Super Specialty Hospital Research Articles

Imaging Approaches in Dementia: A Retrospective Cohort Study of Cross-sectional Imaging in the Indian Population

Introduction: Dementia is a broad medical term that describes the progressive cognitive decline of brain function due to disease or impairment, resulting in interference with daily activities. Magnetic Resonance Imaging (MRI) is commonly used for the clinical diagnosis of dementia by identifying cerebral atrophy and structural alterations. Furthermore, Magnetic Resonance Spectroscopy (MRS) can detect biochemical abnormalities in dementia patients, which may be beneficial for early diagnosis and treatment. Aim: To provide a comprehensive protocol and a guidance tool for radiologists to effectively diagnose dementia and its subtypes {Alzheimer’s Disease (AD), frontotemporal lobe dementia, etc.} based on radiological findings coupled with volumetry, spectroscopy, and Arterial Spin Labelling (ASL) findings. Materials and Methods: A retrospective observational study was conducted in the Department of Radiology, Nanavati Max Superspeciality Hospital, Mumbai, Maharashtra, India, between June 2022 and June 2023. A total of 125 patients were analysed to observe the correlation between whole brain volume, Intracranial Volume (ICV) of different cortical regions, hippocampal atrophy, and MRS findings. Descriptive statistics were used, and results were expressed as means and standard deviations for continuous variables, and as frequencies and percentages for categorical variables. Results: Out of 125 patients, 71 (56.8%) were males, and 54 (43.2%) were females, with ages ranging from 41 to 96 years. The majority presented with Mild Cognitive Impairment (MCI) 36 patients (28.8%) and Vascular Dementia (VaD) (18 patients - 14.4%). Some clinical features and imaging findings overlapped, resulting in some cases being a combination of different types of dementia. MRI, MRS, and Medial Temporal Atrophy (MTA) played a crucial role in allowing clinicians to perform a differential diagnosis. Conclusion: The use of MR volumetry and spectroscopy aids in classifying the type of dementia, which, in turn, gives treating clinicians a better perspective for further treatment and its outcomes.

Incidences and classification of medication errors - a case study

Background. The Medication errors (MEs) affect severely ill health or death and have a substantial financial effect on the patient and health care organization. The present study aims to detect the incidences and classify MEs and increase the patient safety medication of Super Specialty Hospital, Kolkata. Materials and Methods. The prospective observational study of patient prescriptions, transcription, indenting, dispensing, and administration were followed up daily to identify the medication errors in 400+ beds across each admitted inpatient department (IPD) patients file from June 2019 to July 2019 at a Super Specialty Hospital, Kolkata. Results. A total of 395 prescriptions were reviewed in the present study. A total of 29.36% of medication errors have been reported. In June 2019, MEs occurrence rate was 44.85%. The most common MEs were found in Transcription errors (TEs) (77.72%), followed by Administration errors (AEs) (55.44%), Prescription errors (PEs) (55.18%), Dispensing errors (DEs) (31.89%), and Indenting errors (IEs) (4.05%). In comparison, 13.87% of medication errors occurred in July 2019, four times less than in June 2019, with 28.10% in PEs, followed by TEs at 24.05%, AEs at 9.11%, DEs at 8.10% and 0% in IEs. Conclusion. This study revealed that MEs occurred from the common mistake of illegible handwriting, which causes many problems while transcribing and indenting medicine by chemists and nurses while cross-checking the patient file documentation with a medicine card. Further study is needed to determine the factors governing MEs low reporting.

To Evaluate the Epidemiology, Etiology, Risk Factors and Treatment Management in Chronic Kidney Disease in Children, Adult and Geriatric Patients in a Tertiary Care Teaching Hospital in Nellore

Chronic renal failure is a life-threatening disease to society. The study was conducted from October 2021 to June 2023 the study was done in the Nephrology inpatient ward, Vijaya Super Speciality Hospital, Pogathota Nellore, Andhra Pradesh. The study design is a cross-sectional for epidemiology and prospective observational study-1 for etiology, II-risk factors, III-treatment management. The sample size are 381 subjects in that children are 51 subjects, adult 171 subjects and geriatric are 159 subjects. The male are 199 volunteers and the female are 182 volunteers with chronic kidney disease (CKD). The result of this study was the epidemiology factor more in adults (45%) when compared to children (13%) and geriatrics (42%). In the sex parameters are less affected to females (48%) and males (52%) are more affected with chronic kidney disease. The etiology causes in children are glomerulonephritis, adults diabetes mellitus (DM) and geriatrics pyelonephritis these are the main causes for chronic renal disease when compared to other etiological causes. Risk factors in children are congenital defects, adult are diabetes mellitus and geriatric are kidney disease these are the risk factors to the renal failure patients. In treatment management, hemodialysis is the most effective treatment to adults when compared to children’s and geriatric eng stage renal failure disease. The conclusion of this study initially may rectify causes and risk factors of the patients may not high prevalent in end-stage renal failure disease it not cause hemodialysis therapy and renal transplantation in children, adults and geriatric patients.

