Rural Tertiary Care Centre Research Articles

Clinical profile of COVID-19 patients and factors impacting mortality in a rural tertiary care center of Solapur

Background: A retrospective and cohort study was conducted in our center to study the parameters among surviving and non-surviving patients that have a significant impact on in hospital mortality. Along with this, demographic and clinical profile was also studied. Aims and Objectives: The aim of this study was to evaluate clinical profile of COVID-19 patients and factors impacting mortality. Materials and Methods: The present study is a single-center, retrospective, and cohort study done on COVID-19 positive (by real-time polymerase chain reaction) patients admitted between May 2019 and June 2021 in the intensive care unit (ICU). Of the total 1694 patients, 422 required ICU treatment and the remaining 1272 patients were treated in wards and rooms and discharged home. The analysis was based on demographic, clinical, associated comorbidities, laboratory and radiological data, and treatment modalities used. Outcome data were analyzed by regression analysis and the Kaplan–Meir survival plot was used to calculate mortality trend. Results: Of the 422 patients, 158 (37.4%) died and 264 (62.6%) survived. Males predominated with 297/422 (70.4%). ICU admissions comprised 115/158 (72.8%) of the total deaths. Fever (88%), dyspnea (78.48), and cough (67.1%) were the most common symptoms in non-survival group. Hypertension (43.7%) and diabetes (37.3%) were the most common comorbidities. High oxygen (>10 L/min) (P<0.0001), invasive ventilation (P<0.0001), noradrenaline infusion P<0.0001), renal replacement therapy (P<0.0001) and tocilizumab requirement (P<0.0001), procalcitonin (P<0.009) and interleukin-6 (P<0.004) acute respiratory distress syndrome (ARDS) with septic shock, and multiorgan failure (P<0.0001), all indicated higher risk of death. Conclusion: Mortality was 37.4% in our study. Elderly age (>60 years), high serum ferritin (>931.9), and severe disease with a high resolution computed tomography score (>15), ARDS with septic complications requiring invasive ventilation and vasopressor support, are associated with increased mortality in these patients.

A STUDY ON ETIOLOGICAL FACTORS AND CO MORBIDITIES IN CHILDREN WITH SEVERE ACUTE MALNUTRITION ADMITTED IN A RURAL TERTIARY CARE CENTRE

Objectives: In India, children under 5 years of age suffer from varying degrees of malnutrition. As the severity of undernutrition increases, risk of other diseases increases exponentially. The aim of this study was to identify etiological factors for severe acute malnutrition (SAM) in children aged 6 months to 5 years. Methods: This was a cross-sectional descriptive study conducted at Department of Pediatrics of a rural tertiary care center, Tamil Nadu, India, between January and December 2020. All children with SAM in the age group of 6 months to 5 years were included in the study while children with secondary causes of malnutrition were excluded. Sociodemographic data were entered in preformed proforma. Nutritional status was assessed using the World Health Organization (WHO) standard growth charts. Descriptive data were given in summary statistics while Student’s t-test and Pearson’s Chi-square test were used for analyzing variables. p<0.05 was considered statistically significant. Results: Among 111 children included, mean age was 25.2±15.7 months, 55.85% were females, mean height was 82.4±12.0 cm, 85.58% were from lower socioeconomic status, and mean duration of hospital stay was 5.9±2.5 days. Mothers were the caregivers in 80.18%, 63.96% were unaware of breastfeeding practices, and 59.46% had exclusively breastfed for <3 months. Complementary feed was unsatisfactory in 77.48%, and 75.67% of children were given cow’s milk but inadequate. As maternal age increased, awareness of breastfeeding (p=0.0005) and complementary feeding (p=0.0005) significantly increased. The mean weight at admission was 8.09±2.25 kg which increased to 8.26±2.25 kg and was significant (p=0.0005). Conclusion: As mothers were the primary caregivers but with poor awareness on breastfeeding practices, awareness campaigns targeting mothers will be more effective. As awareness on breastfeeding and complementary feeding increased with increasing maternal age, age of childbirth can be increased to more than 20 years.

Aerobic Bacterial Profile of Sepsis and Its Antibiotic Susceptibility Pattern Among Patients in a Rural Tertiary Care Center.

