Male Preponderance Research Articles

The association between systemic immune-inflammation index (SII) and early nosocomial infections after cardiopulmonary bypass surgery in children with congenital heart disease

BackgroundInfections occurring postoperatively in pediatric patients with congenital heart disease (CHD) following cardiopulmonary bypass (CPB) surgery pose a considerable challenge, affecting the duration of hospitalization, financial costs, and patient outcomes. Studies investigating the association between systemic immune-inflammation index (SII) and early infections after CHD surgery are very rare. This study seeks to delineate the link between SII and the occurrence of early nosocomial infections in pediatric patients undergoing CPB surgery for CHD.MethodsA cross-sectional analysis was performed on 325 pediatric patients who underwent CPB surgery for CHD between July 2020 and June 2023. The primary exposure was the SII value on the first postoperative day. The outcome was the occurrence of nosocomial infections within the first week following CPB surgery. Multivariable logistic regression models and subgroup analyses were employed to evaluate the association between SII and the risk of early nosocomial infections.ResultsThe median age of the study cohort was 4.4 years, with a male preponderance of 51.7%. The median SII value was recorded at 0.6 × 10^12/L. The rate of nosocomial infections within the first week post-CPB surgery was 53.5%. An inverse association was observed between SII and the incidence of early nosocomial infections. After controlling for multiple confounders, an increment of 1 × 10^12/L in SII corresponded to a 25% reduction in the likelihood of nosocomial infections (OR = 0.75; 95%CI: 0.57, 0.99; P = 0.044). Subgroup analyses substantiated the consistency of these findings.ConclusionsThe study demonstrated that an elevated SII corresponded to a reduced likelihood of early nosocomial infections after CPB surgery in children with CHD, a finding that merits additional investigation.

Autopsy-Based Cross-Sectional Observational Study On Carotid Artery Injury In Non-Penetrative Neck Trauma

Background: Non-penetrative neck trauma poses a significant risk of carotid artery injury, which can lead to severe consequences. Diagnosis of carotid artery injury in non-penetrative trauma remains challenging due to delayed clinical presentation. Research on non-penetrative mechanisms of injury is relatively less common compared to penetrating trauma. This study aims to analyse patterns of vascular injuries in compression injuries to the neck, focusing on non-penetrative trauma. Materials and Methods: A cross-sectional study was conducted in a Forensic Medicine Department of Government Stanley medical college, Chennai, over a one-year period, analysing 150 cases of non-penetrative neck trauma. Post-mortem data, including gross and histopathological findings, were collected and analysed. Results & Discussion: Among the 150 cases studied, hanging was the most prevalent cause of blunt cervical trauma. The majority of cases affected individuals were between the age group 21 and 40 years, with male preponderance. Gross examination revealed intimal tears in a proportion of cases, with histopathological examination identifying a higher prevalence of injuries. Posterior knot ligatures were predominant in both complete and partial hanging cases, correlating with a higher incidence of carotid body hemorrhage. The association between posterior knot position and carotid body hemorrhage emphasizes specific vulnerabilities in hanging cases. Conclusion: The findings of the study emphasize the importance of forensic investigations in identifying vascular injuries, guiding injury prevention strategies, and informing medicolegal proceedings. Further research is needed to enhance diagnostic and management approaches in clinical and forensic practice.

A Prospective Observational Study to Establish a Correlation Between Tinnitus and Hearing Loss