Impact of Rural-Urban Differences in Acceptance and Meaning of Life among Breast Cancer Patients in India

India is a land of unity in diversity and it is not only true about its sociocultural but also holds residential areas too. Rural and urban areas associated with different sociostructural characteristics may contribute variation in behavioural adaptation. We studied the impact of rural-urban differences on the acceptance level and meaning of life among breast cancer patients in India. The present analytical descriptive cross-sectional study was conducted under superspecialty hospital, West Bengal, India. We compared the acceptance capability and meaning in life in breast cancer patients from rural areas (N = 122) and urban areas (N = 99). Patient-reported data concerning selected psychological (acceptance ability and the meaning of life), sociodemographic, and biological factors were collected by using validated tools. To identify the impact of sociocultural variation, descriptive statistics were calculated as the mean ± standard deviation of the score of validated tools based on acceptance and meaning of life. Patients from urban areas perceived meaning of life significantly worse than rural individuals (33.1 ± 2.44 vs. 24.2 ± 1.02). Education ( p = < 0.01 ), family per capita income ( p = 0 < 0.01 ), and family structure ( p = 0.004 ) factors were evaluated for being predictors of acceptance levels, whereas the educational level ( p = < 0.01 ) has significantly interacted with the meaning of life among both areas’ patients. Disease acceptance levels were found to be significantly higher in urban area’s patients than rural ones (38.6 ± 1.9 vs. 32.7 ± 1.92). The current study demonstrates that the patients of rural background and low education are more likely than their respective counterparts to have a lower level of acceptance capability and meaning of life.

Clinical and diagnostic profile of Tolosa-Hunt syndrome; a 7-year retrospective observational study.

Tolosa Hunt Syndrome (THS) was first delineated in 1954 and is caused by a granulomatous inflammation in the cavernous sinus, superior orbital fissure or orbit. In this study the different clinical and diagnostic findings of THS are discussed. Case records of patients diagnosed with THS using the International Classification of Headache Disorders 3rd edition criteria from January 2016-July 2022 were considered for the current study. Demographic, Clinical, Laboratory and Radiological data of all patients fulfilling the inclusion and exclusion criteria was collected from the patient case records through the Medical Records Department of BMCRI Super Specialty Hospital. A total of 60 patients were included in the study with mean age with SD, 50.9 years (13.9) and were predominantly male (66.6%). Restriction of eye movements was the most common symptom affecting 31 (51.7%) patients. Oculomotor nerve (IIIrd Cranial Nerve) palsy was the most common nerve palsy, affecting 36 (60%) patients. Contrast enhancing lesions or T2/FLAIR Hyper-intense areas were seen in the Magnetic Resonance Imaging (MRI) of 59 (98.3%) patients. Cavernous sinus involvement, was the most common site of involvement, in 25 (41.6%) of the patients. All patients were treated with intravenous methyl prednisolone injections and responded well. Restriction of eye movements was the most common symptom, along with cavernous sinus being the most common site of involvement in THS. MRI scans are important diagnostic tools for THS.

Trends in seroprevalence of enteric transmitted hepatitis virus infections at a tertiary care hospital in Delhi: a 4-year review

Background: Hepatitis A virus (HAV) and hepatitis E virus (HEV), both enteric hepatitis viruses, are transmitted through the feco-oral route. These infections can range from asymptomatic or subclinical cases to acute viral hepatitis, occasionally leading to mortality. To gain an understanding of the disease and develop effective management strategies, comprehending the disease burden is essential. This study aimed to provide insights into the prevalence of enteric transmitted hepatitis viruses among individuals with acute hepatitis in the Delhi region. Methods: A retrospective investigation was conducted at a prominent tertiary care super specialty hospital in Delhi, spanning from February 2019 to December 2022. Serum samples from patients suspected of having hepatitis and sent for HAV and HEV testing were included. The samples underwent enzyme-linked immunosorbent assay to detect HAV and HEV immunoglobulin (Ig)M antibodies. Collected data was analyzed using SPSS software version 21, employing Chi-square and Fischer exact tests where applicable. Results: Throughout the study period, a total of 1275 samples were incorporated. Viral etiology was evident in 197 patients (15.45%). Among these, IgM HAV was identified in 142 patients (11.13%), and IgM HEV was present in 55 patients (4.31%). HAV infection was notably more prevalent in the pediatric age group (20.89% or 89/426; p<0.001), while HEV was significantly more common among adolescents and adults (5.77% or 49/849; p<0.001). Conclusions: Regular surveillance of enteric transmitted viruses causing hepatitis should encompass both hospital and community levels to accurately gauge disease burden and evolving epidemiology.

