South Kerala Research Articles

S1391 Population-Based Screening Strategy for Liver Stiffness Using Fibroscan in a Transition Society of South Kerala, India

S1391 Population-Based Screening Strategy for Liver Stiffness Using Fibroscan in a Transition Society of South Kerala, India

Demographics, Clinicopathological Profile of Oral Lichen Planus of South Kerala Population: A Cross-Sectional Study.

Oral lichen planus (OLP) is a chronic mucocutaneous inflammatory lesion of unknown cause. The buccal mucosa is the most frequently affected anatomic site and the lesion is bilateral. The objective of this retrospective study was to investigate the epidemiological and clinical characteristics of 250 OLP patients in South Kerala. This was done by figuring out these patients' epidemiological and clinical characteristics. Materials and methods:In the present study,patients who reported between September 2018 and December 2021were selected employing the diagnostic criteria consistent with the WHO classification of OLP. Data of all the patient's characteristic featureswere collected and evaluated using the Statistical Package for the Social Sciences (SPSS) software for statistical analysis. Out of 250 patients, 52% were females and 48% were males. Reticular (n = 145, 58%) and erosive forms (n = 105, 42%) were the two clinical presentations of the lesions that were most consistently observed. The age group of 25-34 years reported the highest number of cases (n = 71, 28.4%). According to the chi-square test, there were statistically highly significant differences between the hyperpigmentation, age, and type of OLP. While 43.2% (n = 108) of cases reported a burning sensation, pain, or soreness, 56.8% (n = 142) of cases were asymptomatic. There were statistically significant differences between the type of OLP and the reported symptoms (p = 0.001). Mild to moderate dysplastic changes were documented in 5.6% during the follow-up period. A successful treatment outcome with topical steroid administration was recorded in the study sample. It was apparent that patients typically have bilateral lesions involving the buccal and labial mucosa, manifesting with varying degrees of oral discomfort. Although patients frequently have more than one variant of OLP, the lesions are typically reticular or erosive in nature. A meticulous follow-up is crucial to determine its malignant change.

Palaeoclimatic Studies of the Late Quaternary Sediments from Chirakkara, Kollam District, Kerala, India

The Quaternary period is considered one of the most eventful periods of all geologic periods. The present study intends to understand the paleo-environmental conditions that prevailed in the southern part of the Kerala State, India, during the Late Quaternary period. The present study aims to understand the climatic variability of the Holocene epoch in the Chirakkara region, the easternmost part of Polachira wetland, Kollam district, South Kerala, by using granulometric data and geochemical proxies. A core of 2.5 m in length has been collected from the study area, and both textural and TOC/TN analyses were carried out. The variation in grain size is attributed to the variations in the energy level of the transporting medium and turn to the climatic conditions, especially rainfall. The sediments encountered in the core are dominated by sand-sized particles indicating dynamic high energy conditions and high precipitation events. The ternary plot of the sediment samples also suggests violent environmental conditions during the deposition of the sediments. The predominance of low values of TOC/TN ratio found at both ends of the core indicates an autochthonous source for organic carbon, possibly due to the aggravated aquatic phytoplankton activity, and increased lake bioproduction, and/or decline in the delivery of organic matter from the terrestrial environment. High values of the TOC/TN ratio noted at the middle portion of the core at depths from 120 cm to 210 cm indicate the allochthonous source for the organic carbon. Among allochthonous sources, the C3-type plant is dominant, indicating a cool and wet climate. At the same time, the extremely high TOC/TN values at 170 cm core depth indicate a short period of hot and sunny climatic conditions. The analysis of the granulometric data and organic matter proxies suggest that the study area has experienced wet climatic conditions with occasional dry spells during the Late Quaternary Period.