Introduction: The prevalence of tinnitus in adults with hearing problems is very high (59 - 86%). Both tinnitus and sensorineural hearing loss can occur when there is damage throughout the auditory pathway from the inner ear to auditory cortex. Our aim of the study was to evaluate the prevalence of hearing loss in patients with tinnitus and to assess the association between tinnitus and hearing loss. Materials and methods: This prospective observational study was conducted for 12 months between May 2022 and April 2023. 60 patients of both the sexes >15 years of age presenting with tinnitus in one or both ears were included in our study. Mentally ill and/or intoxicated patients were excluded. After clinical examination patients underwent Pure Tone Audiometry - average was calculated across 500, 1000, 2000, 4000 Hz in terms of air conduction, bone conduction and air bone gap. Hearing loss was classified as conductive, sensorineural and mixed types. Tinnitus pitch and loudness matching was done for which opposite ear was taken as test ear. In cases of bilateral tinnitus with equal intensity, right ear was taken first as test ear. In case of bilateral tinnitus with unequal intensity, ear with higher intensity tinnitus was tested first. Sensation level of tinnitus was calculated by subtracting the hearing loss threshold from tinnitus loudness in decibel. Result: In our study the mean age was found to be 44.20± 17.01years, with a male preponderance, and maximum number of cases complaining of left sided tinnitus. In an attempt to find a correlation between tinnitus and hearing loss, in right and left ears separately, ‘P’ value calculated to be <0.001.We also attempted to find a correlation between highest hearing loss and tinnitus loudness. We found that relative coefficient, ‘r’ being 0.309 on right side and 0.270 on left side. ‘P’ value on right is 0.097 and on left is 0.117. Conclusion: Since most of the cases of tinnitus also complaints of hearing loss, so it is necessary to identify a relation between the two. If a relation between tinnitus and hearing can be identified, it helps to identify the pathophysiology, which will further be helpful to plan the line of management. There are very limited number of studies conducted. Our study suggests a definite relation between tinnitus and hearing loss though there is no statistically significant correlation found between tinnitus loudness and highest hearing loss in the same ear.

Changing age pattern and diverse outcomes of herpes zoster ophthalmicus: exploring the temporal trend, decrease in incident age and influence of treatment strategies.

Herpes Zoster Ophthalmicus (HZO) is a disease commonly affecting the elderly and immunocompromised. Over the last several years, a trend towards decreasing incident age, albeit with varying clinical features, has been observed. This temporal trend towards the younger age group necessitates a detailed evaluation to determine possible causes of its occurrence in this population. This is a hospital-based retrospective study. 154 datasheets were initially identified. After excluding non-relevant data sheets (88), 56 relevant and complete records were subjected to comprehensive analysis in adherence to the inclusion criteria. Most commonly affected age group was < 40years, with the mean age being 38. Conjunctivitis was the most frequent occurrence seen in 82.05%. Keratitis was seen in varying forms as, epithelial (64.44%), stromal (15.3%) & nummular (3.57%). Anterior uveitis in 35.89%, posterior uveitis (retinitis, neuro-retinitis) in 7.69% of cases, posterior segment involvement (rhegmatogenous retinal detachment, optic atrophy) in 8.8%, secondary glaucoma in 28.2%, optic neuritis in 5.3% while orbital apex and cavernous sinus involvement were seen in one case. This study reflects a temporal shift in the incidence of HZO towards the younger age group. The proportion of younger patients with HZO is increasing with some male preponderance. Identifiable factors contributing to potential risk, recurrence, and chronicity of HZO are related to demographics, immune status, dietary, environmental associations, vaccination status, and previous history of recurrences. Reported outcomes can be valuable in understanding the evolving patterns of HZO and improving patient care, public health and vaccination policies.

A Retrospective Review of Ambulatory Oral and Maxillofacial Surgery in a Suburban Tertiary Hospital in Nigeria

Background Ambulatory surgical procedures are integral aspects of oral and maxillofacial surgical (OMS) practice. Objective The aim of this study is to report the scope of ambulatory OMS procedures in a Nigerian suburban teaching hospital. Method A retrospective review of ambulatory OMS procedures performed at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, between March 2021 and February 2022 was conducted. Sociodemographic data, diagnoses, procedures, type of anesthesia, and immediate postoperative complications were retrieved from patients' records. Data were analyzed using the Statistical Package of Social Sciences (SPSS) version 22. Results Two hundred and fifty-two ambulatory OMS procedures were performed during the 12-month study period. This accounted for 80.3% (252/314) of elective surgeries. The patients' mean (standard deviation [SD]) age was 32.2 (10.4) years, while a slight male preponderance (51.6%) was recorded. Third molar surgery was the commonest (48.0%) procedure undertaken in ambulatory setting. Most (90.9%) of them were performed under local anesthesia. Satisfactory postoperative pain control was achieved with the use of oral nonsteroidal anti-inflammatory analgesics in most patients (81.7%). However, owing to a failed ambulatory session, there was an eventual admission rate of 0.4% (1/252). Conclusion Ambulatory surgical procedures constitute the majority of the OMS elective cases, with third molar surgery being the commonest procedure. Judicious prescription and administration of oral analgesics were effective in managing postoperative pain in our day case OMS patients. We recommend a prospective study to determine an intermediate/long-term outcome of care in ambulatory settings.

