Retrospective Case Record Review Research Articles

MORBIDITY AND MORTALITY PROFILE OF NEONATES ADMITTED IN NEONATAL INTENSIVE CARE UNIT IN A TERTIARY CARE HOSPITAL, SOUTH-EASTERN RAJASTHAN, JHALAWAR MEDICAL COLLEGE, JHALAWAR: A RETROSPECTIVE STUDY

Objective: The objective of this study was to study the morbidity and mortality patterns in a special newborn care unit (SNCU)/neonatal intensive care unit (NICU) of a tertiary care teaching hospital. Methods: A retrospective study was carried out in the SNCU/NICU of Jhalawar Medical College, Jhalawar. The duration of the study was 3 years. A retrospective case record review and analysis was done. Secondary data collected from the online SNCU Software (National Health mission Government of India). Results: Eight thousand seven hundred and forty-eight neonates were admitted in NICU. 2488 (59.9%) were male and 1657 (40.1%) were female, 4047 (46.3%) were normal birth babies, and 4701 (53.7%) were low birth weight babies. According to the outcome, total 6753 (77.19%) were discharged successfully, 1464 (16.66%) died, 382 (4.36%) were referred, and 149 (1.7%) were leave against medical advice. Birth asphyxia was the most common morbidity 2404 (27.36%) followed by neonatal sepsis (18.06%) and neonatal jaundice (15.44%). Birth asphyxia were more in inborn unit (p<0.0001). Sepsis is more prevalent in out born unit (p<0.0001). Hypoxic ischemic encephalopathy/moderate-to-severe birth asphyxia was the most common cause of death (28.23%), followed by neonatal sepsis (20.62%) and respiratory distress syndrome (19.35%), and major congenital malformations were cause of death in 106 (7.24%). Mortality due to neonatal sepsis was significantly high in outborn unit (p<0.0001). Conclusion: Birth asphyxia, neonatal sepsis, and respiratory distress syndrome were the leading causes of mortality in this study. These leading causes of mortality in the study could be prevented by adequate training of nursing staff and doctors, timely referral to tertiary care if required.

Unraveling cervical cancer screening dilemmas: histopathological insights from VIA and LEEP at bugando medical centre, Mwanza

BackgroundThe single-visit strategy, also known as the “screen-and-treat” approach, is widely used to screen for cervical cancer in low- and middle-income countries. The screen-and-treat approach leads to unnecessary or inadequate treatment. Thus, a study was conducted to determine the histopathological patterns of aceto-white lesions on visual inspection with acetic acid (VIA) in patients who underwent a Loop Electrosurgical Excision Procedure (LEEP) at Bugando Medical Centre between January 2016 and December 2020.MethodA 5-year retrospective cross-sectional case record review was conducted on 329 women who had LEEP at Bugando Medical Centre following a positive VIA cervical screening test. A standard data abstraction form was used to collect patient information. Missing client information records and LEEP without histopathological results were exclusion criteria. For statistical analysis, STATA version 15 was used; in descriptive statistics, frequency, mean, and standard deviation were used. The Chi2 and Fisher’s exact tests were used to investigate the relationship between patient characteristics and histopathological patterns, and a P-value of 0.05 was considered statistically significant in multinomial models.ResultsThis study looked at 329 patients who had LEEP following a VIA positive but were not eligible for cryotherapy. Our study participants had a mean age of 40 ± 8.2 SD. There were 203 (61.7%) patients with benign lesions, including 4 with schistosomiasis and 2 with cervical tuberculosis. The precancerous lesions were discovered in 100 cases (30.4%), and 26 (7.9%) already had invasive cervical cancer. Out of 100 patients with precancerous lesions, 58 (17.6%) and 42 (12.8%) have high- and low-grade squamous intraepithelial (HSIL and LSIL) lesions, respectively. The presence of a precancerous lesion was found to be associated with age 31–40 years (P-value 0.042) and HIV positivity (P-value 0.004).ConclusionMost patients in this study had benign cervical lesions, which do not require LEEP treatment. Nonetheless, a considerable percentage of invasive cervical malignancies and rare benign diseases such as schistosomiasis and cervical tuberculosis were identified. A screen-and-treat approach within well-equipped tertiary hospitals like Bugando Medical Centre should explore alternative options instead of relying solely on straight LEEP.