Background Bloodstream infections (BSI) are one of the most life-threatening infections associated with high morbidity and mortality. Early diagnosis with appropriate and timely treatment improves the patient outcome. The recent surge in multidrug-resistant (MDR) strains is a matter of concern. This study aims to determine the bacterial etiology and antibiotic sensitivity pattern in BSI among different age groups. Materials and methods The microbiological data of blood culture and sensitivity between April 2019 and April 2021 were extracted from the laboratory recordsand analyzed for the bacterial profile and antibiotic sensitivity pattern. Results Out of the total 3893 blood cultures received during the study period from April 2019 to April 2021, 194 pathogens were isolated, accounting for a prevalence of 4.98%. Among 194 patients with culture-proven BSI, 54.12% (105/194) were adults, and 45.87% (89/194) were children. Of these 194 bacterial isolates, 58.76% (114/194) were gram-negative bacteria, and 41.24% (80/194) were gram-positive bacteria. With regard to the bacteria isolated,Enterococcusspecies with 23.71% (46/194) andAcinetobacterspecies with 22.16% (43/194) were the most common bacteria. The prevalence of MDR was 59.27% (115/194). Notable MDR types were methicillin-resistantStaphylococcus aureus(MRSA) in 15/22 (68.2%) and extended-spectrum beta-lactamase (ESBL) producers in 15/48 (31.25%) cases. Conclusion There is a significant geographical diversity of bacteria causing sepsis and their antibiotic susceptibility pattern. Recent trends showthat multidrug-resistant gram-negative bacilli are the predominant isolates causing BSI. Increased antibiotic resistance is leading to treatment failure and poor clinical outcomes. Hence, there is a need to monitor antibiotic resistance among patients with BSI.

Sociodemographic Profile and Psychological Factors Influencing Deliberate Self Harm in a Tertiary Rural Health Care Setup: A Cross-sectional Study

Introduction: There has been a rising trend of deliberate self-harm (DSH) in India recently. The tendency to harm oneself is associated to female sex, younger age, stressful life events and mental illnesses such as depression. Knowledge of socio-demographic factors and psychiatric morbidities in patients having self-harming behavior can be helpful in planning suicide prevention strategies.Methods: This was a hospital-based descriptive, observational, cross-sectional study. The data was collected from 150 consecutive referrals DSH to the psychiatry OPD in Rural Tertiary Care Centre. Corresponding validated psychometric scales quantified severity of depression, and suicide intent.Results: Most of the study population belonged to 18 to 29 years age group and most were males (n = 105, 70%). Poisoning was the most common mode of DSH (n = 133, 88.7%). Diagnosable psychiatric illnesses were found in 52 (34.6%) patients, most common being adjustment disorder (n = 25, 16.6%).Conclusion: Our study highlights the socio-demographic, psychosocial and clinical factors present in individuals attempting self-harm.

Cytomorphological Pattern of Neoplastic and Non-Neoplastic Breast Lesions - An Institutional Experience of a Rural Tertiary Care Center

BACKGROUND
 Among Indian population, benign as well as malignant breast lesions are quite common. Fine needle aspiration cytology (FNAC) is frequently carried out as it is a simple, safe, reliable and time saving procedure. A short retrospective study was designed to evaluate the role of fine needle aspiration cytology (FNAC) & frequency of palpable breast lesions/lumps. Early diagnosis of breast lesions through FNAC prompts early treatment without the need for biopsy. The purpose of this study was to analyse the cytomorphological patterns of non-neoplastic and neoplastic lesions diagnosed by FNAC over a time period at a tertiary care hospital.
 METHODS
 This retrospective observational study was conducted as a hospital opd based procedure from June 2019 to December 2019. A total of 210 patients having breast lesions/lumps were included, among which 5 patients were excluded because of unsatisfactory FNAC aspirate. Smears were processed and their cytological evaluation was done by experienced pathologists.
 RESULTS
 Among all breast lesions, non-neoplastic was most commonly seen in 2nd decade of life and neoplastic in 5th decade of life. Fibroadenoma was the most common benign breast lesion followed by fibrocystic disease while among neoplastic lesions invasive ductal carcinoma was most common. Involvement of left breast was most common.
 CONCLUSIONS
 Benign breast diseases are quite common in younger population. Fibroadenoma is the most common benign condition among females of reporductive age group. FNAC is routinely done to separate malignant lesions from benign ones which makes it an important tool in guiding further management as it is a quick, simple, feasible, and cost-effective method.