Clinico-etiological profile of seizures in the pediatric age group

Background: The etiologies of pediatric seizures are multifaceted, involving infections, structural brain abnormalities, or genetic factors. The objective of this study was to find the clinico-etiological profile of seizures in children and to estimate the association of different seizure etiology with demographic factors Methods: This cross-sectional study was conducted over 18 months on 400 children aged between 1 month and 18 years presenting with their first episode of seizures at Hind Institute of Medical Sciences, Sitapur. Data was collected on predesigned Performa which included history, clinical examination, and laboratory investigations. The data was analyzed using SPSS-22 software. A p-value&lt;0.05 was considered significant. Results: The mean age of children was 5.51 (4.43) years. The majority of children were from the age group 3-6 years (164, 41%). Males were 242 (60.5%). Most were birth order &gt;3 (153, 38.2%). Most were from joint families (259, 64.8%), from rural livelihood (349, 87.3%), and from lower socioeconomic status (134, 33.5%). Family history of seizures was positive in 78 (19.5%). Generalized tonic-clonic seizures were the most common type (159, 39.8%). The leading causes of seizures were febrile seizures (153, 38.2%), and CNS infections like meningitis (97, 24.2%). Fever was the most common symptom (282, 70.5%). A significant association of etiology of seizures was seen with lower age groups, lower socioeconomic status, rural livelihood, and positive family history. Conclusions: Seizures are common in &lt;6 years of age with male preponderance and febrile seizure is the most common cause. Most of these seizures are generalized in nature.

A Comparative Review of Spine Surgeries in Two New Neurosurgery Centres in an Urban and Rural Environment in Southeast Nigeria

Background: The Imo State University Teaching Hospital (IMSUTH) located in a rural setting commenced neurosurgical services in January 2016 with a spine procedure as the first case whereas the Imo State Specialist Hospital (IMSSH) located in an urban setting commenced neurosurgical services in April 2021 and spine procedures in August 2021. The presentation of surgically managed spine pathologies in both hospitals were compared. Aims: The study aimed to descriptively compare the number of spine procedures performed in both hospitals including the age and gender distribution of the surgically managed spine patients, the spine pathologies and their distribution. Methods: The surgical records of all spine patients who had surgical procedures at IMSUTH, Orlu, from January 2016 to May 2020 (42 months), and at IMSSH, Owerri, from August 2021 to July 2024 (36 months) were retrospectively reviewed. Results: During the study periods, in IMSUTH, Orlu, there were 27 spine surgeries, giving an average of 1 spine procedure in 2 months whereas in IMSSH, Owerri, there were 157 spine surgeries giving an average of 4 spine surgeries per month. Interestingly the distribution of spine procedures revealed that the highest frequency of spine surgeries was performed in the lumbar spine (n=7, 26% in IMSUTH; n=43, 27.3% in IMSSH) followed by lumbosacral spine (n=6, 22.2% in IMSUTH; n=42, 26.8% in IMSSH) in both hospitals. And quite interesting also is that trauma (n=15, 55.6%) accounted for the highest number of spine surgeries in the rural environment of IMSUTH, Orlu, while degenerative spine diseases (n=113, 71.9%) accounted for the highest number of spine surgeries in the urban environment of IMSSH, Owerri. Conclusion: The study revealed that spine pathologies are not uncommon in resource poor settings especially in the urban environment. There is a male preponderance for spine surgeries. Lumbar/lumbosacral spine pathologies are common in our resource poor settings but trauma related spine pathologies are more common factors for spine surgeries in rural settings. There is need to improve access to spine care in the rural environments.