Assessment of prescribing pattern in uncomplicated and complicated Type 2 diabetes mellitus in a tertiary care hospital

Background: Diabetes mellitus (DM) is a major public health problem globally and in India. Many studies in the past have documented inadequate glycemic control and complication rates among the Indian diabetic population due to inappropriate or inadequate pharmacological treatment. Studies assessing the prescription pattern are also very scare from the country. The present study has been conducted with the objective of assessing the profile of diabetic patients admitted to a tertiary care teaching hospital and the prescription pattern of anti-diabetic medication among them. Aims and Objectives: The aimed to analyze the current prescribing patterns for patients with both uncomplicated and complicated Type 2 DM in a tertiary care hospital and to identify the most commonly prescribed antidiabetic medications and their combinations in both uncomplicated and complicated cases. Materials and Methods: The present study was a retrospective case record review of 136 patients with Type 2 DM admitted in the ward of general medicine department of a tertiary and is teaching hospital. Results: The mean age was 54.39 ± 12.46 years and 61.03% of participants were males. Comorbidities such as systemic hypertension were present in 21.32% of participants and hyperlipidemia was present in 11.76% of participants. The proportion of subjects, who had complicated DM, was 52.21%. Among the study population, 77 (56.62%) had oral hypoglycemic agents (OHA) alone, 27 (19.85%) had insulin alone, and 32 (23.53%) had Insulin + OHA. Among the study population, 70 (51.47%) had single OHA, 32 (23.53%) had dual combination of OHA, and 7 (5.15%) had triple combination OHA. The majority (53.70%) people were taking metformin, 20 (14.71%) people were taking glimepiride, 16 (11.76%) people were taking glibenclamide, 13 (9.56%) people were taking gliptins. Among the study population, 34 (25%) people were taking actrapid, 32 (23.53%) people were taking mixtard, and 10 (7.35%) people were taking lup Insulin. Among the study population, 32 (23.53%) had anti-hypertensive drugs, 19 (13.97%) had statins, 14 (10.29%) had antiplatelet, 12 (8.82%) had antibiotics and 4 (8.94%) had diuretics. The mean fasting blood sugar at admission was 178.51 ± 69.56 g/dL and at the discharge was 123.23 ± 24.92 g/dL and the mean difference (55.29) between two groups was statistically significant (P < 0.001). The mean postprandial blood sugars at admission was 228.92 ± 67.03 g/dL and at the discharge was 166.66 ± 30.73 g/dL, and the mean difference (55.29) between two groups was statistically significant (P < 0.001). Conclusion: The treatment intake was inadequate and glycemic control was poor in majority of the diabetic population. There is high reliance on metformin and sulfonylureas and insulin is underutilized even in patients with poor glycemic control. There is strong need to optimize the therapy in diabetic patients.

Assessment of prescribing pattern in uncomplicated and complicated Type 2 diabetes mellitus in a tertiary care hospital

