610 and 0.9921, respectively. Similar results are obtained on retinal fundus images of PGIMER Chandigarh with sensitivity-0.9234, specificity-0.9955 and accuracy-0.9682.

A prospective survey on trephine biopsy of bone and bone marrow: an experience with 274 Indian patients’ biopsies

Trephine bone marrow biopsy is an effective technique for diagnosing hematological malignancies in patients of different ages. During trephine biopsy, bone marrow cores are obtained for detailed morphological evaluation to look for any abnormality and arrive at a diagnosis. The primary goal of this work is to perform a survey on Indian patients of various ages for the trephine bone marrow biopsy process. In the present study, data related to 274 trephine biopsy samples from 300 patients were acquired at the Post Graduate Institute of Medical Education and Research (PGIMER) in Chandigarh, India. Pain was found to be the sole major procedure-related complication, and patients reported no/less pain in 41 BMB (14.96%) patients, moderate pain in 82 (29.92%) cases, and unbearable pain in 151 (55.1%) BMB cases. In addition, the patients were evaluated by the authors and hematologist as non-anxious for the procedure in 34 (12.4%), anxious in 92 (33.57%), and very/highly anxious in 148 (56%) cases. The bone texture of the patients significantly affected the needle bending, number of repetitions required, and size of the bone marrow sample. This demonstrates the need for improvement in the biopsy procedure. To this end, a survey was conducted to assess the numerous difficulties and diagnostic outcomes throughout the trephine biopsy process.

Doffing Corridor: Establishing Expedited High-Volume Doffing With Exposure Reduction to Contaminated Personal Protective Equipment (PPE) in a COVID-19 Hospital in India.

Background Considering the virulent nature of the COVID-19, the safety of healthcare workers (HCW)became a challenge for hospital administrators. Wearing a personal protective equipment (PPE) kit, called donning, which can be easily done by the help of another staff.But correctly removing the infectious PPE kit (doffing) was a challenge. The increased number of HCWs for COVID-19 patient care raised the opportunity to develop an innovative method for the smooth doffing of PPEs. Objective We aimed to design and establish an innovative PPE doffing corridor in a tertiary care COVID-19 hospital during the pandemic in India with a heavy doffing rate and minimize the COVID-19 virus spread among healthcare workers. Methodology A prospective, observational cohort study at the COVID-19 hospital, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India, was conducted from July 19, 2020, to March 30, 2021. The time taken for PPE doffing process of HCWs was observed and compared between the doffing room and doffing corridor. The data was collected by a public health nursing officer using Epicollect5 mobile software and Google forms. The following parameters, like grade of satisfaction, time and volume of doffing, the errors in the steps of doffing, rate of infection, were compared between the doffing corridor and the doffing room. The statistical analysis was done by the use of SPSS software. Result 'Doffing corridor' decreased the overall doffing time by 50% compared to the initial doffing room. The doffing corridor solved the purpose of accommodating more HCWs for PPE doffing and an overall saving of 50% time. Fifty-one percent of HCWs rated the satisfaction rate as Good in the grading scale. The errors in the steps of doffingthat occurred in the doffing process were comparatively lesser in the doffing corridor. The HCWs who doffed in the doffing corridor were three times less likely to get self-infection than the conventional doffing room. Conclusion Since COVID-19 was a new pandemic, the healthcare organizationsfocused on innovations to combat the spread of virus. One of these was an innovative doffing corridor to expedite the doffing process and decrease the exposure time to the contaminated items. The doffing corridor process can be considered at a high-interest rate to any hospital dealing with infectious disease, with high working satisfaction, less exposure to the contagion, and less risk of infection.