Acceptance and knowledge of COVID-19 vaccine in southern Kerala during first vaccination drive

Background: Coronavirus disease 2019 (COVID-19) pandemic has affected most the countries causing a devastating influence on world health and economics since its appearance. The accelerated development of the COVID-19 vaccine has become vital, and early data suggests that it is both, safe and efficacious. However, the acceptance of the COVID-19 vaccine depends on several socio-demographic characteristics as well as people’s knowledge and misconceptions.Methods: The objective of this study was to assess the knowledge and acceptance of the COVID-19 vaccine in the southern districts of Kerala during the first vaccination drive. This is a cross-sectional study conducted by analyzing the data collected through a self-administered questionnaire that was shared online and directly across southern Kerala from January 2021 to June 2021. The survey questionnaire consisted of demographic characteristics of the respondents and queries pertaining to knowledge and acceptance of the COVID-19 vaccine.Results: The results of the study showed that the respondents showed a good level of knowledge and acceptance. This study highlights that 83.6% of the participants in South Kerala have demonstrated their willingness to receive the COVID-19 vaccine.Conclusions: Findings from this study could help governments, public health agencies, and awareness-raising organizations to address immunization hesitation and improve uptake of COVID-19 vaccines.

Caries Risk Assessment in Young Adults of South Kerala with Multiple Dental Restorations Using the Cariogram with Salivary Tests

Caries Risk Assessment in Young Adults of South Kerala with Multiple Dental Restorations Using the Cariogram with Salivary Tests

Clinical and radiological evaluation of isolated frontal sinus disease: a case series

<div><p>Isolated frontal disease is a rare entity, although it has been widely discussed in literature. The frontal sinus features a wide variation in pneumatisation and drainage pattern and also has close proximity to the orbit and skull base. <sup> </sup>A retrospective study conducted at a tertiary care centre in South Kerala, between 2019 and 2021, identified five cases of isolated frontal diseases. Patients were diagnosed on the basis of clinical examination, radiological investigations and histology. Management decisions were based on size of the tumour, suspicion of malignancy and extend of disease. </p></div><div> </div>

Psychological impact of COVID-19 among health care workers working in a tertiary care hospital of South India: a cross-sectional study

Background: This study aimed to find out the psychological impact faced by the health care workers in a tertiary care hospital of India which will help in generalizing it to other states of the country as well other countries.Methods: A cross-sectional study was conducted in a tertiary care hospital of South Kerala. Study period was from July 2020 to August 2020 during the post lockdown period. Study participants included the staff nurses, interns, post graduate students, doctors, pharmacists, supporting staff. A pre-designed, semi-structured questionnaire was administered to the study subjects. The general health questionnaire (GHQ 12) questionnaire was used to find out the mental health of the participants.Results: A total of 200 subjects were included in the study among them 81 (40.5%) were males and 119 (59.5%) were females. Out of 200, doctors 148 (74%), nurses 36 (18%), pharmacist 6 (3%),supporting staff 10 (5%).Mean age of the population was 30.63±7.32 years. A GHQ-12 model questionnaire was used to assess the psychological distress among health care workers. In our study, the average GHQ-12 was 3.48 which was higher than the cut-off.Conclusions: COVID-19 has led to lot of mental health problems and the impact is very huge among health care workers. Main concerns were anxiety, burnout, depression, stress-related disorders, over work, concern about family members and so on. Policies should be made in the international and national levels to help health care workers manage pandemic in the coming days with less stress and anxiety.

Exposure to medical education and its role in Covid19 pandemic associated anxiety among medical students in South Kerala

Medical students have varying levels of understanding about Covid19 based on their level of exposure to medical education. This influences their mental health status. There is no clear cut idea about whether Covid19 related anxiety among medical students increases or decreases with increase in scientific knowledge. This study aims to find out the proportion of anxiety related to COVID19 among medical students in South Kerala and assess the role of medical education on anxiety. Analytical cross-sectional study was conducted among 500 medical students in South Kerala. Anxiety was assessed using Generalized Anxiety Disorder7 (GAD-7) scores. Univariate and Bivariate analysis were performed. P value < 0.05 was considered as statistically significant. The median GAD-7 score obtained was three (IQR 5.75). GAD-7 score >10 were reported among 9.8% participants. Anxiety level was found to be significantly associated with the year of admission (p=0.021). Among those who were tested Covid19 positive, 11.9 % hadGAD7 score >10 and among those who faced Covid related stigma, 28.6% had GAD-7 score >10. Association between anxiety and stigma related to Covid19 was found to be statistically significant (p=0.017). Proportion of students with moderately severe or severe anxiety was more among preclinical students and among students who faced Covid19 related stigma. Better knowledge about preventive measures, symptoms, treatment, complications and prognosis of Covid19 can lessen pandemic induced anxiety. Government initiated programs are required to counter the rising levels of stigmatizing attitudes associated with Covid19