Barriers to Care for Pediatric Rural Medulloblastoma Patients Receiving Craniospinal Proton Radiotherapy without In-State Facilities

Medulloblastoma represents ∼20% of all pediatric brain malignancies. The preferred treatment modality for craniospinal irradiation (CSI) has evolved to be proton beam therapy to reduce late toxicities including secondary malignancy. Access to proton therapy centers is more limited in states without one. Barriers to access for rural patients are underreported in the literature. Patients <25 years old with a diagnosis of medulloblastoma were identified from a tumor registry at a rural academic center. A chart review was conducted to identify specific barriers to proton beam CSI. Descriptive analyses were performed to describe this cohort and their barriers. We identified a total of 18 patients diagnosed between 2000 and 2022. The mean age was 10 years old (range 11 months - 20 years). 2 patients were excluded who had minimal documentation. 7 patients were diagnosed before 1/1/2014, a cutoff after which protons were considered more often in this patient population. Patient demographics were 39% female, 61% male, 22% Black, and 72% White, 6% Hispanic. 3 patients received protons. 2 patients had recurrence and 3 patients developed secondary malignancy. Out of 18 patients, proton therapy was discussed with 11 patients. The rates of documented barriers to radiotherapy for the cohort at large (n = 18) and for those where proton therapy was discussed in particular (n = 11) are as follows (cohort at large / had discussion): 4(22%) / 4(36%) difficulty obtaining insurance approval, 4(22%) / 4(36%) inpatient medical needs, 5(28%) / 5(46%) outpatient medical needs, 4(22%) / 4(36%) family scheduling conflicts, 3(17%) / 3(27%) travel costs/financial burdens, 4(22%) / 4(36%) not a clinical trial candidate, 3(17%) / 3(27%) radiotherapy delay, 9(50%) / 5(46%) other barriers to non-radiotherapy care. For the cohort at large or for those with proton therapy discussions, there were no significant associations between white and underrepresented minorities for the aforementioned barriers to care. To our knowledge, this is the first study that identifies patient barriers to accessing proton beam CSI for medulloblastoma patients from a rural tertiary care center without in-state proton radiotherapy centers. This study yields insight into the particular barriers encountered by these patients and their families, allowing clinical teams to identify potential issues in an effort to overcome those barriers. Advocacy for access to care on behalf of this vulnerable patient population may be required by our field on a state and national level.

Predictors and timeline of spontaneous conversion to normal sinus rhythm: A single center retrospective cohort study of patients with symptomatic atrial fibrillation

IntroductionAnnual healthcare expenditures associated with atrial fibrillation (AF) in the United States (US) continue to grow as more symptomatic patients present to emergency departments (ED). Predictors of spontaneous conversion to normal sinus rhythm (ScNSR) remain poorly understood, as well as the timeline of ScNSR remains unclear. We sought to 1) to assess the association of key demographics, anthropometric, and clinical factors to ScNSR and 2) to evaluate the timeline of ScNSR, and 3) determine clinical predictors of ScNSR. MethodsThis single center, retrospective cohort study analyzed patients aged ≥18 years with symptomatic AF as diagnosed and evaluated through the ED of a rural tertiary care center in West Virginia from September 2015 to December 2018. ResultsOur cohort consisted of 375 AF patients (mean age 65 years, 54% male). A total of 177 patients attained ScNSR either in the ED or after hospital admission with a mean conversion time of 14.7 h (±12). Onset of symptoms <24 hrs has strong positive association to ScNSR 3.97 (95% CI: 2.24–7.05; p < 0.0001). Male gender 0.55 (95% CI: 0.35–0.85; p = 0.007) and hypertension 0.48 (95% CI: 0.31–0.76; p = 0.002), showed a strong negative association to ScNSR. Of the patients that converted spontaneously (177), the majority, 136 (76.8%) achieved ScNSR within 24 h of ED triage without use of electrical or chemical cardioversion. ConclusionMost patients with AF in the ED converted spontaneously to sinus rhythm within the first 24 h which underscores the importance of earlier watchful waiting over interventions to achieve normal sinus rhythm (NSR).