A Case Series of Foreignbody Oesophagus and its Management at Tertiary Care Hospital

Objectives: To study the role of clinical examination as well as radiological investigations to rule out oesophageal foreign bodies as well as its plan of management.  Methodology: In total 10 patients with foreign body oesophagus came to Emergency department and ENT OPD in GGH, Anantapuram were prospectively analysed. The study period was from january 2023 to june 2023.A detailed clinical examination and radiological investigations done.  Results: There was male preponderance with children younger than 10 years compromising 50% of the patients. Upper oesophagus 80% was the favoured site for foreign body lodgement. were coins (60%) ,bones of chicken and meat(30%) gold chain (10%). There were no mortality or no major complications in this study group.  Conclusion: The complications due to oesophageal foreinbodies can be prevented by the early identification as well as referring the patients helps in proper management.The treatment of foreign body of oesophagus with the help of rigid esopaghoscopy was an effective ,safe and reliable procedure.

The Recurrent E-Cadherin (CDH1) Mutation c.760G>A Causes Orofacial Clefts but Does Not Predispose to Hereditary Cancer.

Objective: Congenital, non-syndromic orofacial clefts (CL/P) are infrequently monogenic in etiology. However, heterozygous pathogenic CDH1 germline variants were reported in a few non-syndromic CL/P families, as well as in one syndromic form of CL/P: the blepharocheilodontic syndrome. CDH1 encodes epithelial cadherin (E-cadherin), and close to 300 different pathogenic CDH1 variants are listed in the ClinVar mutation database. The majority of CDH1 germline variants are implicated in hereditary diffuse gastric cancer (HDGC) susceptibility. The purpose of this study was to classify the CDH1 c.760G>A (p.Asp254Asn) mutation with respect to its resulting phenotype. Methods: Exome sequencing and targeted Sanger sequencing were performed in a family segregating CL/P. A review of pathogenic CDH1 variants in ClinVar and those identified in a PubMed/MEDLINE search was performed. Results: We identified a family with six individuals, who were 35-77 years old (mean 56 years) at their last examination, uniformly affected with bilateral CL/P. The CDH1 c.760G>A variant segregated with CL/P. This variant had been reported in 21 individuals, most often children and young adults, from six families. We determined a significant sex preponderance for this variant regarding CL/P: all 16 male and 5 of 11 female heterozygotes presented with CL/P. Furthermore, none of the heterozygous individuals in seven families reported any gastrointestinal tumors. Conclusions: The recurrent CDH1 c.760G>A mutation confers a high risk for CL/P, with strong male preponderance. This review of 27 mutation carriers, including 3 who were 68, 70, and 77 years of age, indicates that c.760G>A does not confer an increased risk for HDGC. The relevance of differentiating craniofacial from cancer phenotypes in mutation carriers is substantial for precision medicine and for counseling families.

Infantile Sinonasal Tract Myxomas with Orbital Involvement: Presentation of Two Cases and Comprehensive Literature Review.

Objective: Our aim is to present two cases of infantile sinonasal tract myxoma with orbital involvement and conduct a comprehensive literature review of the topic. We aim to provide a summary of the presentation of infantile sinonasal tract myxomas to effectively aid clinicians in considering this rare entity as a potential diagnosis. Methods: We present a case series and a retrospective review of the published literature in the English language. A search was conducted between 1945 and 2023 on sinonasal myxoma. Cases of infantile (<3 years) sinonasal myxoma in the literature were reported as well as two cases of our own. Data was collected from each of the identified articles on the age of presentation, sex, initial presentation, tumor location, imaging, pathology, and treatment. Results: Forty-eight cases of sinonasal myxoma in children <3 years of age were identified. These cases had a slight male preponderance (F:M, 1:1.39) and an average age of diagnosis of sixteen months. Of the cases included, the majority involved the maxilla and maxillary sinuses (83.3%) and commonly presented with a painless slow-growing mass in the region of the tumor. Characteristic CT findings are homogenous solid masses with heterogeneous contrast enhancement. On MRI, these lesions appear hypointense on T1 with highly variable contrast enhancement and hyperintense on T2. Conclusions: We present two cases of infantile sinonasal myxoma with secondary orbital involvement followed by a major review. Treatment of these cases with surgical excision (confirmed clear margins) provided 0% rates of recurrence in the reported cases. Due to the rarity of these tumors and recent histological reclassification, a comprehensive review of this condition will assist clinicians in their management of it.

