Predominant Presenting Symptoms Research Articles

Factors Associated With Survival Among Patients With Multiple Myeloma in Northeastern Tanzania.

This study sought to delineate the clinical, laboratory, and imaging characteristics during multiple myeloma (MM) diagnosis, outline the treatment modalities administered, and ascertain the survival rates among patients with MM over a comprehensive 5-year span in Tanzania. This retrospective cohort study investigated patients diagnosed with MM at the Cancer Care Clinic, Kilimanjaro Christian Medical Centre, between January 2017 and June 2022. Demographic data, clinical profiles, and survival outcomes were collected. The study employed the Kaplan-Meier method to determine overall survival (OS) and survival rates, supported by univariate analysis and a multivariate Cox regression model with significance of P < .05. In this study of 76 patients with MM, bone pain was the most common complaint (76.3%), and patients were age typically older than 50 years (82.5%). Laboratory tests showed frequent abnormalities, such as anemia (51.3%) and hypercalcemia (23.9%). Most patients were at stage III according to Durie Salmon Staging (82.7%), with imaging revealing various bone abnormalities. The median OS was 18.0 months, with 46.1% of patients passing away during the study period. Factors linked to shorter survival included anemia, renal failure, and bone involvement. Infection was the primary cause of death among these patients. The presenting complaint of bone pain significantly affected survival outcomes. This study provides a comprehensive understanding of MM within the Sub-Saharan African context, highlighting age-related disparities in diagnosis, predominant presenting symptoms like bone pain, factors contributing to delayed diagnoses, and the impact on survival rates. The findings underscore the critical need for early recognition, improved diagnostics, and tailored interventions to enhance outcomes for patients with MM in this region.

Adult intussusception: a systematic review of current literature.

Intussusception in adults is a rare condition characterized by a low incidence, which complicates the establishment of standardized management protocols unlike those readily available for pediatric cases. This study presents a case series from our institution alongside a systematic review of existing literature. The objective is to delineate effective management strategies for adult intussusception. A systematic search of databases was conducted covering the period from January 2000 to May 2024. The study focused on adult patients diagnosed with intussusception either pre-operatively or intraoperatively and managed with either surgical intervention or conservative methods. The analysis also included retrospective review of patient records from our institution, specifically targeting individuals over 18years of age, to determine the predominant types of intussusception and identify any pathological lead points associated with these cases. In our study, a total of 1,902 patients were included from 59 selected articles, with a mean age of 52.13 ± 14.95years. Among them, 1,920 intussusceptions were diagnosed, with 98.3% of cases identified preoperatively. Computed tomography (CT) scan was the primary diagnostic modality used in 88.5% of cases. Abdominal pain was the predominant presenting symptom, observed in 86.23% of cases. Only 29 out of 1,920 cases underwent attempted reduction, while the majority required surgical resection due to the high incidence of malignancy in adult cases. The most common type of intussusception identified was colocolic (16.82%), followed by enteric (13.28%), ileocolic (4.89%), and ileocaecal (0.78%) types. A pathological lead point was observed in 302 out of 673 patients (44.84%), with a notably higher frequency of malignancy associated with colocolic intussusception. Surgical management remains the cornerstone in treating adult intussusception, particularly in cases involving the colocolic type, where there is a significant risk of underlying malignancy. Attempts at reduction are generally avoided due to the potential risk of tumor dissemination, which could adversely impact patient outcomes. Contrast-enhanced computed tomography (CECT) of the abdomen is pivotal for accurately diagnosing intussusceptions and guiding appropriate management strategies. It is imperative to adhere strictly to oncological principles during surgical interventions to ensure optimal patient care and outcomes.

Exploring the Histopathological Landscape of Urinary Bladder Diseases: A Tertiary Care Center Study.

Introduction Urinary bladder lesions encompass a wide spectrum, from benign inflammatory conditions to malignant neoplasms, presenting diagnostic and therapeutic challenges. Urothelial carcinoma predominates among bladder malignancies, exhibiting diverse clinical presentations and prognoses. Objective This study aimed to delineate the histopathological spectrum of urinary bladder lesions and correlate demographic profiles, clinical features, and cystoscopic findings with various bladder lesions. Methods This prospective descriptive observational study spanned 24 months at a tertiary care center, involving 65 cases of urinary bladder biopsies, including transurethral resection of bladder tumors, cystoscopic biopsies, and cystectomy specimens. The histopathological examination followed the WHO 2022 classification of urinary bladder tumors and the American Joint Committee on Cancer eighth edition staging. Clinical data, including age, gender, cystoscopic findings, and presenting symptoms, were correlated with histopathological diagnoses to explore the spectrum of bladder lesions. Results Neoplastic lesions predominated, constituting 92.3% of cases, with urothelial carcinoma comprising 83.33% of these cases. Among neoplastic lesions, invasive high-grade urothelial carcinoma (36.7%) and non-invasive low-grade papillary urothelial neoplasm (20.0%) were the most frequently observed subtypes. Non-neoplastic lesions accounted for 7.7%, including various forms of cystitis. Hematuria was the predominant presenting symptom (81.5%), while cystoscopic examinations revealed that most lesions were situated in the lateral bladder wall. High-grade urothelial carcinomas were mostly associated with muscularis propria invasion. Conclusion This study underscores the critical role of histopathological examination in diagnosing and managing urinary bladder diseases and distinguishing between non-neoplastic and neoplastic lesions. Urothelial carcinoma, prevalent among older age groups, often demonstrated muscle invasion indicative of high-grade tumors. Including the muscle layer in cystoscopic biopsies is crucial for an accurate diagnosis. Conversely, though less common, non-neoplastic conditions encompass various forms of cystitis. These findings highlight the importance of precise diagnostic tools such as cystoscopy and histopathological examination for the early detection and management of bladder neoplasms. Histopathological assessment offers essential prognostic guidance, aids in precise staging and grading, and directs tailored treatment strategies.