A 5 Year Analysis of Different Types of Urothelial Malignancies with Special Reference to The Expression Of EGFR in These Tumours

Background:
 Urothelial neoplasms are a heterogenous group of neoplasms with high propensity for recurrence. EGFR is a novel and potential biological marker for predicting the prognosis of urothelial malignancies. This study highlights the diagnostic and prognostic usefulness of EGFR as a phenotypic marker in urothelial malignancies. Thus, it warrants for anti-tumour therapy and prevention of recurrence of urothelial cancers by anti-EGFR therapy.
 Methods:
 Current study includes 500 cases of urothelial tumours received in a major tertiary center in South Kerala. Based on the histopathological features these tumours were classified according to the WHO-2016 criteria. Proportion in each class of urothelial tumours during the study period was calculated. In addition to that, we also studied relation between EGFR expression and tumour grade and recurrence. Inclusion criteria: All consecutive cystoscopy biopsies, transurethral resection of bladder tumour (TURBT) and radical cystectomy specimens histologically diagnosed as urothelial malignancies of bladder. Exclusion criteria: All benign urothelial cases.
 Result:
 Out of the 500 cases of urothelial malignancies included in the study, the non-invasive papillary urothelial carcinoma, low grade constituted the major part, the second being invasive urothelial carcinoma, high grade, followed by noninvasive urothelial carcinoma, high grade. A strong expression of EGFR was found to be significantly associated with higher tumour grade (P = 0.001) and recurrence (P = 0.010).
 Conclusion: 
 Histopathology supported by immunohistochemistry is a helpful tool in subtyping the various urothelial malignancies. EGFR can be considered as an adverse prognostic factor, the expression of which increases with tumour grade and stage. EGFR positivity may favor the use of targeted therapy in urothelial malignancies.

English

BACKGROUND Dry eye diseases (DED) tend to be more seen in patients with auto immune disease. This study was an attempt to assess the prevalence of DED among the patients who were diagnosed and confirmed cases of Rheumatoid arthritis (RA), SLE and Primary Sjogren’s syndrome (Primary SS). Objective of the study was to assess the prevalence of Dry eye disease among the study participants and determine its severity in connective tissue disorders. METHODS This was a cross sectional study conducted at a tertiary care hospital in the South Kerala. The study period was six months. 30 study participants were enrolled for the study who fulfilled the selection criteria. The study participants were evaluated for DED by Schirmer’s test, Tear break up time and ocular surface staining. Data collected was entered in Microsoft Excel and descriptive data was expressed as frequencies and percentage. RESULTS The overall prevalence of the Dry eye disease was found to be 54%. The prevalence was significantly higher in patients with Primary SS which accounted for 70% followed by patients with RA; which accounted for 52. Dry eye disease was seen only in 40 % of the study participants diagnosed with SLE. Similarly, the severity of Dry eye disease was found higher in patients with Primary SS; where about 35 % had severe to very severe disease. 22 % of the study participants with RA had severe to very severe dry eye disease. There was no severe or very severe dry eye disease in the study participants who had SLE. CONCLUSIONS The overall prevalence of Dry eye disease in patients with autoimmune disease was found to be significantly higher especially in patients who were diagnosed to have Primary SS and RA. There is a need for early diagnosis of dry eye disease in such patients which can improve the cure rate, reduce the complications of the disease and reduce the visual morbidity. KEY WORDS Dry Eye Disease, Primary sjogrens Syndrome, Rheumatoid Arthritis, SLE

Absolute Eosinophil Count versus C Reactive Protein as a Diagnostic and Prognostic Marker on Sepsis among in Patients of a Tertiary Care Centre in South Kerala

Absolute Eosinophil Count versus C Reactive Protein as a Diagnostic and Prognostic Marker on Sepsis among in Patients of a Tertiary Care Centre in South Kerala