Transarterial Embolization of Pulmonary Sequestration

HomeRadioGraphicsVol. 43, No. 2 PreviousNext Letter to the EditorTransarterial Embolization of Pulmonary SequestrationAkshay Kumar Saxena, Niveditha Naik, Anmol Bhatia , Nidhi Prabhakar, Kushaljit Singh SodhiAkshay Kumar Saxena, Niveditha Naik, Anmol Bhatia , Nidhi Prabhakar, Kushaljit Singh SodhiAuthor AffiliationsDepartment of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, Indiae-mail: [email protected]Akshay Kumar SaxenaNiveditha NaikAnmol Bhatia Nidhi PrabhakarKushaljit Singh SodhiPublished Online:Jan 26 2023https://doi.org/10.1148/rg.220204MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In

Analysis of Risk Factors and Outcomes of Fontan Procedure in Single Ventricular Repair: A Retrospective Observational Study

Introduction: The Fontan operation is a surgical technique used to treat cyanotic heart diseases with single ventricle physiology. Although it has undergone several modifications since its inception in 1971, it is still associated with significant morbidity and mortality. Aim: To examine the outcomes of the Fontan operation and identify various risk factors associated with it. Materials and Methods: This retrospective observational study was conducted at the Postgraduate Institute of Medical Education and Research (PGIMER) in Chandigarh, India from January 2014 to December 2017. All patients who underwent the Fontan operation at PGIMER were included in the study. The study analysed outcomes such as survival, arrhythmias, neurological complications, heart failure, cirrhosis, and Protein Losing Enteropathy (PLE) following the Fontan operation. Various risk factors that could potentially influence the outcome of the Fontan operation were assessed, including preoperative, intraoperative, and postoperative factors. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software, version 25.0. The Chi-square test was utilised to determine predictors of survival and other longterm outcomes, with a p-value of <0.05 considered statistically significant. Results: A total of 35 patients underwent the Fontan operation during the study period and completed five years of follow-up. Out of these, 28 were known to be alive at the last contact. There were six early deaths (less than one year). The overall oneyear and five-year survival rates from the time of the operation were 29 (83%) and 28 (80%), respectively. Graft thrombosis/ thromboembolism was observed in three cases (8.6%) and neurological complications in three cases (8.6%) during the early postoperative period. Arrhythmias in 6 cases (14%) were the most common late postoperative complication. Conclusion: The Fontan procedure is currently the best available palliative treatment for cyanotic heart diseases with single ventricle physiology. Patient selection is crucial in this procedure, as the presence of risk factors may adversely affect the outcome.

The minimal important difference of six-minute walk test in subjects with chronic pulmonary aspergillosis treated with six-months of oral itraconazole.

The minimal important difference of six-minute walk test in subjects with chronic pulmonary aspergillosis treated with six-months of oral itraconazole.

Genotyping Indian patients with primary cardiomyopathies-analysis of database

IntroductionEach population has its own unique genotype. Genotyping data on Indian cardiomyopathy patients is lacking. MethodsWe aimed to create and analyse a database of sequence variations in Indian patients with primary cardiomyopathies. This included all data of the cardiomyopathy cohort at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh. In addition, all published papers in Pubmed containing sequence variations in Indian cardiomyopathy patients till December 2020 using specific search terms were included. Affected genes and sequence variations, methodologies and quality of clinical data was analysed. Novel sequence variations were documented. ResultsA database of 493 datasets including 417 different sequence variations was created. Of these, the PGIMER database had 137 datasets consisting of 94 different variants. Only 63 publications included genotyping data of Indian cardiomyopathy cohort from 2000 to 2020 reporting 335 sequence variations. Five (7.9%) studies were from institutions abroad. Of published variations, 35.1% were novel. Most studies carried out selective genotyping. Comprehensive genotyping using cardiomyopathy panels or whole exome sequencing was reported in only 9 (14.3%) publications. ConclusionDatabase of 417 different sequence variations in Indian cardiomyopathy patients was analysed. Over a third of all reported sequence variations in Indians were novel.