Background: Diabetes mellitus (DM) is a major public health problem globally and in India. Many studies in the past have documented inadequate glycemic control and complication rates among the Indian diabetic population due to inappropriate or inadequate pharmacological treatment. Studies assessing the prescription pattern are also very scare from the country. The present study has been conducted with the objective of assessing the profile of diabetic patients admitted to a tertiary care teaching hospital and the prescription pattern of anti-diabetic medication among them. Aims and Objectives: The aimed to analyze the current prescribing patterns for patients with both uncomplicated and complicated Type 2 DM in a tertiary care hospital and to identify the most commonly prescribed antidiabetic medications and their combinations in both uncomplicated and complicated cases. Materials and Methods: The present study was a retrospective case record review of 136 patients with Type 2 DM admitted in the ward of general medicine department of a tertiary and is teaching hospital. Results: The mean age was 54.39 ± 12.46 years and 61.03% of participants were males. Comorbidities such as systemic hypertension were present in 21.32% of participants and hyperlipidemia was present in 11.76% of participants. The proportion of subjects, who had complicated DM, was 52.21%. Among the study population, 77 (56.62%) had oral hypoglycemic agents (OHA) alone, 27 (19.85%) had insulin alone, and 32 (23.53%) had Insulin + OHA. Among the study population, 70 (51.47%) had single OHA, 32 (23.53%) had dual combination of OHA, and 7 (5.15%) had triple combination OHA. The majority (53.70%) people were taking metformin, 20 (14.71%) people were taking glimepiride, 16 (11.76%) people were taking glibenclamide, 13 (9.56%) people were taking gliptins. Among the study population, 34 (25%) people were taking actrapid, 32 (23.53%) people were taking mixtard, and 10 (7.35%) people were taking lup Insulin. Among the study population, 32 (23.53%) had anti-hypertensive drugs, 19 (13.97%) had statins, 14 (10.29%) had antiplatelet, 12 (8.82%) had antibiotics and 4 (8.94%) had diuretics. The mean fasting blood sugar at admission was 178.51 ± 69.56 g/dL and at the discharge was 123.23 ± 24.92 g/dL and the mean difference (55.29) between two groups was statistically significant (P < 0.001). The mean postprandial blood sugars at admission was 228.92 ± 67.03 g/dL and at the discharge was 166.66 ± 30.73 g/dL, and the mean difference (55.29) between two groups was statistically significant (P < 0.001). Conclusion: The treatment intake was inadequate and glycemic control was poor in majority of the diabetic population. There is high reliance on metformin and sulfonylureas and insulin is underutilized even in patients with poor glycemic control. There is strong need to optimize the therapy in diabetic patients.

Outcomes of topography-guided PRK/CXL in keratoconus using the NIDEK CXIII system-"Bharat Protocol" (Pilot study).

Outcome of topography-guided excimer laser ablation in conjunction with accelerated, high-fluence cross-linking in corneal ecstatic disease using the NIDEK CXIII equipped with CATz algorithm from the FinalFit software-"Bharat Protocol." Retrospective case record review of 30 eyes of 17 patients of stage 1-3 keratoconus who underwent the procedure was performed. Data collected were for visual acuity, distortion-induced eye pain, and keratometry. Pachymetry, lower order and higher order aberrations, spherical aberrations, and topographic cylinder were documented from by Scheimpflug imaging (Pentacam 70700: Oculus, Wetzlar, Germany). At a minimum follow-up of 6 months (range 6.2-13 months), there was significant improvement in UCVA (P < 0.00001), BCVA (P = 0.0061), decrease in Kmax (P = 0.0349), Ksteep (P < 0.0411), Kflat (P = 0.0099), and pachymetry (P = 0.0001). Significant improvement was also seen in distortion-induced eye pain (27/30 to 2/30; P < 0.00001). A more than two-line improvement in UCVA and BCVA was seen in 23/30 and 17/30 cases, respectively. Ectasia was stabilized in all cases at the last follow-up, and no complications were seen. The "Bharat" Protocol to arrest keratectasia progression and improve corneal regularity is a safe and efficacious alternative as a keratoconus management option. This is the first such study on Nidek Platform for the same.

Ocular Autoimmune Systemic Inflammatory Infectious Study (OASIS) – Report 6: Dengue Uveitis at a Tertiary Eye Institution in Singapore

ABSTRACT Objectives To identify the characteristics, treatment, and visual outcomes of dengue uveitis at a tertiary eye care centre in Singapore. Methods Retrospective case record review of all consecutive dengue uveitis patients (2004 to 2015) from the Ocular Autoimmune Systemic Inflammatory and Infectious Study (OASIS) database. Results Fifty-four patients were identified from the OASIS database. The most common ocular symptom was blurring of vision (n = 41, 75.9%), followed by floaters (n = 9, 17.0%), scotoma (n = 5, 9.3%), and metamorphopsia (n = 3, 5.7%). Scotoma based on history, Amsler grid, and perimetry accounted for 27 (50%) patients. Majority presented with either a posterior uveitis or retinal vasculitis (n = 51, 94.4%). Treatments ranged from close observation for spontaneous improvement, to the use of high-dose corticosteroids. Conclusions Dengue uveitis may present with a spectrum of disease manifestations including posterior uveitis, vasculitis, and macula edema. Scotoma is significant and may be found on history taking, Amsler charting, and perimetry.

Surgical Management of Vision Loss in Cerebral Venous Thrombosis: Case Series from a Tertiary Care Stroke Center.