Characterizing colon lipomas: Insights from a retrospective analysis of clinical presentation and management strategies.

This retrospective study aims to examine the characteristics and treatment approaches of colon lipomas, which are benign tumors found in the colon. We analyzed a cohort of 25 patients, focusing on demographic characteristics, clinical presentation, location and size of the lipoma, concomitant pathologies, and treatment methods. The average age of the patients was 67.3 years, with 36% being male and 64% female. The majority of lipomas were located in the ascending colon (52%), and their median size was 2 cm. The predominant presenting symptom was constipation, affecting 83.3% of the symptomatic patients. Surgical resection was undertaken in only 1 patient due to obstruction. Statistically significant differences were observed between symptomatic and asymptomatic patients regarding various parameters, including the size of the lipoma (P = .033). Colon lipomas are generally benign and frequently asymptomatic but may necessitate different treatment approaches depending on their size, location, and the presence of symptoms. Further studies are imperative to refine treatment strategies and enhance patient care outcomes.

Cerebral venous thrombosis and deep medullary vein thrombosis: Padua experience over the last two decades.

Cerebral venous thrombosis (CVT) is a cerebrovascular disorder that accounts for 20% of perinatal strokes. CVT incidence ranges from 0.67 to 1.12 per 100,000 newborns, while the incidence of "deep medullary vein thrombosis" (DMVT), a subtype of CVT, cannot be accurately estimated. This study aims to analyze the case history of CVT in the neonatal period, with a specific focus on DMVT. Newborns diagnosed with CVT, with or without DMVT, between January 2002 and April 2023, were collected using the Italian Registry of Infantile Thrombosis (RITI). Cerebral MRIs were reviewed by an expert neuroradiologist following a standardized protocol. Forty-two newborns with CVT were identified, of which 27/42 (64%) had CVT, and the remaining 15/42 (36%) had DMVT (isolated DMVT in 9/15). Symptom onset occurred in the first week of life (median 8days, IQR 4-14) with a male prevalence of 59%. The most common risk factors for CVT were complicated delivery (38%), prematurity (40%), congenital heart diseases (48%), and infections (40%). Seizures were the predominant presenting symptom in 52% of all cases. Hemorrhagic infarction was higher in cases with isolated DMVT (77%) compared to patients with CVT without DMVT (p = 0.013). Antithrombotic treatment was initiated in 36% of patients. Neurological impairment was observed in 48% of cases at discharge, while 18 out of 31 infants (58%) presented one or more neurological deficits at long term follow up. Conclusion:DMVT occurs in over a third of neonates with CVT. Multicentric studies are essential to establish standardized protocols for therapy, neuroimaging, and follow-up in these patients.

Prevalence and Characteristics of Influenza Cases From 2017 to 2019 at a Tertiary Care Teaching Hospital in Karnataka.

Introduction Influenza virus is a significant human pathogen causing severe acute respiratory illness (SARI) associated with significant mortality worldwide. The H1N1 Influenza virus that caused a pandemic in 2009 continued to cause periodic epidemics worldwide, with new variants posing significant public health problems. The present study was carried out to determine the prevalence and characteristics of influenza at a tertiary care teaching hospital. Methods From 2017 to 2019, respiratory samples from suspected cases of influenza belonging to category C received at the microbiology laboratory were transported to Manipal Centre for Virus Research, Manipal,in the cold chain for testing of influenza virus by real-time reverse transcriptase polymerase chain reaction (rRT-PCR) as per CDC guidelines. The microbiological reports were collected and evaluated. The details of patients positive for influenza were analyzed for demographic and clinical characteristics. Results During the study period, 172 samples from SARI patients were tested, out of which 44 patients were positive for the influenza virus, accounting for a prevalence of 25.58%; 84% (n=37) of the cases were infected with H1N1 influenza virus, and the other 11.36% (n=5) and 4.54% (n=2) cases yielded H1N2 and H1N3 influenza virus, respectively. Among 44 patients, 56.81% (n=25) were females and 43.18% (n=19) were males. Most of the patients, 65.9% (n=29), were between 40 and 60 years old. The predominant presenting symptoms were fever in 81.81% (n=36) patients, breathlessness in 56.8% (n=25) patients, and cough in 54.54% (n=24) patients. Twelve (27.27%) patients had acute severe respiratory distress syndrome (ARDS). A significant mortality rate of 22.72% (n=10) was noted in the study. Conclusion A significant prevalence of influenza was noted in the study at 25.58%. Along with the H1N1 Influenza virus, the new strains detected in our region were H1N2 and H1N3 influenza viruses. Regular surveillance is important in the early detection of cases, for timely management, to reduce mortality, and to take measures to prevent the spread of this important infectious disease.