Study of bacteriological profile and its antibiogram in the newborn care unit of a rural tertiary care centre in India

Objectives: Neonatal sepsis is a serious medical condition that affects the newborn babies up to 28 days of postnatal life. Regular monitoring of the prevalent bacterial agents causing sepsis is essential for better patient management. The objective of the study was to determine the bacteriological profile and antibiotic susceptibility pattern of culture-positive neonatal sepsis in the newborn care unit of a rural tertiary care centre in India. Material and Methods: The venous blood sample collected on the day of admission or on the 3rd day of admission for the neonates suspected to have sepsis with poor clinical improvement after a 2-day trial of empirical antibiotic therapy was subjected to culture and sensitivity pattern. Antibiotic susceptibility test was done using the Kirby-Bauer disc diffusion method. Data regarding the identified organism and its antibiotic sensitivity pattern from the blood samples of neonates were collected from the newborn care unit records. Results: Out of 387 samples, culture positivity was 10.8%. Among culture positive isolates 57.14% are Gram-negative isolates and Klebsiella being the most common Gram-negative organism and 42.85% of Gram-positive isolates with staphylococcus predominance. Conclusion: Klebsiella (40.4 %) followed by Staphylococcus (35.7%) are the most common bacterial pathogens identified in the rural newborn care centre in India. The routine empirical antibiotics in our unit cefotaxime and ampicillin are 100% resistant and need appropriate changes in the antibiotic policy by making piperacillin or cefoperazone and gentamicin as first-line empirical antibiotics.

Assessment of peripheral lymph node tuberculosis: a prospective study of 24 cases

Abstract Introduction: Tubercular lymphadenitis which comes under Extra-pulmonary Tuberculosis (EPTB) has been affecting mankind since ancient times. Peripheral lymph node involvement is the commonest form of EPTB among which cervical lymph nodes are most frequently affected. Objectives: The aim of this study was to evaluate the demographic, clinical characteristics and treatment outcomes of peripheral lymph node Tuberculosis cases in a rural tertiary health care centre. Methods: The study was conducted prospectively at Prathima Institute of Medical Sciences, Nagunur, Karimnagar between January 2021 to August 2022. Pathologically confirmed cases of lymph node Tuberculosis were assessed and followed up. Results: 24 cases of lymph node TB were included with 83.3% females and 16.6% males (p=0.02) with a mean age of 32.6 ± 15.24 years. The mean age among males was 37 ± 15.59 years and among females was 31.75 ± 15.24 years. 58.3% were from rural areas. All of them presented with a history of swelling, 37.5% had a fever, 50% had a loss of appetite and 54.1% had a loss of weight. 8% had a past history of tuberculosis. 79.1% had cervical swelling and 20.8% had axillary swelling. 83.3% had multiple lymph nodes and 33.3% had lymph node matting. Three cases were lost to follow-up, 79% improved with standard anti-Tuberculosis treatment (ATT) and one case died during treatment. Conclusion: Lymph node TB is still prevalent in TB endemic countries and has to be considered first in the differential diagnosis of peripheral lymph node swellings.

Assessment of Medical Certification of Cause of Death at a Tertiary Care Center in rural region of Western Maharashtra, India

The aim of this study was to evaluate the precision and compliance with international guidelines in the medical certification of cause of death at a rural tertiary care center in Western Maharashtra, India. Additionally, we aimed to identify prevalent errors and discrepancies while investigating the factors that influence the medical certification process at the center. By conducting this research, we sought to obtain comprehensive insights into the accuracy of cause of death documentation and contribute to enhancing the adherence to standardized practices in this crucial aspect of medical practice. The Medical Certificate of Cause of Death (hereafter MCCD) is an important document issued by a doctor for which the World Health Organisation has prescribed a standard format, together with the International Classification of Diseases (hereafter ICD). In it, the doctor records the time, causes and circumstances of the deceased person's death. 615 MCCD forms were available during two years from the MAEER MIT Pune’s MIMER Medical College &amp; BSTR Hospital, Talegaon Dabhade and Pune. All of them were scrutinized for the completeness of the certificate and tried to find out the cause of death in which underlying cause of death was written. Data was analyzed and expressed in the percentage form. Ethical clearance was obtained from the Institutional ethics committee (No. IEC/MIMER/2021/761). Main leading cause of death in the present study was disease of circulatory system 868 (29.35%), followed by Neoplasm (16.54%) and Certain infectious and parasitic disease (16.44%). The present study showed incompletely and inaccurately filled MCCD forms. Therefore, adequate training and proper sensitization of the doctors regarding the usefulness of MCCD data is required.