Cerebral venous thrombosis (CVT) presenting as vision loss is uncommon. Raised intracranial tension in CVT is proposed as one of the mechanisms (13.2%). There are still unknown underlying mechanisms to explain vision loss in CVT. The safety and outcome of the surgery (optic nerve sheath fenestration [ONSF] or theco-peritoneal shunt [TPS]) to reduce intracranial hypertension and prevent vision loss has not been studied. A retrospective case record review of CVT patients with impending vision loss who underwent ONSF/TPS from 2007 to 2019 was performed from the stroke registry. All patients had formal neuro-ophthalmological evaluation and documentation of visual acuity, supplemented by visual field assessments by perimetry in a subset of patients. Safety and outcomes were assessed based on vision improvement and adverse effects after the surgery. Among approximately 1400 patients with CVT admitted in the stroke ward over 12 years, surgery for rescuing vision was done in 18. Among these, the males were 6, and the females were 12. The mean age of presentation was 24 (range 18-52 years). All of them had headaches and progressive blurring of vision with papilledema. The number of patients who underwent TPS was 13, ONSF was 1, and both were 4. In the TPS group (26 eyes), vision improved in 15 eyes (57.7%), remained status-quo in 8 eyes (30.7%), and worsened in 3 eyes (11.5%). Four patients underwent both surgeries; three eyes improved, two remained status quo, and three worsened. One patient underwent ONSF, and his vision remained status quo (no perception of light). Three patients (17.6%) of the TPS group had minor complications (low-pressure headache, subdural hygroma), and five (29.4%) had major complications like subdural hemorrhage, abdominal wound infection, and meningitis. In patients with CVT, adequate vision monitoring is mandatory. Shunt surgeries (especially TPS) may help in stabilizing/improving vision in CVT patients with impending vision loss, despite adequate anti-edema measures (53.8% improved). Early diagnosis and precise decisions in referring for surgery are crucial.

Impact of COVID-19 pandemic on the burden of dog bite cases at the National Referral Hospital in Bhutan

Introduction: Dog bite is a public health problem in Bhutan incurring huge cost of treatment. The general objective of the study was to see the impact of COVID-19 pandemic on the burden of dog bite cases and the profile of patients, comparing with that of the year before the COVID-19 pandemic started (2019) at the National Referral Hospital. Methods: This is a retrospective record review of the dog bite cases in the year 2019 and 2020. The target population of the study were people living in Thimphu city. The dog bites that occurred outside Thimphu were excluded from the study. Proportion of dog bite according to demographic and clinical variables were calculated. Univariate and multivariate analysis were done to look for risk factors responsible for dog bite in 2020 compared to 2019. A statistically significant level was set at &lt;0.01. Results: The dog bite cases in the year 2019 and 2020 were recorded at 3.3% and 2.4% respectively There was male predominance and highest incidence of the dog bite was in age group of 20-59 years. The commonest site of bite were lower limbs and stray dog bites were highest risk exposure. Conclusion: less dog bite cases reported in 2020 which may be due to the impact of pandemic. Majority of the cases were stray dog bites and high incidence of dog bites can be a major concern for health, social and economic wellbeing of the nation which needs urgent intervention.

Clinical, epidemiological, and spatial features of human rabies cases in Metro Manila, the Philippines from 2006 to 2015.

Rabies remains a public health problem in the Philippines despite the widespread provision of rabies vaccines and rabies immunoglobulin (RIG) as post-exposure prophylaxis (PEP). Detailed descriptions of recent human rabies cases in the Philippines are scarce. This study aimed to describe the clinical, epidemiological, and spatial features of human rabies cases between January 1, 2006, and December 31, 2015. We conducted a retrospective hospital-based case record review of all patients admitted to one referral hospital in Manila who received a clinical diagnosis of rabies. During the 10-year study period there were 575 patients (average 57.5 cases per year, range 57 to 119) with a final diagnosis of rabies. Most patients were male (n = 404, 70.3%) and aged ≥ 20 years (n = 433, 75.3%). Patients mostly came from the National Capital Region (n = 160, 28.0%) and the adjacent Regions III (n = 197, 34.4%) and IV-A (n = 168, 29.4%). Case mapping and heatmaps showed that human rabies cases were continuously observed in similar areas throughout the study period. Most patients had hydrophobia (n = 444, 95.5%) and/or aerophobia (n = 432, 93.3%). The leading causative animals were dogs (n = 421, 96.3%) and cats (n = 16, 3.7%). Among 437 patients with animal exposure history, only 42 (9.6%) had been administered at least one rabies vaccine. Two patients (0.5%), young children bitten on their face, had received and a full course of rabies vaccine. Human rabies patients were continuously admitted to the hospital, with no notable decline over the study period. The geographical area in which human rabies cases commonly occurred also did not change. Few patients received PEP and there were two suspected cases of PEP failure. The retrospective design of this study was a limitation; thus, prospective studies are required.