An International Multicenter Study of Primary Vitreoretinal Lymphoma from the Australasian Lymphoma Alliance and Collaborators

Background: Primary vitreoretinal lymphoma (PVRL) is a rare high-grade extranodal non-Hodgkin lymphoma characterized by frequent and often fatal central nervous system (CNS) relapse. Despite improved outcomes for patients with primary CNS lymphomas over the last decade, approaches to the diagnosis and management of PVRL remain contentious. Given limited prospective data to date, there is need to better elucidate current international practice in the modern era to optimize outcomes for this patient group. Methods: Patients with pathologically confirmed PVRL diagnosed between January 2010 and December 2022 were identified from ten sites across Australia, Singapore, Canada and the United Kingdom. Patients were aged ≥18 years, with isolated PVRL at diagnosis (i.e. no concomitant CNS involvement at baseline or secondary vitreoretinal involvement). Variables included were baseline demographic data, presenting symptoms, diagnostic procedures undertaken and sample characteristics such as cytological, immunocytochemical and flow cytometric features. Where available, molecular results and biomarkers such as IL-10 and IL-6 were also collected. Treatment approaches including local, systemic and combined local/systemic therapies were captured. Outcomes measured included response rates, patterns of relapse, progression-free (PFS) and overall survival (OS). Results: 36 patients were identified with a median age at diagnosis of 68 years (range 38-89) with a female predominance (58%). Most patients presented with bilateral involvement (72%) with decreased visual acuity being the predominant presenting symptom (53%). Most patients received a PVRL diagnosis within weeks to months of symptom onset, however a third of patients had &amp;gt;12 months delay to diagnosis. Ancillary diagnostic tests such as flow cytometry, molecular and cytokine measurements performed in a minority of patients only, largely due to sample viability and paucity. Concurrent CNS involvement was evaluated by brain MRI in 97% with diagnostic lumbar punctures performed in 64%. Exclusion of systemic disease was predominantly done via PET or PET/CT (69%) with the remainder via CT alone (Table 1). Upfront treatment choices were highly varied across participating sites with incorporation of systemic therapy in the majority (64%) of cases, either alone (25%) or in combination with local therapies (39%). For those who received systemic therapy, all incorporated high-dose methotrexate with the median dose delivered of 3.5g/m 2 per cycle and rituximab was incorporated in 48%. Autologous stem cell transplantation (ASCT) was part of frontline management in 19% of cases, and the median age of those receiving frontline ASCT was 55 years versus 71 years in those who did not. With median follow-up of 57 months (IQR 24-74 months), the median OS was 90 months whilst median PFS was only 23 months (Figures 1 and 2). 18 patients experienced disease relapse during follow up, only 2 of which had received frontline ASCT. The median PFS and OS of those who received frontline ASCT was not reached and 92 months respectively. Patients who had systemic treatment incorporated into frontline management had a trend toward improved OS than those who did not (Figure 3). Of those with relapsing disease, 14 (78%) had CNS involvement, and 29% of these patients experienced concurrent CNS and systemic involvement at relapse. Median OS from time of relapse was 8 months (IQR: 3-89 months). Of the 14 deaths occurring during follow up, 6 (43%) were secondary to lymphoma, 2 (14%) were related to toxicities of treatment and the rest were unknown or related to other co-morbidities. Conclusion: To our knowledge, this is the largest international multicenter cohort of patients with isolated PVRL reported in the modern era. The apparent improvement in OS compared with historical cohorts may reflect improvements in therapy in the recent decade, and incorporation of systemic therapy in frontline management demonstrated a trend to improved OS. However, high rates of CNS relapse continue to be a challenge. Delays in diagnosis and variation in diagnostic and management pathways reflect the need to develop prospective studies and international consensus guidelines for managing this rare lymphoma.