A clinico – pathological study of patients undergoing thyroidectomy in a rural tertiary care center of northern Kerala

The aim of the study is to assess the clinical profile of patients undergoing thyroidectomy and to determine its association with FNAC (fine needle aspiration cytology) and histopathological report; and to compile a statistical data on the percentage of various malignancies and benign conditions of thyroid in patients undergoing thyroidectomy. This was a prospective study conducted in a rural tertiary care centre among the patients undergoing thyroidectomy. Minimum sample size was estimated to be 110. Convenience sampling technique was adopted and data was collected using pretested semi-structured questionnaire with the help of interviews, clinical examinations and investigation reports. Data was analyzed using SPSS trial v25. Mean age of those who underwent thyroidectomy was 44.81 years. 96% were females. Most common clinical diagnosis was multinodular goiter (80%). Malignancies constituted 4%. Most common diagnosis as per FNAC was Colloid goiter (73%). There was statistically significant association of clinical diagnosis with, FNAC findings and with postoperative histopathological examination. As per the present study, efficacy of FNAC to differentiate malignant lesions was 100%. Most common malignancies were: Papillary Ca and Follicular Ca. Among benign lesions, colloid goiter was most common. Clinically, 4% thyroid cases were identified as malignancies, which were consistent with findings of FNAC and post-operative HPE reports. With efficacy of 100% in the present study, FNAC stands as an important premanagement investigation; hence the study recommends FNAC mandatorily with or without other investigation such as radiological features.

Seminal plasma testis expressed sequence (TEX)-101 as a biomarker for the qualitative assessment of male factor infertility: A case-control study

ObjectiveThe study was conducted to assess the role of seminal plasma Testis Expressed Sequence (TEX)-101 as a biomarker of male infertility. Study designThe study was conducted on 180 men (20–50 years) with 90 having abnormal semen reports as cases and 90 with normal reports as controls in a rural tertiary care center in Southern India over two years. After the enrolment of cases and control, semen samples were cryopreserved till the desired sample size was achieved and a biochemical test for TEX-101 was run using Human Testis-expressed Protein 101 ELISA Kit. The results of TEX-101 were compared between cases and controls and correlated with various semen parameters. Statistical analysis was done using SPSS software version 22.0, a p-value < 0.05 was considered statistically significant. ResultsMean ± SD age of all participants was 29.94 ± 4.91 years. Of 90 cases, 48.9% had asthenospermia, 24.4% oligoasthenospermia, 15.6% oligospermia, 11.1% azoospermia. A statistically significant difference was observed in mean values of seminal plasma TEX-101 between cases (1.45 ± 0.08 ng/mL) and controls (2.26 ± 0.18 ng/mL), p = 0.001. A significant correlation (p = 0.001) was found between seminal TEX-101, semen volume, sperm concentration, progressive motility, and morphology. The area under the Receiver Operating Characteristic curve of TEX-101 between cases and controls was 1.00 (p = 0.001), indicating TEX-101 as a potential biomarker for distinguishing men with abnormal semen parameters from those with normal semen parameters. At a cut-off value of 1.84 ng/mL, seminal plasma TEX-101 had a sensitivity, specificity, and negative and positive predictive values of 100% for male infertility prediction. ConclusionSeminal TEX-101 is a potential seminal biomarker and can be used in the qualitative assessment of male factor infertility.

Exploring the Relationship Between the Indices of Body Composition With Grip Strength Performance and Peak VO2.

Background The importance of measurements of body composition in terms of various indices including Body Mass Index (BMI), Body Surface Area (BSA), Body Size Index (BSI), and Waist to Height ratio (WtHR) in the diagnosis of health risks and mortality outcome analysis has largely been limited to their use relating to determining abdominal obesity. The understanding of the extent of implications of the newer, underutilized indices of body composition is deficient. Peak VO2(maximal oxygen uptake) majorly serves for the evaluation of the measure of aerobic capacity. Grip strength performance is a simple, primary, objective predictor of overall physical status and muscular and cardiovascular fitness. This study aimed to derive the relationship between a gamut of parameters such as BMI, BSA, WtHR, BSI, grip strength performance and peak VO2 investigated using the latest scientific methodology in a cross-section of the population in a rural tertiary care center. Methodology This study was a descriptive, cross-sectional study carried out in a rural medical college in central India. Sixty participants from the healthcare setting were considered eligible for the study within the age group of 18 to 45 years. Anthropometric assessments like height (in cm), weight (in kg), waist circumference (in cm), and BMI were carried out. BSA, WtHR, and BSI were calculated using the respective formulae.VO2max (maximal oxygen uptake) recordings were done using thetreadmill/ergometer andmetabolic module of LabChart software (Bella Vista,New South Wales, Australia).Grip Strength Performance was quantified by measuring the amount of static force with which the hand is able to squeeze a transducer. It was measured using Grip Force Transducer (MLT004 / ST) from AD Instruments (Bella Vista,New South Wales, Australia). Results Upon analysis, a significant negative correlation was obtained between BSI and BMI (r= -0.51, p<0.0001) whereas a significant positive correlation was found between BSA and BMI (r= 0.71, p< 0.0001). A significant correlation was also seen between WtHR and BMI (r= 0.71, p< 0.0001) while a negative significant correlation between peak VO2 and BMI (r= -024,p=0.0425) was deduced. Similarly, a negative correlation was evident between BSA and BMI (r= -0.46, p=0.0002) with a positive correlation between WtHR and BSA (r= 0.30,p=0.0188). Grip strength performance positively correlated with BSA (r= 0.58, p< 0.0001) whereas peak VO2 showed a significant negative correlation with WtHR (r= -026,p=0.043). There was also a positive significant correlation between grip strength performance and peak VO2 (r= 0.37, p=0.0033) Conclusion The study determined the relationships of grip strength performance and peak VO2, with the body composition indices in order to provide an overview of the mortal risks of an individual which might mediate the prognosis. Based on the relative independence of BSI with peak VO2 and grip strength performance, the unification of these parameters can help assess the overall health of an individual.