Retrospective review of case records of snakebite presenting to a single tertiary care centre over a 5-year period.

Background Snakebite is a disease of the poor, and hospitals catering to these individuals are often resource-constrained. Lack of electronic medical records in these resource-limited settings makes the capture of data even harder. Methods Before establishing a snakebite registry in the region, we did a retrospective case record review of all snakebite victims (n=3229) over 5 years who presented to a single tertiary care centre, catering to one of the largest number of snakebite victims in the country. Results Of the 451 cases, 262 (58.1%) presented to the emergency department within 2 hours of the bite. In 170 instances, the snake was brought along and the species of the snake was recorded. Russell's viper was the most common (130; 76.5%). Blood products were used in 237 (52.5%) patients. Acute kidney injury occurred in 165 (36.6%) patients, of whom 37 (8.2%) required dialysis. The mean (SD) duration of hospital admission was 10.5 (7.4) days. There was a significant correlation between number of snakebites with rainfall and humidity. One hundred and seven cases (3.3%) of snakebite resulted in mortality. A majority of mortality records were not available (88%; 94/107), rendering us incapable of doing reliable mortality data correlations or interpretation. Conclusion Viperidae bites predominate in the region, with renal injury being the most common cause for morbidity. Region-specific, prospective snakebite mapping could be a cost-effective strategy that might help in vulnerability analysis of the region. A multi-centric region-specific snakebite registry encompassing not just the clinico-epidemiological characteristics of snakebite victims, but also the demographic data, the pre-hospital care and local remedial practices, geospatial distribution, anti-snake venom and blood product usage, will help in developing better healthcare strategies for snakebite victims in India.

Airway management, procedural data, and in-hospital mortality records of patients undergoing surgery for mucormycosis associated with coronavirus disease (COVID-19).

PurposeAlthough unexpected airway difficulties are reported in patients with mucormycosis, the literature on airway management in patients with mucormycosis associated with Coronavirus disease is sparse.MethodsIn this retrospective case record review of 57 patients who underwent surgery for mucormycosis associated with coronavirus disease, we aimed to evaluate the demographics, airway management, procedural data, and in-hospital mortality records.ResultsForty-one (71.9%) patients had a diagnosis of sino-nasal mucormycosis, fourteen (24.6%) patients had a diagnosis of rhino-orbital mucormycosis, and 2 (3.5%) patients had a diagnosis of palatal mucormycosis. A total of 44 (77.2%) patients had co-morbidities. The most common co-morbidities were diabetes mellitus in 42 (73.6%) patients, followed by hypertension in 21 (36.8%) patients, and acute kidney injury in 14 (28.1%) patients. We used the intubation difficulty scale score to assess intubating conditions. Intubation was easy to slightly difficult in 53 (92.9%) patients. In our study, mortality occurred in 7 (12.3%) patients. The median (range) mortality time was 60 (27–74) days. The median (range) time to hospital discharge was 53.5 (10–85) days. The median [interquartile range] age of discharged versus expired patients was 47.5 [41,57.5] versus 64 [47,70] years (P = 0.04), and median (interquartile range) D-dimer levels in discharged versus expired patients was 364 [213, 638] versus 2448 [408,3301] ng/mL (P = 0.03).ConclusionIn patients undergoing surgery for mucormycosis associated with the coronavirus disease, airway management was easy to slightly difficult in most patients. Perioperative complications can be minimized by taking timely and precautionary measures.