Demography, Clinical Profile and Outcome of COVID-19 Patients in the east-southern region of Bangladesh

Introduction: In Bangladesh, the first confirmed case of COVID-19 was detected on March 8 2020, about 3 months after the initial outbreak in late December 2019 in Wuhan, China. Both affected cases and deaths have increased exponentially during this global pandemic. Demographic and clinical data on COVID-19 in Bangladesh is still deficient. Our study aims to evaluate the demographic, clinical profile and outcome of COVID-19 Patients in the east-southern region of Bangladesh. Methodology: It was a cross sectional study. All RT-PCRpositive patients who tested in the RT-PCR lab of Comilla Medical College on 10 days of each month from July to December 2020 were included in this study. Ten days in each month were selected by lottery. After getting the verbal consent, selected patients were interviewed over the telephone by the investigator team, and their information was recorded accordingly in a preformed data sheet. Results: A total of 606 COVID-19 RT-PCR-positive patients were interviewed. The mean age was 40.39 ± 15.42 years; 62.8% were male, and 17.3% of patients had positive contact history with COVID-19 patients. Predominant presenting symptoms were fever (71.8%), cough (41.3%), breathlessness (22.8%), fatigue (18.3%), anorexia (26%) and diarrhea (4.1%). Hypertension (13.1%), diabetes mellitus (16.1%), ischemic heart disease (IHD) (2.8%) and chronic kidney disease (CKD) (0.4%) were frequent comorbidities. 72% of the patients were mild, 16% moderate , 7% severe, and 5% critically ill. 78% took home treatment and 5% were in ICU. 97.2% recovered and 2.8% died. Older age (p= 0.001), male sex (p= 0.007), smoking (p= 0.001), breathlessness (p=0.001) and presence of comorbidities (p= &lt; 0.05) were significantly associated with mortality. 33.8% had post- COVID symptoms, including fatigue 26.7% and shortness of breath 13.2%. Conclusion: Younger age groups were more affected than older age groups. Majority of the patients did not have a history of contact with COVID-19 patients. Most of the patients had mild symptoms. About one fourth were hospitalized, among them 5% got treatment in ICU. Most of the patients recovered, and 2.8% died. Death was more common in patients with multiple comorbidities. One third of recovered patients had post-COVID symptoms. J Bangladesh Coll Phys Surg 2023; 41(4): 298-304

Infection-Associated Mortality During Induction Chemotherapy in Group B Intermediate-Risk Pediatric Burkitt's Lymphoma.

Background Burkitt's lymphoma (BL) in the pediatric population has significantburden in developing countries. Infection-related complications during the induction chemotherapy phase pose a major challenge and contribute to high mortality rates due to a severely immunocompromised state. However, there is scarcedata on the etiologies and optimal management strategies for infection-related mortality in pediatric BL patients, especially in developing countries like Pakistan. Methods This is across-sectional study that included a total of 116 pediatric patients with intermediate-risk BL. All patients were treated based on theChildren's Cancer and Leukaemia Group (CCLG) 2020 guidelines. Data on patientdemographics, presenting symptoms, diagnosis, infectious etiologies, and outcomes were collected. Infection-related complications and mortality were monitored during the induction chemotherapy period. The results of relevant culture reports were tabulated and data were analyzed. Results Among the 116 included patients, 61.1% were males with a mean age of 4.83 ± 2.12 years. Abdominal BL was the most common anatomical location. During the induction period, 66 patients (56.9%) had culture-proven infections, resulting in 33 deaths (28.4%). Fever was the predominant presenting symptom in all patients, followed by vomiting (57.6%), loose stools (42.4%), and cough (18.2%). Neutropenic colitis, sepsis, pneumonia, and meningitis were among the diagnosed infections. Hospital-acquired bacterial infections, including multi-drug resistantgram-negative and gram-positive organisms, were the main cause of mortality, with fungal infections and cytomegalovirus viremia also identified in a few patients. Conclusions This study highlights the urgent need for improved management strategies in pediatric BL patients in Pakistan to reduce infection-related complications and mortality rates, emphasizing the importance of context-specific approaches for infection prevention and management.

A Scoping Review of Functional Neurological Disorder in Sexual and Gender Minority People (P1-12.004)