Our Experience with Cut Throat Injury Cases in a Rural Tertiary Care Centre

ABSTRACT Background: Cut throat injuries are one of the most challenging surgical emergencies encountered by Ear, nose, throat (ENT) surgeons. If not treated in time, they may lead to death. Prevention of mortality depends on immediate resuscitation by securing the airway by tracheostomy or intubation, prompt control of bleeding, and wound closure. Aims and Objectives: Our study was conducted to observe and analyze: 1. The sociodemographic profile of cut throat injury patients admitted in our hospital. 2. The modes of cut throat injury cases admitted in our hospital. 3. Anatomical region and depth of the cut throat injury patients admitted in our hospital. 4. Treatment of cut throat injury patients given at our hospital. Materials and Methods: This is a prospective study of about 25 cases of cut throat injury presented to the emergency department in our tertiary care hospital situated in the rural area of Tamilnadu (India), between June 2021 and September 2022. Cut throat injury patients were managed by multidisciplinary approach headed by the ENT team. Results: In our study, 72% were males and 28% were females. The peak age of incidence is fourth decade (48%). People with lower socioeconomic status were affected more (40%). Eighty percent of the patients had Zone II injuries. Seventy-six percent of cases presented with active bleeding and 60% of cases came with breathing difficulty. The most common cause of cut throat injury had been found to be suicidal (52%). Sixty percent had laryngeal injuries. Seventy-two percent of the cases were managed with tracheostomy. Conclusion: Our study found that the majority of cut throat injury patients were males of age between 30 years to 40 years from poor socioeconomic status. Social involvement and political motivation, poverty reduction, individual awareness, increase in economic growth along with literacy rate will prevent the cut throat injuries. Early and improved proper management will reduce the mortality and morbidity.

Immune therapy related adverse events in metastatic non-small cell lung carcinoma patients at a rural academic center.