COMPARISON OF LIVE BIRTH RATE IN IVF PATIENTS WITH SEVERE OATS AND NORMOZOOSPERMIC IN MALE FACTOR INFERTILITY

Introduction: Infertility is defined as the inability of couples to have a baby after one year of regular unprotected intercourse, affecting 10-15 percent of couples. Aims &amp; objective: The present study aimed to compare of live birth rate in IVF patients with severe OATS and Normozoospermic in male factor infertility. Methods: It is retrospective case record review of patients undergoing ICSI from 2018-2020 in a specialty fertility center. Infertile patients presenting at the Radha Hospital, CANDOR IVF Center, Surat were diagnosed for the study. Sample of male partner was diagnosed for different sperm parameters and select Normozoospermic and severe OATS patients. Results: Total 100 infertile patients were considered for study, out of which 50 were or Normozoospermic and 50 patients with Severe OATS. The Fertilization Rate ( 95% and 87.5%) , Blastocyte Rate(67.5% and 58.8%) , Implantation Rate (39.9% and 28.9%), Pregnancy Rate (64% and 58%), Missed Abortion Rate (16% and 8%), Live Birth Rate (32.9% and 21.9%) in Normozoospermic and in severe OATS patients. Conclusion: This study concludes, Fertilization Rate, Blastocyst rate, Pregnancy Rate, implantation Rate &amp; Live Birth Rate are Slightly or mild higher in Normozoospermic compare to Severe OATS. While Missed Abortion Rate is higher in severe OATS. Overall, a negative relationship is observed between semen quality (Severe OATS) and Fertlization Rate, Blastocyst Rate, Pregnancy rate, Implantation Rate, Missed Abortion Rate and Live Birth rate.

Pembrolizumab for advanced non-small cell lung cancer (NSCLC): Impact of autoimmune comorbidity and outcomes following treatment completion.

Pembrolizumab, an immune-checkpoint inhibitor, is approved for first-line treatment of metastatic NSCLC in patients with tumours expressing programmed death-ligand 1 (PD-L1) with tumour proportion score (TPS) of ≥50%. We aimed to clarify some uncertainties regarding use of immunotherapy in patients with previous autoimmune (AI) disorders and assess real-world outcomes following treatment completion. We performed a retrospective case record review of 82 patients with tumours expressing PD-L1 at TPS ≥ 50% and receiving first-line Pembrolizumab. Survival was estimated using the Kaplan Meier method. After 36.93 months (IQR: 34.37-40.20) median follow-up, median OS was 13.6 months (95% CI 8.9-19.3). There were 10 patients (12%) with AI co-morbidities and there was a trend toward improved median OS for this group versus those without AI comorbidity, 42 months (14.87-NR) versus 10.7 months (7.3-17.8), p = 0.073. Sixteen patients (20%) with nonprogressive disease at 2 years had significantly better median OS compared to those who did not complete 2 years of treatment, NR (42- NR) and 8.7 (5.8-14.1), p < 0.001.Immune related adverse events (irAE) of any grade occurred in 90% of the AI cohort compared with 70.8% of patients without AI comorbidity. Low grade adrenal insufficiency was the only irAE which occurred at a significantly higher rate in the AI group, p = 0.02. Patients with previous AI diseases tolerate treatment well, and there is a non-significant trend for improved outcomes in this group. Patients who complete the course of pembrolizumab have significantly better survival outcomes than those who do not.

Age at diagnosis for autism spectrum disorders: Does it differ by place of residence?

Despite steady decline in the age of diagnosis (AOD) at the global level, it has not declined uniformly, and marked disparities are documented by income, education, race, and access to health care. The objectives of the study are to examine the urban/rural disparities in the initial age of autism diagnosis and to understand the interplay of the underlying demographic and social factors. A retrospective case record review of all children who received their initial diagnosis of autism at the Pediatric Psychology Clinic (1997-2018) of a tertiary advanced pediatric center at Chandigarh was conducted. A structured abstraction data form was used to extract demographic, socioeconomic, and clinical information from the files maintained at the clinic. A total of 1321 case records were examined. The mean AOD was 4.62 years (standard deviation = 2.38) and children from rural communities were diagnosed at 4.87 years, nearly 0.35 years later than urban children (t = 2.47, P = 0.013). Results indicated that 31.1% of the variance in the AOD for children from rural areas was predicted by two variables, namely the number of children in the family and total Childhood Autism Rating Scale (CARS) score (F = 13.62, P = 0.001). For the urban sample, three variables emerged as significant predictors including the number of children in the family, total CARS score, and maternal education and these together explained 20.2% of the variance in the AOD (F = 19.60, P = 0.001). The public health system must be sensitized to the unmet needs of the marginalized socioeconomic groups to access diagnostic and management services in a timely manner.