<h3>Objective:</h3> To report the literature regarding sexual and gender minority (SGM) people with functional neurological disorder (FND). <h3>Background:</h3> Minority stress and resilience theory describes the risks and protective factors that constitute social determinants of health and may increase neurological disparities among SGM communities. Little is known about the prevalence and experiences of SGM people with FND. <h3>Design/Methods:</h3> A search string with descriptors of SGM identity and functional somatoform disorders was entered into PubMed, Embase, Web of Science, PsycInfo, and CINAHL for articles that included SGM people diagnosed with FND, conversion disorder, or hysteria published before May 24, 2022, yielding 2940 items entered into Covidence. Two neurologists screened titles and abstracts based on predefined criteria, followed by a full-text review. A third neurologist adjudicated discrepancies. Eligible publications underwent data abstraction and statistical description. <h3>Results:</h3> Our search identified 4 published cases of presumed cisgender sexual minority (SM) people and 1 gender minority (GM) person with an FND or related diagnosis. GM people were overrepresented (5/106 [5%]) in a FND clinic sample compared to the general population (&lt;1%). Among cases, predominant presenting symptoms included seizures (n=2), tic-like behaviors (n=1), swallowing dysfunction (n=1), or mixed presentation with disturbed consciousness (n=1). Initial diagnoses were made by electroencephalography (n=3) and clinical history and non-specific studies (n=2). No neurological exam data were reported. Stressors related to SGM experience preceded onset in 3 cases with improvement coinciding with discussion and/or affirmation of SGM identity in 3 cases. <h3>Conclusions:</h3> Despite a methodologically rigorous search, limited data exist on FND in SGM communities. The data support the relevance of minority stress and resilience theory within the broader context of a stress-diathesis framework. More research is needed to understand and address known barriers to SGM-affirming care, which may be further exacerbated by FND-related stigma. <b>Disclosure:</b> Dr. L’Erario has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ohio State University, University of Colorado, Sacred Heart University, The LOFT LGBT Community Center . Dr. L’Erario has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Weiss Law. Dr. L’Erario has received publishing royalties from a publication relating to health care. Dr. Fusunyan has nothing to disclose. Mr. Stave has nothing to disclose. Dr. Waugh has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Two independent law firms. The institution of Dr. Waugh has received research support from AAN. Dr. Wilkinson-Smith has nothing to disclose. Ms. Roldan has nothing to disclose. Dr. Keuroghlian has received publishing royalties from a publication relating to health care. Jack Turban has nothing to disclose. Dr. Perez has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wiley: Brain and Behavior. The institution of Dr. Perez has received research support from NIH. The institution of Dr. Perez has received research support from Sidney R. Baer Jr. Foundation. Dr. Perez has received publishing royalties from a publication relating to health care. Dr. Maschi has nothing to disclose. Dr. Rosendale has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Continuum. The institution of Dr. Rosendale has received research support from American Academy of Neurology. The institution of Dr. Rosendale has received research support from NIH StrokeNet Fellowship. Dr. Rosendale has received publishing royalties from a publication relating to health care.

Characterization of the Common Symptomology and Great Mimickers of Autoimmune Encephalitis (P4-5.011)

<h3>Objective:</h3> To identify clinical and systemic variables associated with mimickers of Autoimmune Encephalitis (AE). <h3>Background:</h3> The classical presentation of AE includes acute or subacute onset of impaired memory and cognition, in combination with progressive neurologic symptoms which may include abnormal movements, seizures, psychosis, and balance, speech, or vision problems. However, diagnosis can be challenging due to broad differential diagnoses and variable presentations of patients with suspected AE. Greater awareness of AE has led to increased consideration of AE as a potential etiology of neurologic symptoms, and accordingly, misattribution of symptoms to AE in some instances. <h3>Design/Methods:</h3> We performed a single-center retrospective chart review of 212 patients from the University of Utah Health identified by query of the ICD-10 code G04.81: Other encephalitis and encephalomyelitis between January 2012–August 2022, which is the diagnostic code inclusive of AE and other related or nonspecific encephalitis. <h3>Results:</h3> We describe the patient demographics of this cohort, as well as relevant clinical data including the predominant presenting symptom(s), cerebrospinal fluid characteristics, electroencephalography and neuroaxis imaging findings, suspected initial diagnosis, timing and duration of treatment interventions (including immunomodulatory therapy), final diagnosis, and outcomes. <h3>Conclusions:</h3> The diagnosis of AE remains challenging, especially in patient presentations with a predominant psychiatric phenotype at onset, or in those with atypical features. Recognition of the most common pitfalls to diagnosis and disease mimics may improve timely and accurate recognition of causative etiologies and help to direct the most appropriate treatments and interventions. <b>Disclosure:</b> Miss Soneji has nothing to disclose. Miss Shapiro has nothing to disclose. Dr. Wright has nothing to disclose. Dr. Noroozi Gilandehi has nothing to disclose. Miss Francis has nothing to disclose. Dr. Smith has nothing to disclose. Mr. Wong has nothing to disclose. Dr. Clardy has received personal compensation for serving as an employee of Veterans Health Administration (VHA). Dr. Clardy has received personal compensation for serving as an employee of University of Utah Health. Dr. Clardy has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology/AAN Publications. The institution of Dr. Clardy has received research support from Sumaira Foundation for NMO. The institution of Dr. Clardy has received research support from Western Institute for Veteran Research. The institution of Dr. Clardy has received research support from NIH/NINDS. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving as a AAN Summer Meeting CoDirector Travel and Lodging with AAN. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving as a Grand Rounds Travel and Lodging with U of Iowa. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving as a Speaker Honoraria for Grand Rounds with Barrow Neurological Institute. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving as a Speaker Honoraria for Grand Rounds with Beaumont Health.