PP076 [Combined Organ Systems » Renal / Electrolytes imbalance]: RESTRICTED VERSUS LIBERAL MAINTENANCE FLUID STRATEGY IN MECHANICALLY VENTILATED CHILDREN: AN OPEN-LABEL RANDOMIZED TRIAL

Division of Pediatric Emergency and Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

Stress Level of Parents of Hospitalized Preterm Neonates

Background: Preterm birth is an unexpected event, which is very stressful for the parents and family members as they are never prepared for this situation. The major stressors of parental stress such as the appearance of the neonate, neonatal intensive care unit (NICU) environment, condition of the neonate, behaviour of care professionals and financial implications are well documented. Objective: To assess the level of stress among the parents of preterm hospitalized neonates admitted in the NICU, Nehru Hospital, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh. Methods: Data were collected by interviewing 17 parents on the fifth day of admission to the NICU, PGIMER, Chandigarh, after taking informed written consent from them. The Parental Stress Scale–NICU (PSS-NICU) and the fathers stress scale were used to assess the stress level of parents of hospitalized preterm neonates. Data were analysed by using SPSS (version 20). Results: The mean age of mothers was 28.24 ± 4.96 and that of the fathers was 30.29 ± 4.25. The total mean mothers’ stress score was 171.76 ± 33.44, and the total mean fathers’ stress score was 125.02 ± 36.16. Conclusion: The study showed that mothers and fathers were very stressful during the period of hospitalization of their preterm neonates.

P411 Genus specific real-time PCR-a promising technique for rapid diagnosis of fungal keratitis

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PMObjectiveComparison of different existing molecular methods for diagnosis of fungal keratitis (FK) and to develop and validate genus-specific PCR for identification of most predominant FK causative agents.MethodA prospective multicentric study was performed between November 2019 to August 2021 from four centers across India. Corneal tissue/scraping samples were collected from patients with suspected keratitis for preliminary microbiological workup at respective centers and molecular diagnosis at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh. A total of 87 corneal button samples were used for standardization. All samples were subjected to DNA extraction followed by molecular diagnosis using pan-fungal primers by conventional PCR, semi-nested PCR, and real-time PCR targeting the internal transcribed spacer (ITS) region of rDNA. The genus-specific primers for the most common causative agents of FK (Aspergillus sp., Fusarium sp., Alternaria sp., and Curvularia sp.) were designed in ITS2 region and standardized for real-time PCR. The best performing protocol was validated in 145 corneal samples.ResultA total of 68 patients out of 87 were diagnosed with FK of which 91.17% (n = 62/68) were microscopy positive and 82.3% (n = 56/68) were culture positive. Among the culture positive, the most common isolate was Aspergillus sp. (26, 46.42%) followed by Fusarium sp. (21, 37.5%) while the remaining samples grew dematiaceous fungi. Real-time PCR targeting ITS2 region proved to be most sensitive (52.94%) and specific (84.21%) compared with conventional PCR and semi-nested PCR. Genus-specific real-time PCR for Aspergillus sp. and Fusarium sp. showed improved sensitivity and specificity of 82.76%, 87.18%, and 90.91%, 93.48% respectively compared with all other diagnostic methods used in the study. The positive (PPV) and negative predictive value (NPV) for Aspergillus sp. specific PCR were 82.76% and 87.18% while Fusarium sp. specific PCR showed PPV of 86.96% and NPV of 95.56%. Genus-specific real-time PCRs did not show any amplification of 19 FK negative samples while faint amplification was observed in conventional PCR which on sequencing proved to be non-specific. No cross-reactivity was observed in clinical sample standardization. Due to the lack of Alternaria sp. and Curvularia sp. positive clinical samples, both PCRs were standardized using respective culture DNA which showed a positive result. Aspergillus sp. and Fusarium sp. genus-specific PCRs were further validated in 145 corneal samples, of which 91 were FK positive and showed similar results as that of standardization data. Genus-specific PCRs also reduced the turnaround time (˂24 h) by decreasing the need for the identification of causative agents.ConclusionReal-time PCR targeting ITS 2-region, particularly the genus-specific PCRs proved to be the most efficient for molecular diagnosis of FK. The genus-specific PCRs reduce the turnaround time by avoiding the need for sequencing and thus facilitating in rapid diagnosis of FK.