EPID-21. PRIMARY INTRAMEDULLARY LYMPHOMA OF SPINAL CORD (PILSC): A SYSTEMATIC REVIEW OF CASE REPORTS AND CASE SERIES FROM 2000 TO 2023

Abstract BACKGROUND AND OBJECTIVE Primary CNS lymphoma accounts for three percent of all newly diagnosed CNS tumours and 1-3% of all non-Hodgkin’s lymphomas. The oncologic origin of primary intramedullary lymphoma of the spinal cord (PILSC) is an enigma. We aim to determine the clinical manifestations, disease course and management of PILSC. MATERIALS AND METHODS A comprehensive literature search using PubMed Central and Google Scholar, was done, retrieving 17 case reports and two case series of 21 patients with PILSC and included using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, published between 2000 and 2023. RESULTS About 90.48% patients inflicted with PILSC were adult, with male predominance, 61.90%. The most common complaint at presentation was neurological deficit of motor type in 32.14% patients. MRI proved to be helpful in 76.19% cases, with spinal cord enlargement and high signal intensity in 19.04% cases. Adjuvant chemotherapy and radiotherapy was acquired by 52.38% and 38.09% patients. Non-Hodgkin type was reported in 90.47% cases and Hodgkin lymphoma was seen in 9.52% patients. Diffuse large B cell lymphoma was culprit in 41.10% cases. Five out of 21 cases had variable post-operative complications. The average follow-up was 16.16 months. CONCLUSION PILSC is a multifaceted neoplasm in all its clinico-pathological aspects of presentation. Although rare, PILSC can involve adult and paediatric populations with a clear male preponderance. The MRI findings are not reliable to make a preliminary diagnosis. Like other lymphomas, the role of chemoradiotherapy is clearly more significant than surgical intervention in improving patient prognosis. Histopathologically, it can be Non-Hodgkin or Hodgkin, B-cell type or T-cell type and has a wide array of immunohistochemistry positivity.

Functional Outcome of Cast Immobilisation and Functional Treatment in Management of Lateral Ankle Sprain (Grade 1 and 2)

Background: Pain and functional constraints from ankle sprains, which mostly impact the lateral ligamentous complex, can lead to the consumption of medical facilities and unavailability from workplace. No single technique is regarded as the most effective, despite the fact that this injury occurs frequently. This study evaluates the management modalities for lateral ankle sprain i.e. functional treatment and cast immobilization with pain and function as outcome variables.  Materials and methods: Seventy patients with lateral ankle sprains (grade 1 and 2) were included in this study. Each alternate participant was placed in a functional treatment (group A), while the other participants were placed in a cast immobilization group (group B). Every patient was assessed at a follow up of 2 and 6 weeks using Visual analog scale and Karlsson score for quantifying pain and function respectively.  Results: Thirty-two patients in the functional therapy group and twenty-eight in the cast immobilization group finished the study. The functional therapy group's mean age was 27.7 years, while the cast immobilization group's was 29.4 years. While both the right and left ankles were similarly impacted in the cast immobilization group, the dominant ankle involved in the functional treatment group was the right ankle in 19 patients and the left ankle in 16 patients. In both groups, a male preponderance was seen. By the end of the study, the mean differences between the two groups' Karlsson scores and visual analog scale scores were statistically significant.  Conclusion: Our study's findings show that a functional treatment outperforms immobilization in terms of both functional outcome and pain reduction.

Isolated Sixth Cranial Nerve Palsy in Patients with Pituitary Apoplexy.