Clinical profile and outcome of H1N1 influenza patients in a tertiary care hospital in Kochi, Kerala

Background: After the 2009 pandemic, a re-emergence of hemagglutinin type 1 and neuraminidase type 1 (H1N1) influenza cases has been noted in India recently. The number of swab-positive cases has increased in the year 2017 compared to yesteryears. Since the current circulating strain (A/Michigan/7/2009 [H1N1] pdm09) is different from previous pandemic strains, a look into the clinical profile is imperative. Aims: The aim is to study the clinical, biochemical, and radiological profile of H1N1 patients at initial presentation and its influence on the mode of treatment and outcome. Patients and Methods: A cross-sectional record-based analysis of all confirmed cases of H1N1 influenza admitted at Lourdes Hospital, Kochi, Kerala, between 2015 and 2017. Confirmation of cases was done by reverse transcriptase polymerase chain reaction of respiratory specimens at Manipal Centre for Virus Research. Results: A total of 76 confirmed cases of H1N1 influenza were detected during the study period of which 36 required Intensive Care Unit admission. Most patients were between 51 and 60 years (25%). The predominant presenting symptoms were fever (98.7%), dry cough (61.8%), breathlessness (53.9%), and the most common auscultatory finding being bilateral crepitations (64.47%). Around 32.89% of cases presented with bilateral lung infiltrates on X-ray. Sixty-nine of 76 patients (90.79%) survived the disease. Conclusions: Vaccination, early recognition of the disease, and prompt initiation of treatment seem to be the only way to reduce H1N1 disease progression and associated mortality. Patients with risk factors require additional attention as clinical course can be unpredictable. Pregnancy is associated with higher rate of complications. Early respiratory support helped in preventing progression to respiratory failure in most of our patients.

Clinico-epidemiological characteristics of pediatric COVID-19 patients in Bangladesh

Background: The objective of the study was to delineate the clinico-epidemiological characteristics of pediatric coronavirus disease-2019 (COVID-19) patients.Methods: This observational study included 290 pediatric patients with a definite diagnosis of COVID-19 admitted to Dhaka Shishu hospital, Bangladesh, from April 2021 to October 2021. Clinical and epidemiological characteristics were analyzed based on demographic data, medical history, laboratory tests, and outcome information. Data analysis was performed with SPSS 26. Ethical measures were taken in compliance with the current declaration of Helsinki, and final analysis was performed using SPSS 26.Results: Of all, 42 (14.5%) were neonates (&lt;28 days), 88 (30.3%) were infants (28 days to &lt;1 year) and 160 (55.2%) were children (1-17 years). The median age of the children was 18 (0.3-204) months, 58.3% were male, 62% had malnutrition, and presented with various clinical presentations. The main symptoms were fever (5.7%) and breathlessness (20%). Approximately 22% of children were asymptomatic, and 57% had at least one comorbidity. Fever and abdominal pain were predominant presenting symptoms in children compared with neonates and infants (p&lt;0.01 for both), while cough and breathlessness were more frequent in infants (p&lt;0.01 for both). The infants suffered significantly from neutropenia and lymphocytosis than neonates and children (p&lt;0.001 for both). The discharge and death rates were 77.8% with 6.9%. Overall case fatality was higher among neonates than others.Conclusions: Compared to other pediatric groups, neonatal case fatality was higher, and COVID-19 in neonates, infants, and children has similar epidemiological and clinical manifestations. The findings from this study might help to guide the development of measures to prevent and treat this ongoing global pandemic of these particular age groups.

PATTERN OF OUTCOME OF COVID-19 PATIENTS ON THE BASIS OF CLINICODEMOGRAPHIC PROFILE

Background st - Severe acute respiratory syndrome corona virus-2 with pneumonia like clinical manifestations emerged 1 in December 2019 and quickly escalated into a pandemic. With high person-person transmission ,it has serious implications on health, economy and mental well being and the clinical outcome of COVID-19 patients is variable in different countries.Aims- To study the pattern of outcome of COVID-19 patients on the basis of their clinicodemographic prole. A retrospectiveMethodology- observational tertiary care hospital based study was done that included COVID-19 positive patients admitted to the Institution from March 2021 to June 2021.Only patients with moderate and severe disease were admitted ,rest were advised home quarantine. Besides patient prole &amp; clinical course,oxygen requirement ,ICU utilization rate,need for ventilatory support ,associated comorbidities and outcome was studied. Results- Out of 265 patients , 66.4% were males &amp;33.5% females with a mean age of 51.4+/- 13.65 yr . Shortness of breath &amp; cough were the predominant presenting symptoms (71.6%)with 26.4% of the patients having 50-75% lung involvement and 8.3% of patients having &gt;75% lung involvement .ICU utilization rate was 42.3% ,however only 5.5% of the patients required mechanical ventilation. The mortality rate was 21% with hypertension(44%),diabetes mellitus(34%) and CKD(8%) being the most frequent comorbidities. More than 50% of lung involvement, preexisting comorbidities and Intensive care unit necessity were the important parameters contributing towards mortality. ThisConclusion- study gives a better insight into the clinical and demographic prole and outcome of the patients hospitalized with COVID-19 illness by providing us a baseline data which will help us combat the pandemic swiftly in future.