A ten-year retrospective analysis of nocardiosis in a tertiary care center of South-coastal India.

Nocardiosis is an uncommon life-threatening infection caused by Nocardia spp. This study aimed to review the distribution of risk factors, clinical characteristics, microbiological findings, treatment and outcome of patients diagnosed with nocardiosis. This study was a retrospective case record review of all nocardiosis cases that were diagnosed at our tertiary care hospital from January 2008 to December 2019. A total of 48 patients with a mean age of 52.2±16.28 years were included. Out of which forty one (85%) were diagnosed as pulmonary nocardiosis and seven (14.6%) as disseminated disease. Chronic lung disease 25 (52.1%), long term steroid use 22 (45.8%) followed by diabetes mellitus 11 (22.9%) were common predisposing factors. The common symptoms were fever (87.5%), cough (79.2%) and breathlessness (52.1%). The most frequent radiologic finding included consolidation in 38 (79.1%), cavitation with thickened wall in 2 (4.1%), reticulonodular shadows in 2 (4.1%), and unilateral pleural effusion in 5 (10.4%). Nocardia otitidiscaviarum (22.9%) was frequently isolated from cultures. Resistance to trimethoprim-sulfamethoxazole (TMP-SMX) was observed in 21% cases. Mortality was noted in 6 (12.5%) patients and all were with pulmonary involvement. The percentage of death among those with and without pulmonary tuberculosis was 33.3% and 5% respectively. Patients affected by pulmonary nocardiosis with previous history of pulmonary tuberculosis showed significant association with poor outcome (p-value=0.05). In conclusion, nocardiosis mainly affects patients with structural lung disease or immunocompromised hosts with adverse outcome. Awareness of this infection is crucial for a clinician, and any suspicion should lead to make an early diagnosis and choose an appropriate empirical treatment to improve the outcome in this population.

Skin Prick Testing for Food Allergens in a Peripheral Metropolitan Unit

Background: Skin prick testing (SPT) is a standard method of testing for allergies including food allergies. However, differentiation between allergy and sensitization requires clinical interpretation. Our aim was to describe the referral patterns and SPT results for food allergens in a cohort of children referred to a peripheral SPT unit at Mt Druitt Hospital, in Western Sydney. Methods: This was a retrospective case record review. Results: Over 1 year, 380 children were referred for SPTs. Of these, 295 had an SPT for at least one food allergen. Of these 295 children, 225 had a confirmed or suspected food allergy (FA), of whom 180 were positive on SPT for at least one food allergen. Children with asthma and/or eczema without a confirmed or suspected FA were less likely to have a positive SPT for food (P &lt; 0.001). Conclusions: A child in this setting with a diagnosis of asthma and/or eczema in the absence of a clear diagnosis of FA is less likely to have a positive SPT for food. Int J Clin Pediatr. 2021;10(4):65-69 doi: https://doi.org/10.14740/ijcp452

370Measuring pneumococcal conjugate vaccine impact in a low-resource setting with minimal baseline data

Abstract Background We aimed to measure 13-valent pneumococcal conjugate vaccine (PCV13) impact on various pneumococcal endpoints with minimal baseline data. Methods PCV13 was introduced in October 2013 in Lao People’s Democratic Republic. We implemented studies to evaluate PCV13 impact: retrospective record review of pneumonia cases for three years pre-PCV13; prospective study of acute respiratory infection (ARI) for 4.5 years post-PCV to demonstrate effectiveness against hypoxic pneumonia; invasive pneumococcal disease (IPD) surveillance (2004-2019); carriage in children hospitalised with ARI (2013-2019); and community carriage surveys pre- and two years post-PCV13. Results Annual incidence of hospitalized pneumonia pre-PCV13 in children 2-59 months was 1,530 (95% confidence interval [CI] 1,477-1,584) per 100,000. Vaccine effectiveness against hypoxic pneumonia was 37% (95% CI 6-57%). In children &amp;lt;5 years, 85% (11/13) of IPD cases were due to PCV13 serotypes pre-PCV13, and 43% (3/7) post-PCV13; and in individuals ≥5 years, 61% (27/44) and 42% (17/40), respectively. In hospitalised children, vaccine type carriage prevalence reduced from 20.0% (95% CI 15.2-24.9%) in 2013 to 12.8% (95% CI 8.5-17.1%) in 2019 with increasing vaccine coverage. Results were consistent with community carriage studies. Conclusions Despite limited baseline data in Laos, we found evidence of PCV13 impact using a variety of methods. Our approach could be used in similar settings to augment existing WHO guidelines. Key messages A combination of methods may be useful to determine the impact of vaccine introduction in countries with limited surveillance.