Impact of covid 19 pandemic on severe maternal outcomes -An observational study from a referral institute of India

IntroductionCovid 19 pandemic has taken the world by storm. As far as maternal health is concerned, it has been affected both directly and indirectly. Not only are the women getting affected by COVID disease but also the health services are suffering in terms of availability, approachability and access. The study aimed to analyze the change in the trends of maternal near and maternal mortality comprising severe maternal outcome (SMO) between 2019 and 2020 in the department of obstetrics and gynaecology of our hospital due to COVID pandemic. MethodsThis retrospective study was conducted in the Obstetrics and Gynaecology department of Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh. The maternal death review data and maternal near miss statistics were analysed. This included assessing the change in the number of maternal deaths and obstetric near miss, their respective causes, and case fatality rate specific to COVID during pregnancy. ResultsThe total births decreased from 6056 in 2019–4140 in 2020 whereas women with severe maternal outcomes increased from 4.6% in 2019 to 6.5% in 2020(p value < 0.001). The incidence of nearmiss increased significantly from 3.5% in 2019 to 5.1% in 2020(p value < 0.0001) and maternal mortality ratio increased from 1122 per 1 lakh births to 1425 per 1 lakh births. Haemorrhage was the most common cause of maternal near miss with 45.8% in 2019 and an increase to 50.2% in 2020. The percentage of illiterate patients with near miss statistically reduced in 2020(p value - 0.004). Average hospital stay also reduced from 16.5+/-2.1 days to 12.6+/-6.3 days (p value < 0.0001). The average time taken to reach the hospital, however, increased from 27+/-3 h to 36+/-4 h (p value < 0.0001). The rate of direct maternal deaths increased from 45.6% to 52.5% between 2019 and 2020(p-value-0.434). ConclusionCovid 19 pandemic has affected both maternal mortality and morbidity. Keeping the current situation in mind, it becomes increasingly important to develop patient education via electronic media and teleconsultations. One-stop portals and helplines which involve multidisciplinary teams should be available to all such pregnancies.

Intrathecal 2% prilocaine for elective caesarean section - shorter is not necessarily better.

From the Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, Punjab, India (VA) Correspondence to Vighnesh Ashok, Department of Anaesthesia and Intensive Care, Level 4, Nehru Hospital, PGIMER, Chandigarh 160012, Punjab, India E-mail: [email protected]

POS-811 A RETROSPECTIVE STUDY TO ASSESS DROPOUT RATE AND ITS CAUSES IN LIVING DONOR TRANSPLANT PROGRAM IN INDIA

Kidney transplant programs in developing countries rely heavily on living donor programs. Though increasing, deceased donor programs are still in infancy due to resource constraints and social or cultural barriers against deceased organ donation. As the burden of end-stage kidney disease (ESKD) is rising, the waiting times for transplants in living donor kidney transplant programs in public sector hospitals are increasing. A significant proportion of patients who do register with provisionally eligible living kidney donors ultimately do not receive transplants. Therefore, we decided to explore the reasons for dropout from the living donor kidney transplant program at a large public sector hospital in India. The study was done at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. At PGIMER, living kidney donors are provisionally registered in the program after ruling out kidney disease and its risk factors. Thereafter, the recipient-donor pairs are extensively evaluated. The priority is decided by the date of donor registration. Retrospectively, we looked at all the provisionally eligible recipient-donor pairs registered between 1stJanuary 2018 and 31stDecember 2019. Pairs who did not undergo a kidney transplant at our center were contacted and reasons for the same were noted. A total of 576 eligible recipient-donor pairs were registered between 2018 and 2019. 252 (43.8%) underwent a living donor kidney transplant at our center (figure 1). The median waiting period from the time of registration to the date of the transplant was 246 days (IQR 133 days). 130 (22.6%) pairs could not be reached despite repeated attempts. Out of the remaining 194 (33.7%), 33 underwent a kidney transplant with the same donor at a private center due to long delays at our center. In the remaining 161 pairs, reasons for not getting the transplant were as follows: 73 (12.7%) recipients died while they were waiting for the transplant, donors were detected to be medically or surgically unfit in 44 (7.6%) pairs at subsequent evaluation, 12 (2%) had a positive crossmatch and 15 (2.6%) recipients changed their mind and continued hemodialysis. Other reasons included poor finances, legal issues in approval of donor, and death of other kidney paired donation (KPD) recipients thereby leaving the first recipient without an eligible living donor. 56.2% of living kidney recipient-donor pairs dropped out of living donor kidney transplant program at a large public sector hospital in India. 22.5% could not be contacted while 5.7% went on to get the transplant at a private center. 12.7% died while waiting to get a slot for surgery. Despite the availability of living kidney donors, 36% (161/446) failed to get a transplant. It is likely that the outcomes would be at least similar in the group that could not be contacted. The data suggest an urgent need for upscaling living donor kidney transplant programs, laying the foundation for quality improvement (QI) initiatives to optimize resource utilization and hence, improve accessibility in living donor transplant programs.