Acute Esophageal Necrosis: A Retrospective Cohort Study Highlighting the Mayo Clinic Experience

ObjectiveTo describe the clinical, endoscopic, and histologic features in patients with acute esophageal necrosis (AEN). Patients and MethodsIn this retrospective cohort study, patients who were diagnosed as having AEN at Mayo Clinic sites in Minnesota, Florida, and Arizona between January 1, 1996, and January 31, 2021, were included. Data were collected on patient clinical characteristics and endoscopic and pathologic findings. ResultsThe study included 79 patients with AEN with a median (range) age of 64 years (12 to 91 years); 53 (67.1%) were men. Predominant presenting symptoms were hematemesis (49 of 79 [62.0%]), abdominal pain (29 [36.7%]), and melena (20 [25.3%]). Shock was the triggering event for AEN in 49 (62.0%). The 30- and 90-day mortality were 24.0% (19 of 79) and 31.6% (25), respectively. The presence of coexisting infection or bacteremia was significantly associated with 90-day mortality (P<.01). Endoscopically, involvement of the distal third only, distal two-thirds only, and entire esophagus was observed in 31.6% (24 of 76), 39.5% (30), and 29.0% (22), respectively. The length of esophageal involvement correlated with duration of hospitalization (P=.05). The endoscopic appearance of the esophageal mucosa ranged from predominantly white (21 of 44 [47.7%]) to mixed white and black (13 [29.6%]) to predominantly black (10 [22.7%]), and sloughing was present in 18 (40.9%). In the 26 patients with histopathologic findings available for review, 25 (96.1%) had necrosis and/or ulceration with abundant pigmentation. Among the 79 patients, 39 (49.4%) had a follow-up esophagogastroduodenoscopy; 26 of these 39 patients (66.7%) had resolution while 5 had persistent AEN, 4 of whom had improvement. Esophageal strictures developed in 7 of the 39 patients (18.0%). ConclusionAcute esophageal necrosis is a serious condition observed in critically ill patients. Its endoscopic appearance can be highly variable. In patients with an unclear diagnosis, esophageal biopsies may be helpful given the characteristic histologic findings.

Nephrectomy in Children: A Single Center Experience

Background: The surgical removal of the kidney, nephrectomy, is not a minor surgical procedure. It is a major endeavor. Indications for nephrectomy range from benign to malignant pathological conditions. Materials and Methods: This was a retrospective study of children aged 15 years and below who had nephrectomy between January 2016 and December 2020 at the pediatric surgery unit of a teaching hospital in Enugu, Nigeria. The information extracted included the age of the patient at presentation, gender, and predominant presenting symptom and the pathology (indication), duration of symptoms before presentation to the hospital, time interval between presentation and nephrectomy, operative procedure performed complications of treatment, duration of hospital stay and outcome of treatment. Results: Eighteen (18) pediatric nephrectomies were performed during the study period. There were 14 (77.8%) males and 4 (22.2%) females. The mean age of the patients was 6 years with a range of 3 years to 9 years. Nephroblastoma was the most common indication (pathology) for nephrectomy. Nephrectomies were performed more on the left side than on the right. Simple nephrectomy was performed in all the patients. However, children with nephroblastoma had nephroureterectomy. Surgical site infection was the most common post-operative complication. About one-quarter of the patients expired due to tumor metastasis. Conclusion: Nephrectomy is the optimal procedure for neoplasm of the kidney or non-functional kidney. Malignant kidney tumour (nephroblastoma) was the most common indication for nephrectomy in the present study.

Emergence of Scrub Typhus in Urban Areas: a Report from South India

Aims: To study the epidemiology and clinical presentation of Scrub typhus in Southern India.&#x0D; Study design: Observational study&#x0D; Place and Duration of Study: Apollo Hospital, Chennai, India, between January 2010 and December 2011.&#x0D; Methodology: This is an observational study of 182 patients from a tertiary care center between January 2010 and December 2011. Cases of scrub typhus were defined by a positive IgM scrub typhus ELISA, compatible clinical features and negative workup for other pathogens. Epidemiological data and clinical data were collected from the records for the study purpose.&#x0D; Results: Fever (100%), headache (69.7%) and cough (47.8%) were the predominant presenting symptoms. The majority (85.7%) of cases were during the period from July to December in both the years, corresponding to the monsoon in South India. 62% of cases were from urban areas and 47.3 % of cases required admission to the critical care unit. An eschar was present in 46.7% of cases and 97.3% of the cases improved with therapy. All patients received either doxycycline or azithromycin or a combination of both as therapy. Defervescence was seen within 72 hours in 98.5% of patients. &#x0D; Conclusion: Scrub typhus is a re-emerging disease in South India. It should be considered in the differential diagnosis of acute undifferentiated febrile illness even in urban areas in all age groups, especially during the monsoon season. Careful search for an eschar is important. Treatment with doxycycline or azithromycin is effective. The mortality rate is expected to be high if untreated, so we suggest that these antibiotics be part of initial empiric therapy whenever the disease is in the differential diagnosis in all severely ill patients awaiting diagnostic results.