Incidence of acquired ventricular septal defect after transcatheter aortic valve replacement: A large single center experience.

To determine the rate and clinical outcomes of post-TAVR VSD. Transcatheter aortic valve replacement (TAVR) is a safe and established procedure for patients with severe symptomatic aortic stenosis. Ventricular septal defect (VSD) is a rare complication of TAVR. The rate of post-TAVR VSD and patient outcomes are not well known. A retrospective record review of VSD cases occurring after all TAVRs performed between January 2012 and September 2020 at one urban US tertiary hospital. VSD rate and early- and long-term outcomes were analyzed. Computed tomography images taken before TAVR and transthoracic echocardiograms done before and after each procedure were analyzed. Of the 1908 patients who underwent TAVR in the study period, 7 patients (0.37%) had post-procedure VSD. The average patient age was 77 ± 11 years with average society of thoracic surgeons short-term risk score of 6%. All 7 implanted valves were balloon-expandable. Of the 7 TAVR procedures, 5 were performed on a native tricuspid valve, 1 was performed on a native bicuspid valve, and 1 was done as a "valve-in-valve" procedure on a prior surgical bioprosthetic valve. All VSDs were small and restrictive in nature. Right heart failure in a patient with preexisting right ventricular dysfunction occurred in 1 (13%) patient who died. The remaining 6 patients (86%) were discharged. All 6 patients (86%) were alive and stable at 1year follow-up, reporting improvement in symptoms (NYHA class I-II), with no evidence of right ventricular dysfunction. VSD is a rare complication of TAVR. Hemodynamic and clinical sequelae in majority of the patients in this study did not result in mortality. Proper imaging techniques and appropriate pre-procedure planning are needed to decrease the incidence of VSD formation post-TAVR.

Coronavirus Disease 2019 and Pituitary Apoplexy: A Single-Center Case Series and Review of the Literature

BackgroundPituitary apoplexy (PA) is a rare, but life-threatening, condition characterized by pituitary infarction and hemorrhage, most often in the setting of a preexisting adenoma. The risk factors and mechanisms associated with PA are poorly understood. Although neurovascular manifestations of coronavirus disease 2019 (COVID-19) infection have been documented, its association with PA has not yet been determined.MethodsFrom a prospectively collected database of patients treated at a tertiary care center for pituitary adenoma, we conducted a retrospective medical record review of PA cases during the COVID-19 pandemic from March 2020 to December 2020. We also conducted a literature review to identify other reported cases.ResultsWe identified 3 consecutive cases of PA and concomitant COVID-19 infection. The most common symptoms at presentation were headache and vision changes. The included patients were successfully treated with surgical decompression and medical management of the associated endocrinopathy, ultimately experiencing improvement in their visual symptoms at the latest follow-up examination. COVID-19 infection in the perioperative period was corroborated by polymerase chain reaction test results in all the patients.ConclusionsWith the addition of our series to the literature, 10 cases of PA in the setting of COVID-19 infection have been confirmed. The present series was limited in its ability to draw conclusions about the relationship between these 2 entities. However, COVID-19 infection might represent a risk factor for the development of PA. Further studies are required.

Association of meteorological parameters with intussusception in children aged under 2 years: results from a multisite bidirectional surveillance over 7 years in India

ObjectivesThe study aimed to document the association between intussusception in Indian children and meteorological parameters and examine regional variations.DesignA bidirectional (retrospective and prospective) surveillance between July 2010 and September 2017.SettingAt...