Molecular detection and characterization of dengue isolates circulating in north India.

Background and Objectives:In recent decades, the incidence of dengue has increased dramatically. In dengue-endemic countries, changes in dengue virus serotypes, genotypes, and lineages have been reported. This study was designed to detect and characterize the dengue virus isolates circulating in North India by serological and molecular techniques.Materials and Methods:This study was conducted at the Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. NS1 antigen and IgM antibody against dengue were detected by ELISA methods, viral RNA was extracted and amplified by conventional PCR and one-step single-tube multiplex PCR. The purified PCR products were cycle sequenced and a database search was implemented for the confirmation of the sequence product. Phylogenetic analysis was carried out with previously reported sequences.Results:Among 1509 samples, 205 (13.6%) were found positive for IgM antibodies with the highest number (n=67) among the 21 to 30 years age group with peak positivity during post-monsoon months. Among acute samples, NS1 antigen was positive in 62.9%. Seven patients out of 13 had dengue viral RNA in PCR. It comprised six DENV-2 serotypes and one DENV-3 serotype. On phylogenetic analysis, DENV-2 strains grouped with genotype IV and DENV-3 with genotype III.Conclusion:Dengue infection was found frequently during post-monsoon season. The positivity rate of the dengue NS1 antigen test was greater than that of the antibody test. The dengue isolates were characterized as genotype IV and genotype III of DENV-2 and DENV-3 respectively.

Covid-19 and Psychology: A Scientometric Assessment of India’s Publications during 2020-21

International Journal of Medicine and Public Health,2022,12,1,1-7.DOI:10.5530/ijmedph.2022.1.1Published:January 2022Type:Review ArticleCovid-19 and Psychology: A Scientometric Assessment of India’s Publications during 2020-21Sandeep Grover, BM Gupta, Madhu Bansal, and K.K. Mueen Ahmed Sandeep Grover1,*, BM Gupta2, Madhu Bansal3, K.K. Mueen Ahmed4 1Post Graduate Institute of Medical Education and Research, Chandigarh, INDIA. 2Formerly with CSIR-NISTADS, New Delhi 110012, INDIA. 3Panjab University, Department of Mathematics, Chandigarh, INDIA. 4Phcog.Net #17, Cox Town, Bengaluru, Karnataka, INDIA. Abstract:Objectives: The present study examines the publication output of authors from India on the topic of “Covid-19 and Psychology” using bibliometric methods. Methods: The publications as listed in Scopus database were identified by using “Covid-19” and its synonyms keywords in “Keyword” and “Title” tags. The results obtained were further restricted to subject “Psychology” under subject tag and country to India. Results: 372 publications emerged in the last 2 years on the topic of “Covid-19 and Psychology”, accounting to 4.63% share of global output. About 9.95% and 25.81% share of Indian publications received external funding support and involved international collaboration, respectively. The author’s from 277 organizations and 416 authors participated unevenly in the research in this area. The highest number of publications emerged from National Institute of Mental Health and Allied Sciences (NIMHANS), Bangaluru, followed by Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, All India Institute of Medical Sciences (AIIMS), New Delhi and All India Institute of Medical Sciences (AIIMS), Bhubaneswar. Authors from Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry had highest impact in terms of citations per paper and relative citation index, followed by authors from King George’s Medical University (KGMU), Lucknow, and Manipal Academy of Higher Education (MAHE), Manipal. The journals that published the highest number of publications were Asian Journal of Psychiatry (158 papers), Indian Journal of Psychological Medicine (44 papers), and Frontier in Psychology (18 papers). The most commonly investigated topics in terms of frequency of appearances of keywords were mental health (93), followed by anxiety (80), mental disease (68), depression (64), mental stress (34), and social isolation. Conclusion: Over the last 2 years a large number of publications have emerged in the area of COVID-19 and psychology from India. Keywords: Covid-19, Psychology, India, Bibliometrics, Scientometrics. Keywords:Bibliometrics, COVID-19, India, Psychology, Scientometrics.View:PDF (579.03 KB)