Pituitary apoplexy is an acute clinical syndrome constituted by headache, visual impairment, ophthalmoplegia, and altered mental status. Abducens nerve palsy due to pituitary apoplexy is a significant clinical manifestation in pituitary apoplexy cases.This study aims to investigate the rare occurrence of isolated sixth cranial nerve palsy in patients with pituitary apoplexy, a condition characterized by sudden hemorrhagic or ischemic infarction of the pituitary gland. A search was conducted on major databases, including PubMed, Web of Science, and ScienceDirect, to identify cases of isolated sixth cranial nerve palsy in patients with pituitary apoplexy. Only six cases were found in the available literature. Descriptive statistics were used to summarize the data, and relevant clinical features were compared between the cases. Among the six identified cases, isolated sixth cranial nerve palsy in patients with pituitary apoplexy predominantly affected middle-aged adults, with a prominent male preponderance. Clinical manifestations included acute-onset diplopia and headache, with the most common radiologic finding being pituitary gland enlargement or hemorrhage. Laboratory investigations revealed hormonal dysregulation in some cases. Treatment approaches varied and included conservative management and surgical intervention. Outcomes were generally favorable, with most patients experiencing partial or complete resolution of their cranial nerve palsy. Isolated sixth cranial nerve palsy in patients in the context of pituitary apoplexy is an exceptionally rare occurrence, with only six documented cases in the available literature. Further research and case reporting are essential to better understand this rare clinical entity and guide optimal management strategies.

An Assessment of the Feasibility, Patient Acceptance, and Performance of Point-of-Care Transient Elastography for Metabolic-Dysfunction-Associated Steatotic Liver Disease (MASLD): A Systematic Review and Meta-Analysis.

Background: Vibration-Controlled Transient Elastography (VCTE) with FibroScan is a non-invasive, reliable diagnostic tool for Metabolic-Dysfunction-Associated Steatotic Liver Disease (MASLD), enabling early detection and management to prevent severe liver diseases. VCTE's ease and portability suit primary care, streamlining referrals, promoting lifestyle changes, reducing costs, and benefiting underserved communities. Methods: Studies on point-of-care VCTE were systematically reviewed, followed by meta-analysis using a random-effects model. Pooled proportions with 95% confidence intervals were reported, and heterogeneity was assessed using I2%. Results: A total of twenty studies from 14 countries, including 6159 patients, were analyzed, with three studies from France, two from the U.S., and four from China. The population had a slight male preponderance, with a mean age range of 35-73 years and a BMI range of 24.4-41.1%. The diagnostic accuracy for detecting any fibrosis (≥F1) was reported in four studies (n = 210) with an AUC of 0.74, sensitivity of 69.5%, and specificity of 70.6%. For significant fibrosis (≥F2), eight studies (n = 650) reported an AUC of 0.69, sensitivity of 81.7%, and specificity of 64.6%. Advanced fibrosis (≥F3) was evaluated in 10 studies (n = 619), with an AUC of 0.84, sensitivity of 88.1%, and specificity of 63.8%. Cirrhosis (F4) was assessed in nine studies (n = 533), with an AUC of 0.65, sensitivity of 87.5%, and specificity of 62.6%. Steatosis diagnoses across stages S1 to S3 showed increasing diagnostic accuracies, with AUCs of 0.85, 0.76, and 0.80, respectively. Probe type and BMI were significant covariates influencing diagnostic performance for both fibrosis and steatosis, while the percentage of male participants also showed significant associations. Conclusions: VCTE shows high diagnostic accuracy for fibrosis and steatosis in MASLD patients at the point of care. Future research should assess its implementation in fibroscan settings.

Relationship between Myocardial Performance Index (Tei Index) and angiographic severity of coronary artery disease in patients with Acute ST Elevation Myocardial Infarction

Background: Tei index is a Doppler derived measure of combined systolic and diastolic myocardial function and a better predictor of global LV function and outcome in patients with acute STEMI. The objective of this study was to determine the relationship between the myocardial performance index of LV (Tei index) and angiographic severity of coronary artery disease as assessed by SYNTAX score in patients with acute STEMI. Methods: This was a prospective, observational single centered study conducted from March 2022 to November 2022 at Manmohan Cardiothoracic Vascular and Transplant Centre, Institute of Medicine. (MCVTC, IOM). 160 patients with acute STEMI were enrolled. LV Tei index was calculated with the help of 2D and Tissue Doppler imaging, and the lesion severity was categorized with the help of SYNTAX score after the patients underwent coronary angiography. Results: The mean age was 61.23±12.33 years with a male preponderance. 107 (67%) were male with male to female ratio of 2:1. Tei index was significantly higher among the hypertensive (0.74±0.17) and diabetic (0.78±0.18) patients. 64 (40%), 51(31.9%) and 45(28.1%) had Single vessel disease (SVD), Double vessel disease (DVD) and Triple vessel disease (TVD) respectively with the Mean Tei index values 0.57 ± 0.10, 0.76 ± 0.11, and 0.88±0.11 (p&lt;0.05). The Tei index increased when patients were divided into low, mid, and high SYNTAX score groups as 0.58±0.11, 0.61±0.73, 0.88±0.13 respectively, p-value &lt; 0.05). Moreover, the study showed a positive correlation between Tei index and SYNTAX score with increasing severity of coronary artery stenosis. (r=0.654, p-value&lt;0.001). Proximal LAD, LCx and RCA lesions had greater Tei index than the distal lesions. Conclusion: More proximally located LAD, LCx, RCA lesions had higher value of Tei index, as assessed with the SYNTAX score.