e21203 Background: Immune checkpoint inhibitors (ICIs) have revolutionized treatment for stage IV non-small cell lung cancer (NSCLC) patients. Immune related adverse events (irAEs) are the diverse immunologic side effects of patients receiving ICIs and may result in significant patient morbidity, subsequently impacting quality of life. If severe enough, irAEs may lead to hospitalization and may necessitate administration of immunosuppressants or IL-6 receptor antagonists. Our study sought to characterize irAEs in a patient population receiving ICIs at a rural tertiary care center. Methods: This was an IRB-approved retrospective cohort study using SPSS version 28. Patients with stage IV NSCLC receiving ICIs at ECU Health Medical Center were analyzed and 190 patients met inclusion criteria. Results: Of our cohort, 66.3% (n = 126) experienced at least one irAE of any grade, 46.3% (n = 88) were hospitalized due to grade 3 or 4 irAE, 55.7%(n = 106) were either started on steroids or had a dose increase to treat the irAE, 48.9% (n = 93) received immunosuppression to treat the irAE, and 41.5% (n = 79) had immunotherapy held either temporarily or permanently due to the irAE. 25.7% (n = 49) were rechallenged and 18.9% (n = 36) experienced an irAE after being rechallenged. 34.7% (n = 66) experienced pneumonitis, 22.1%(n = 42) constitutional symptoms, 17.8%(n = 34) gastrointestinal, 10.5%(n = 20) neurological, 10.5%(n = 20) dermatological, 6.8%(n = 13) endocrine, 3.6%(n = 7) hematological, 3.1%(n = 6) musculoskeletal, and 3.1%(n = 6) cardiovascular irAEs. When adjusting for race, sex, line of therapy, and histological type, logistic regression analysis yielded no significant difference in the probability of developing an irAE when comparing patients treated with nivolumab versus atezolizumab and pembrolizumab. Patients treated with atezolizumab (OR:0.17; p = 0.020; 95% CI:0.039-0.757) and pembrolizumab (OR:0.20; p = 0.021; 95% CI:0.055-0.785) were less likely to be hospitalized for an irAE when compared to patients treated with nivolumab. When rechallenged, no difference was noted in recurrent irAE development when comparing pembrolizumab and nivolumab. Cox regression analysis demonstrated that patients treated with atezolizumab (OR:0.36; p = 0.010; 95% CI:0.167-0.781) and pembrolizumab (OR:0.29; p &lt; 0.001; 95% CI:0.291-0.148) had better OS when compared to nivolumab. No difference was evident when comparing White and Black patients experiencing any grade irAE (n = 69, n = 53), grade 3 or 4 irAE (n = 44, n = 40), OS (n = 104, n = 80), and PFS (n = 104, n = 80). Conclusions: Our demonstrated irAE side effect profile is similar to those of published studies. No racial disparities were noted in our cohort when analyzing for any grade irAEs, grade 3 or 4 irAEs, OS, and PFS. Our study yields clinically pragmatic insight into better understanding how various factors, such as ICI selection and race, may impact patient outcomes.

Clinical Spectrum and Treatment Response of Malignant Otitis Externa Patients: A Rural Tertiary Care Centre Experience.

Malignant otitis externa (MOE) is an invasive external ear infection that has a tendency to spread throughthe temporal bone and can further progress to involve intracranial structures. Though the prevalence of MOE is rare, high morbidity and mortality are often associated. Complications of advanced MOE include cranial nerve involvement, most commonly facial nerve, and intracranial infections such as abscesses and meningitis. In this retrospective case series of nine patients diagnosed with MOE, demographic data, clinical presentations, laboratory data, and radiological findings were reviewed. All patients were followed up for a minimum period of three months after discharge. Outcomes were measured in terms of reduction in obnoxious ear pain (Visual Analogue Scale), ear discharge, tinnitus, need for re-hospitalization, recurrence of disease, and overall survival. In our case series of nine patients (seven males and two females), six underwent surgery, and three patients were managed with a medical line of treatment. All patients had a significant reduction in otorrhea, otalgia, random venous blood sugars, and improvement of facial palsy implicating good response to treatment. Prompt diagnosis of MOE warrants clinical expertise and aids in preventing complications. A prolonged course of intravenous anti-microbial agents is the mainstay of treatment, but timely surgical interventions in treatment-resistant cases can prevent complications.

Extra-Parotid Pleomorphic Adenoma and Low-Grade Salivary Malignancy in the Head and Neck Region.

Background and objective Pleomorphic adenoma is the most common major salivary gland neoplasm. Around 80% of them arise in the parotid glands, whereas 10% originate in the minor salivary glands. The pleomorphic adenoma of the extra-parotid site is defined by its location outside the primary salivary gland. The minor salivary gland adenomas occur at the hard and soft palate, lips, tongue, lacrimal glands, pharynx, larynx, paranasal sinus, and nasal cavity. Pleomorphic adenoma in parapharyngeal space may occur de novo or as an extension of the deep lobe of the parotid tumors. Our objective in this study wasto assess the location and presentations of extra-parotid pleomorphic adenomaand frequency of low-grade salivary gland malignancy diagnosed as pleomorphic adenomavia fine-needle aspiration cytology (FNAC)in the head and neck region andthe treatment outcomes after the resection of the tumors. Materials and methods This was a retrospective observational study. All patients with FNAC-diagnosedpleomorphic adenoma of extra-parotid locations of the head and neck region who underwent curative surgery in the Department of Otorhinolaryngology and Head and Neck Surgery at a rural tertiary care center between August 1997 and August 2022 were included in the study. Data on the symptoms, FNAC report, surgical techniques, pathological results, adjuvant therapy, andany recurrence were documented. Data were entered into a Microsoft Excelsheet and analyzed using IBM SPSS Statistics version22 software (IBM Corp., Armonk, NY). Results Our study included 23 patients, of which 14 were females and nine were males. The various sites of involvementwere as follows: parapharyngeal space (four), larynx (one), nasal septum (two), hard palate (five), soft palate (four), hard and soft palate (three), and submandibular salivary gland (four). Of note, 17.3% of the patients had local recurrence withan average time frame of three years post-surgery: 20% in patients with low-grade malignancy and 16.6% in patients with pleomorphic adenoma. Conclusion Extra-parotid pleomorphic adenomas are common and have a high malignant potential. The preferred choice of treatment for extra-parotid salivary tumors is complete resection with adequate clearance. Malignant pleomorphic adenomas may require stagingneck dissection and adjuvant treatment for a better prognosis.