Ensconcing a biostatistics clinic in tertiary care research institute of India: A descriptive study.

ABSTRACTContext:Data collection and statistical analysis are integral components of research. The beauty of statistics lies in its ability to evaluate evidence in the face of uncertainty. However, lack of dedicated biostatistical consultation units, rote academic teaching and training lead to poor statistical analysis. Thus, we aim to explore and understand the challenges of establishing a Biostatistics Clinic (BC) in a tertiary care research institute. A secondary aim is to identify the stage of research at which participants approach biostatisticians.Material and Methods:The data for the current study came from a consultancy unit named as “Biostatistics Clinic” in the department of biostatistics from Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. The residents and students who approached the department of biostatistics for consultancy regarding study design, sample size, statistical analysis and other analytical work were the sampling unitsResults:A total of 208 residents and students made 404 visits to biostatistics clinic. The male and female visits were 118 (56.7%) and 90 (43.5%), respectively. Majority of visitors approached for data analysis (171; 75%) followed by study design and sample size calculation for protocol preparation (43; 18.9%). Leading reference to approach the biostatistics clinic was through a faculty (91; 43.8%) followed by self (54; 26%)Conclusion:Despite the thrust and apparent advantages of contacting statistician at the beginning of the study, majority approached only at the data analysis stage. Therefore, repeated and improved efforts are required to spread the message of approaching statistician early.

Clinical profile of COVID-19 patients and their length of stay: Tertiary care hospital experience.

ABSTRACTBackground:SARSCoV-2, a coronavirus that causes COVID-19, is spreading rapidly. By the middle of August-2021, it has affected over 3 million confirmed cases in India. The main aim of this study was to examine the clinical profile of COVID-19 patients and their length of stay during treatment in a hospital.Materials and Methods:It was a hospital-based retrospective study conducted by using a total enumeration technique in July–August 2021 at Nehru Hospital, Postgraduate Institute of Medical Education and Research (PGIMER) in India. The present study was conducted on 72 COVID-19 patients who took treatment in 4C and 5C wards. Structured questionnaires were used to collect data, which included bio-demographic factors and questions about their treatment and length of stay.Results:The majority of the 72 COVID-19 positive patients were men (62%), belonged to the age group of 41–60 years (35%), had SpO2 levels ranging from 91%–95% (45%), and received room air O2 therapy (63%) during their treatment in the hospital. Female patients had a longer length of stay (7.33 days), patients under the age of 20 years had the longest hospital stay (11.5 days), patients with SpO2 less than 70% had the longest hospital stay (8 days), and patients who received oxygen using a non-rebreathing mask had the longest hospital stay (11 days).Conclusion:To avoid panic situations, regular admission and discharge of patients was essential due to the considerable increase in cases during the second wave. Patient length of stay was reduced as a consequence of collaboration and cooperation among all physicians, residents, staff nurses, and paramedics, with the goal of discharging the patient after a room air trial and follow up if needed.