Prevalence of Meningioma in South Indian Population Diagnosed through Magnetic Resonance Spectroscopy – A Retrospective Study

Introduction: Meningioma originates in cerebral dura mater and can grow at any site, especially at the skull vault and the skull base. Meningioma accounts for 37% of all central nervous system tumor. MRS (Magnetic Resonance Spectroscopy) provides additional structural and metabolic information that helps to diagnose meningioma. Objectives: The aim of the study was to investigate the prevalence of brain tumor meningioma in patients with characteristic risk factors like headache, vomiting, dizziness etc to assess the diagnostic significance. Materials and Methods: This is a retrospective study and was conducted in the Radiology Department and Biophysics Departments of one of the tertiary health care centres in South Kerala. This study was conducted on 81 subjects with brain lesion, including both males and females, who underwent MRS. From MRS findings, the prevalence of Meningioma was detected. Patient’s demographics were also taken for the analysis and interpretation. Results: From this study it was understood that out of the 81 cases, 40 were of Meningioma. In this 40 patients, 22 were females (55%) and 18 were males (45 %). Among these 40 cases, the frequency of brain lesions was higher in old aged group (60 %) when compared to younger (0%) and middle age groups (40%). It was found that out of the 40 patients, 42 % had headache, 28 % had vomiting, 23 % had Type-2 diabetes mellitus and 7% had dizziness. Conclusion: From this study, it is confirmed that among the brain lesions, the incidence of Meningioma is higher and was prominent among old aged group and the incidence is reported to be higher in females. This indicates the need of special attention for these patients for early diagnosis and timely intervention.

Oral Health Status among the Older Population in South Kerala

Oral Health Status among the Older Population in South Kerala

Comparing Three Models of Community-Based Diabetic Retinopathy Screening, Treatment, and Awareness Creation Services in Southern India / South Kerala.

The aim of the study was to evaluate the effectiveness of three models of diabetic retinopathy (DR) screening from an economic perspective and their effectiveness in awareness creation, screening, and ability to deliver treatment. Analysis of a prospective screening program for diabetes mellitus and DR in South Kerala was done. Three models were created: Model 1: blood screening camp, Model 2: comprehensive eye camp, and Model 3: institution-based screening camp. Forty-seven camps were conducted in Model 1, 438 in Model 2, and 18 in Model 3. Of 94,993 people screened, the percentage of diabetes was 17.4. Of the diabetics screened, the percentage of retinopathy was 22.8. Model 1 was most economically viable to detect a large number of new diabetics. Model 2 was more economically challenging but had the best overall pickup rate for new DR patients. Model 3 had a lesser pickup of new DR patients. Model 1 is effective in picking up new diabetics but poor for DR screening. Model 3 is cost-efficient with very high DR detection rates. Cost-effective screening activities and service delivery are best achieved through a well-planned Model 2 camp which has the best overall detection rate for DR.

Factors associated with poor prognosis in corneal ulcer: A clinical and epidemiological study

Aim: To explore the factors associated with culture positivity and worsening of corneal ulcers in patients presenting to a tertiary care teaching hospital in south Kerala. Methods: We did a retrospective review of hospital-based case records from June 2018 to May 2019 and included all cases of infective corneal ulcer admitted during the period of study with corneal stromal infiltrate on slit-lamp examination. Results of gram stain, potassium hydroxide stain, and culture result were noted. The treatment history (moxifloxacin (0. 3%) or fortified cephalosporin and gentamicin or natamycin) was recorded. The data were exported to the statistical software SPSS V27.0 for further analysis. Results: The data of 125 culture-positive and 250 culture-negative ulcers were studied. Most patients were aged >55 years (n = 201, 53.6%) and 35–55 years (n = 120, 32.0%). The association of culture negativity with nontraumatic risk factors was significant (P = 0.01) but not with the size of the ulcer, progress score, or worsening clinical status of the ulcer. More persons with pretreatment (15.2%) showed worsening of the clinical status compared to those who did not (6.3%) (P = 0.005). 63% of the culture-positive cases had not taken any pretreatment. Compared to noncentral ulcers there was a marked deterioration of central ulcers (16.7%) (P = 0.005). Conclusion: Pretreatment and centrally located ulcers were significantly associated with a worsening clinical condition in this study. Culture-positive corneal ulcers showed a tendency toward improvement, but we could not find an association between the detection of the organism and its favorable response to treatment.