Negative pressure wound therapy and conventional wound management at a rural tertiary care center – A comparative study

Background: Wounds are a major source of morbidity and sometimes, mortality and there are several ways to treat them. Negative pressure wound therapy (NPWT) is one way, and this involves the use of a suction device to aspirate and remove fluids, debris, and infectious materials from the wound bed to promote the formation of granulation tissue and wound healing. Another way is with the use of conventional wound dressings. Aims and Objectives: The aim was to compare NPWT and conventional wound dressings for the poor in a rural setting. Materials and Methods: Sixty consecutive cases clinically presenting with wounds between March 2018 and August 2019 were examined and divided into NPWT or conventional wound dressing groups. Outcome was measured by recording wound scores on day 7 or thereafter. Cases and controls were studied from admission until complete healing. Outcome and complications of NPWT and conventional wound dressings were noted. Results were tabulated in MS excel and evaluated using Graphpad Prism 9 software (San Diego, CA, USA). Results: Many patients (33.33%) were in the 5th and 6th decades of life and most (77%) were male. Many wounds were located on the foot (40%). Those patients younger than 40 years of age with a wound &lt;10 days old had a better median wound score in both the groups. The majority of wounds (43.33%) were traumatic. Wound healing was better in non-diabetics and non-smokers. There was a considerable reduction in the organism load in the NPWT group (P=0.0078). Complications were minor. The NPWT group had a significantly shorter mean hospital stay (P=0.0001). Conclusion: NPWT enhanced granulation tissue formation leading to earlier wound healing and faster recovery compared to conventional wound dressings.

Platelet Parameters May be Predictors of Coronary Artery Disease in Prediabetes: Rural Hospital-based Cross-sectional Study

Introduction: Prediabetes is a state of impaired glucose tolerance that often precedes overt diabetes mellitus and is frequently underdiagnosed. Glycation of platelet proteins leads to increased platelet reactivity which can be an essential predisposing event in the pathogenesis of coronary artery disease (CAD). Although research has been conducted to diagnose CAD in prediabetes and to assess platelet indices in prediabetes, there has been no attempt to assess platelet indices in prediabetic patients who have CAD. Methods: This cross-sectional study was carried out in a rural tertiary care center in Central India from September 2019 to August 2021. A total of 180 patients were enrolled in this study, having documented CAD in coronary angiography (CAG) and blood glucose levels in the diagnostic range of prediabetes by the criteria set by the World Health Organization. Platelet indices, glycosylated hemoglobin, blood sugar levels, and CAG findings were documented for all participants. Results: The mean platelet volume (MPV) in our study population was 9.58 ± 1.14 fL, platelet distribution width (PDW) was 15.69% ± 1.36%, plateletcrit was 0.3% ± 0.07%, and platelet count was 319 ± 44 × 103 cells/mm3. PDW was the best tool to predict double-vessel disease (P &lt; 0.0001), while MPV (P = 0.6146) and PDW (P = 0.0266) were best predictors of triple-vessel disease. Conclusion: Platelet indices that are readily available investigations prescribed by clinicians routinely are significantly associated with blood sugar levels and can predict the severity of CAD in prediabetics in terms of the number of vessels involved. Early assessment of platelet indices in prediabetics can aid in the diagnosis and prognosis of CAD, thereby helping in planning early intervention.

Incidental perioperative diagnosis of pulmonary thromboembolism and its successful management in a rural tertiary cancer care centre with limited resources - A case study.

Incidental perioperative diagnosis of pulmonary thromboembolism and its successful management in a rural tertiary cancer care centre with limited resources - A case study.