Lymphocytic Interstitial Pneumonia with Varied Association: Case Series

Lymphocytic interstitial pneumonia (LIP) is an unusual variant of interstitial lung disease with unknown incidence and prevalence. It is often seen in patients with autoimmune diseases and in immune-compromised individuals, and is associated with specific infections; rarely, it is idiopathic. Idiopathic LIP has a male preponderance, while the secondary form is more common in females. It is characterized by dense infiltration of polyclonal lymphocytes, plasma cells, and histiocytes in the interstitial and alveolar spaces. Early diagnosis and treatment initiation are crucial for a favorable prognosis. Here, we present four cases of LIP with variable associations, emphasizing the importance of clinical examination, imaging, and, whenever needed, a transbronchial lung biopsy for accurate diagnosis.

Case-controlled study to compare the neutralizing antibody amongst fully vaccinated breakthrough infections in third wave of COVID-19 and asymptomatic healthcare workers

BackgroundThe SARS-CoV-2 (COVID-19) pandemic declared in March 2020 continues to impact millions globally. India initiated a large-scale COVID-19 vaccination campaign in January 2021 using the CovishieldTM vaccine. Monitoring neutralizing antibody (NAb) levels is essential for assessing vaccine effectiveness, but data on NAb levels after completing two doses of CovishieldTM are limited. This study aimed to investigate the NAb profile among fully vaccinated individuals. MethodsConducted during the third wave of the pandemic starting in January 2022, this study included individuals who received the first two doses of CovishieldTM and visited the flu clinic or vaccination center. NAb levels were measured using an approved kit and "Blocking ELISA" method. Symptomatic individuals underwent COVID-19 real-time polymerase chain reaction (RT-PCR) testing. ResultsThe study included 299 individuals with a median age of 26 years (IQR-11 years; male preponderance: 81.9%). NAb was detected in 91.5% (n=274) of the participants. The mean neutralizing percentage inhibition was 77.26%±26.26%. Significant relationships were found between neutralizing percentage inhibition and past COVID-19 infection (p=0.0005), blood groups (B+ve had the highest Ab inhibition, p=0.0003), and age (p=0.01). No significant correlation was observed with gender (p=0.11), time since the second vaccine dose (p=0.32), and time from the last COVID19 infection (p=0.48). ConclusionDuring the early stages of the third wave of COVID-19 in India (January 2022), a high seroprevalence of NAb was observed among fully vaccinated individuals. Breakthrough infections occurred but with reduced severity. Breakthrough cases had higher percentage inhibition, high NAb positivity, longer time since the last COVID-19 infection, and older age.

Fovea-Sparing Internal Limiting Membrane (ILM) Peeling and ILM Plug: A Novel Approach for Managing Optic Disc Pit Maculopathy.