COVID-19 GIT Affection: An Updated Review

Background: Although it was initially believed that the coronavirus disease 2019 (COVID-19) only attacked the respiratory system, reports over time demonstrated that this disease could attack the gastrointestinal tract (GIT) as well. The predominant presenting symptoms in patients infected with COVID-19 were gastrointestinal, resulting in gastrointestinal (GI) pathological changes. While clinicians’ concerns are mostly related to respiratory system manifestations, GI symptoms should be monitored and managed appropriately. Objectives: This review summarizes the essential information about COVID-19 GIT infection in terms of pathogenesis, major pathological changes, microbiological bases of infection and the possibility of feco-oral transmission, the severity of associated symptoms, the major radiological findings, the impact on GI surgery, the role of therapeutic agents in induction or magnification of GI symptoms, and a pitfall on the nutritional supplementation in COVID-19 patients.

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BACKGROUND:Duration of untreated psychosis refers to the time elapsing between onset of psychosis and treatment initiation. The fact that schizophrenia generally begins in the late adolescence/adulthood, that it often remains untreated for a long time before being recognized and treated, and that it frequently shows a chronic, recurrent and disabling course, dramatically impact on the relational and functional life of patients and care givers. For this reason, the first episode of psychosis, considered as the early stage of schizophrenia, is classically viewed as a critical period.AIMS AND OBJECTIVES:1) To estimate the duration of untreated psychosis and its variation over the years.2) To determine possible correlation between duration of untreated psychosis and other independent variables.MATERIALS AND METHODS:This is a retrospective case record study. Data is collected from medical records department of a tertiary care psychiatric hospital, every five years starting from 1995 to 2020 with a sample size of 50 each year. The data is entered in a data collection sheet. The duration of untreated psychosis and its variation over the years has been estimated. Multivariate analysis to look for possible correlation between duration of untreated psychosis and other independent variables like sociodemographic details, predominant presenting symptoms, presence of aggression and mode of onset of symptoms has been done.RESULTS:The mean duration of untreated psychosis shows a decreasing trend over the years from 1995 to 2020. Most common variables correlating with shorter DUPs include positive symptoms, presence of aggression and male gender.CONCLUSION:Various factors could be attributable to this reduction in duration of untreated psychosis including increasing in awareness about mental health in general population, inception of district mental health programs and reduction in stigma towards mental health. Yet, the present DUP is higher when compared with developed countries.REFERENCES: 1) Prospective study of duration of untreated psychosis and outcome of never-treated patients with schizophrenia in India Jagadisha Thirthalli 1, Naveen Kumar Channaveerachari, Doddaballapura K Subbakrishna, Linda B Cottler, Mathew Varghese, Bangalore N Gangadhar2) An exploratory evaluation of predictors of duration of untreated psychosis in first-episode psychosis in lower income patients Ankita Mishra 1, Abha Bang Soni 2, Maithili S Umate 3, Chittaranjan Andrade 4

Application of International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Cytology- A Retrospective Study

Introduction: Fine Needle Aspiration Cytology (FNAC) is a rapid, minimally invasive and cost-effective procedure with a high sensitivity rate of 92-95% and high Positive Predictive Value (PPV) approaching 100% for the diagnosis of breast malignancies. International Academy of Cytology (IAC) Yokohama system for reporting breast FNACs had been established in 2016 to bring consistency and uniformity of breast cytology reporting. Aim: To classify the breast lesions according to the IAC Yokohama system for cytological reporting of breast lesions. Materials and Methods: This was a retrospective six years study carried out in the Department of Pathology, Karpaga Vinayaga Institute of Medical Sciences, Chinnakolambakkam, Tamil Nadu, India. All females breast FNAC cases reported during the year January 2015 to December 2020 were included in the study according to the inclusion criteria. Relevant clinical and pathological data including the FNAC reports were retrieved from the medical records of the department. Corresponding FNAC smears stained with Haematoxylin and Eosin (H&amp;E) and Papanicolaou stains were reviewed and double-checked with the FNAC reports. All those cases were grouped according to the IAC Yokohama System. Statistical analysis was carried out using Statistical Package for the Social Sciences (SPSS) version 23.0. Results: Of the total 381 female breast FNACs, majority (60%) of them belonged to the age group of 21-40 years. The predominant presenting symptom was palpable breast lump (73%) and Upper Outer Quadrant (UOQ) was involved in 65% of cases. Out of 381 cases, 297 (78%) were benign, 52 (13.6%) were malignant and 32 (8.4%) were inadequate for diagnosis. Total 73.8% cases belonged to “C2” category and fibroadenoma was the most prevalent lesion. Pearson Chi-square test showed highly significant association between patient’s age above 40 years and the risk of having a malignant breast lesion (p&lt;0.0001). Conclusion: FNAC is an effective diagnostic modality for preoperative diagnosis of breast lesions thereby facilitating proper treatment at an early stage of the disease. Also adherence to the standardised cytological reporting system like IAC Yokohama system will ensure quality assurance across various institutions, thereby strengthening the healthcare services.