Impact of Eighth Joint National Committee guidelines on achievement of target blood pressure among hypertensive patients attending tertiary care hospital in South Kerala

Impact of Eighth Joint National Committee guidelines on achievement of target blood pressure among hypertensive patients attending tertiary care hospital in South Kerala

Spatio-Temporal Pattern of Thyroid Cancer Incidence in South Kerala

Spatio-Temporal Pattern of Thyroid Cancer Incidence in South Kerala

Evaluation of rapid antigen test against reverse transcription-polymerase chain reaction for the diagnosis of severe acute respiratory syndrome coronavirus 2 in a tertiary care centre in South Kerala

Evaluation of rapid antigen test against reverse transcription-polymerase chain reaction for the diagnosis of severe acute respiratory syndrome coronavirus 2 in a tertiary care centre in South Kerala

Proportion and Pattern of Chromosomal Abnormalities in Primary Amenorrhea in Kerala- A Retrospective Study

Introduction: Primary amenorrhoea may be due to chromosomal abnormalities and identification of these abnormalities is important for counselling and management of these individuals. Aim: To identify the prevalence of chromosomal abnormalities in a cohort of primary amenorrhoea patients and to evaluate the various pattern of chromosomal abnormalities. Materials and Methods: This retrospective study was conducted at Government Medical College, Thiruvananthapuram, Kerala, India (serves as a referral centre for most of south Kerala and adjoining districts of Tamil Nadu), from January 2013 to December 2020. All phenotypically females, in the age group of 15-30 years, attending the Genetic Clinic with a diagnosis of primary amenorrhoea were evaluated with karyotype from peripheral blood as per the standard protocol. An abstraction proforma was used to collect the data from the master case sheet available in the genetic laboratory. Cytogenetic abnormalities were described as per the standard International System for Human Cytogenomic Nomenclature (ISCN). For statistical analysis, proportion of cases with chromosome abnormality in the cohort was described as percentage. Results: Chromosomal analysis revealed 25.5% (38 out of 149) with abnormal karyotype. Among the abnormalities, the most common abnormality was 45, X (12, 31.6%) Turners syndrome. Other abnormalities included sex reversal female (46, XY) in six (15.8%), isochromosome Turner syndrome in five (13.1%), partial deletion in X chromosome in three (7.8%) and various combination of mosaic pattern in nine (23.7%) cases. Hypergonadotropic hypogonadism was significantly associated with chromosomal abnormality. Conclusion: Cytogenetic abnormality is a cause for primary amenorrhoea in a significant proportion of cases and karyotype should be an integral part of evaluation in such cases. In resource limited settings, karyotype is having more clinical utility in cases with hypergonadotropic hypogonadism.

SUSTAINABLE TOURISM PRACTICES: A PERCEPTION OF BACKWATER TOURISM DESTINATIONS IN SOUTH KERALA, INDIA

The Tourism Industry in South Kerala focuses more on Houseboat Tourism and Backwater Tourism. The unique, natural features set this destination apart from nearby places, as backwater destinations are rich in numerous natural resources. The sustainable development of these resources will highly enhance the livelihood of the communities in the backwater regions. They will be able to attract tourists seeking unique backwater experiences. Therefore, this article intends to comprehend the stakeholders’ perceptions on Sustainable Tourism Development in the backwater destinations of South Kerala in India. A total of 277 respondents participated in the research and the study adopted a quantitative research design, while considering the influence of various factors on the Economic, Social and Environmental Sustainability. The data gathered from the study illustrated that the perception of stakeholders about Sustainable Tourism Development varied across different groups. Hence, all the stakeholders in the Tourism Industry need to work together, as this coordination will help to strengthen future development plans, in order to minimize the negative impacts of tourism in the backwater destinations of South Kerala. The study has also identified key turning points that will help to reshape the Sustainable Development of backwater tourism destinations of South Kerala.