To evaluate the efficacy of fovea-sparing internal limiting membrane (ILM) peeling combined with ILM plug placement in patients with optic disc pit maculopathy (ODP-M). This retrospective study included seven eyes from seven patients diagnosed with ODP-M, treated with fovea-sparing ILM peeling and ILM plug placement. All patients underwent pars plana vitrectomy (PPV), with either SF6 gas or silicone oil used as tamponade. Outcome measures included best-corrected visual acuity (BCVA), central macular thickness (CMT), retinal reattachment, and resolution of retinoschitic lesions (RL). Data were collected at baseline and during follow-ups at 1, 3, 6, and 12 months. The mean age of the study patients was 31 (± 13.14) years, with a marginal male preponderance (M: F = 4:3). All patients achieved complete retinal reattachment, with a significant reduction in CMT from 503.57 (± 154.74) µm preoperatively to 286.29 (± 22.43) µm at 12 months (P=0.02). BCVA improved in 85.7% of patients, from a mean of 0.77 (± 0.19) logMAR to 0.5 (± 0.25) logMAR by 12 months, though this was not statistically significant (P=0.27). Complete resolution of RL was observed in 71.4% of eyes, while 2 eyes showed partial resolution. One patient developed retinal detachment postoperatively, which was successfully managed with additional surgery. Fovea-sparing ILM peeling combined with ILM plug placement resulted in favorable anatomical and functional outcomes for ODP-M patients, with a 100% retinal reattachment rate and significant CMT reduction. This technique offers a viable alternative to conventional approaches, preserving foveal architecture while providing a mechanical barrier to fluid accumulation.

A Cross Sectional Study of the Prevalence of Retinopathy in Patients with Chronic Kidney Disease on Hemodialysis in a Tertiary Care Centre in Chengalpattu District, South India

Context: Many studies have reported varying proportions of retinopathy among cases with chronic kidney disease (CKD). Cases with severe grades of CKD were more likely to develop ocular complications, especially diseases which occurs due to small vessel pathology. Aim: To estimate the prevalence of various types of retinopathies in patients with CKD undergoing hemodialysis in a tertiary care centre in South India. Settings and Design: The outpatient Department of Ophthalmology and Hemodialysis unit of Nephrology, Karpaga Vinayaga Institute of Medical Sciences from January 2022 to June 2023 A cross-sectional hospital-based observational study in a low resource setting. Methods and Material: The study consists of 28 patients who were known cases of CKD on hemodialysis. Patients underwent complete ocular evaluation and findings were noted. The pre hemodialysis values of blood urea and serum creatine, hemoglobin, liver function tests and vital parameters were also noted. Data analysis was done utilising version 20 of Statistical Packages for the Social Sciences (SPSS). Results: 56 eyes of 28 patients on hemodialysis were studied. The mean age was 53 years + 10.9 with a male preponderance. 31.6% had retinopathy of which 26.3% had hypertensive retinopathy and 5.3% had diabetic retinopathy. This is contrary to the previous studies that have reported a higher incidence of diabetic retinopathy in patients with end stage CKD. Hypertension resulted in CKD earlier than diabetes. Conclusion: The results emphasize the importance of frequent eye examination in patients with CKD to identify retinopathy earlier, thus potentially averting permanent vision impairment.

Clinical spectrum of pediatric tuberculosis and early diagnosis by clinical, radiological, and CBNAAT in a Tertiary Care Teaching Hospital in South India

Background: In India, an estimated 220,000 children contract tuberculosis (TB) annually, yet the absence of a gold standard test hinders effective diagnosis and reporting of childhood TB. Objective: This study aimed to analyse the clinical profile of childhood tuberculosis, utilizing relevant laboratory investigations for early diagnosis. Methods: A cross-sectional observational study was conducted at a tertiary care hospital in South India from October 2019 to October 2021. Children under 18 with tuberculosis were included. Data on demographics, symptoms, family TB history, nutritional status, and clinical findings were collected. Laboratory tests included complete blood count, ESR, Mantoux test, chest X-rays, and sputum analyses for acid-fast bacilli (AFB). Results: Among 54 children, the most common age group was over 10 years (51.3%), with a male preponderance (53.3%). Pulmonary TB was diagnosed in 44.4% of cases, while 55.5% had extrapulmonary TB, predominantly pleural (40%). Fever (60.5%) and cough (42.7%) were the most common symptoms. The Mantoux test was reactive in 40.7% of patients, particularly among the undernourished. Chest X-rays indicated TB in 93.25% of pulmonary cases, while CBNAAT showed positive results in 10 cases, with a sensitivity of 18.8% and specificity of 81.25%. Conclusions: Diagnosing childhood TB remains complex, relying on symptom evaluation, clinical history, and laboratory tests. Despite advances in diagnostic methods, negative CBNAAT results do not exclude TB, highlighting the need for thorough clinical assessment and investigation.