Treatment of newly diagnosed paediatric acute lymphoblastic leukaemia on BFM-based chemotherapy protocol: Feasibility and outcome from a tertiary care center in India

BackgroundData on outcomes in children with acute lymphoblastic leukaemia (ALL) who are on Berlin-Frankfurt-Munster (BFM)-based chemotherapy protocol is scarce from India. We share experience on the survival of children with ALL treated on the modified IC BFM 2002 protocol. MethodsChildren (1–18 years) diagnosed with ALL between January 1, 2011 and January 1, 2021 at BLK-MAX Super Specialty Hospital were analyzed retrospectively. Patients were treated with modified IC BFM 2002 protocol. Data on the type of leukaemia, risk status, minimal residual disease (MRD), cytogenetic, and molecular genetics were collected. Disease free survival (DFS) and overall survival (OS) were calculated. ResultsHundred (88 B-cell, 12 T-cell) patients with ALL were evaluated. The median age at presentation was 6.5 years. According to the BFM risk stratification, 35 children were standard-risk, 45 were intermediate and 20 were high-risk. Bone marrow aspiration for MRD by flow cytometry on day 33 of induction chemotherapy was performed in 61 patients. One patient died on day 50 of induction. Day 78 MRD was performed in 60 patients. Day 78 MRD positivity was used for treatment escalation. There were 18 deaths. DFS as on 1st July 2023 for standard, intermediate and high-risk patients was 89%, 85% and 55% respectively. Overall survival in all risk groups was 82%. ConclusionTreating childhood ALL with BFM-based chemotherapy protocol is feasible in developing countries without major modifications and with results comparable to those reported in Western literature.

INCIDENCE AND PREDICTORS OF SURGICAL SITE INFECTION IN MAJOR ABDOMINAL SURGERIES AT A TERTIARY CARE CENTER IN DELHI

Objective: Surgical site infections (SSIs) are the third commonly stated nosocomial infections, with the prevalence rate of 14–16%. In India, the prevalence of SSIs in elective surgeries ranged from 3.83% to 39% and in cases of emergency surgeries, the prevalence ranged from 12.41% to 26.4%. This study was aimed to measure the occurrence of SSIs amid subjects experiencing major abdominal surgeries at tertiary care center in Delhi and to assess the predictors related to occurrence of SSIs in these subjects. Methods: In this cross-sectional study, data were collected over a period of 1 year at the Department of Surgery, Super Specialty Hospital in New Delhi. The, from January 2017 to January 2018. All major gastrointestinal surgeries were considered. Sociodemographic details, clinical history, and surgical details were taken. Results: Out of total 626 patients, 42 (6.7%) developed SSIs. The positive predictors of SSIs in our study were male gender, American Society of Anesthesiology grade of 2 and above, wound class of two and above, longer duration of surgery, emergency surgery, open surgery, laparoscopic converted to open surgery, presence of comorbidities, presence of hypoalbuminemia, and hypoproteinemia. Conclusion: SSIs seems to be a common source of perioperative morbidity and mortality, leading to increased hospital stay and cost of treatment. Proper planning and accordingly managing such case by case scenarios can lead to decreased incidence of SSIs and help reducing burden to the health system.

Modified Single Port Laparoscopic Peritoneal Dialysis Catheter Insertion - Initial Experience and Outcome from a Tertiary Care Centre

Background: Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are emerging as a major health related issues in developing countries. The increasing numbers require rapid adaptation of existing health-care policies. The number of patients requiring renal care is only bound to increase in coming years with the increasing incidence and prevalence of diabetes. Continuous ambulatory peritoneal dialysis (CAPD) catheter placement is performed on end-stage renal disease (ESRD) patients. There is abundant literature regarding post-operative outcomes and re-operative rates following CAPD. We report our initial experience of modified single port laparoscopic technique of placing CAPD catheters using a single port through the Palmer’s point and discuss our surgical outcomes. Methods: This was a retrospective review (2019-2020) of patients undergoing CAPD catheter placement at SMVD Narayana Superspecialty Hospital. Outcome analysis focused on patient related outcomes, including early (< 30 days) versus late (≥ 30 days) complication and re-operation rates. Results: A total of 30 patients with ESRD, (mean ASA score = 3.3) were included in the study who underwent modified single port laparoscopic (n = 30) CAPD catheter placement (mean follow-up = 180 days). The total complication rate with the procedure was 43%, with re-operation rate of 20%. CAPD catheter non-function occurred in 06 patients (20% of total). CAPD catheter migrations occurred in 03 patients (10% of total). CAPD catheter related infections occurred in 05 patients (16% of total), and 02 required re-operation; 03 patients were treated successfully with culture directed antibiotics. There were 2 deaths during the study period, one due to peritonitis and other due to underlying cardiac disease. There was no surgical mortality in the study group. Conclusion: Although CAPD catheter placement in patients with ESRD are technically un-complicated to accomplish, long term results suggest as many as one in three patients will struggle with some form of catheter malfunction or infection. Our modified technique and the results have led to changes in our CAPD catheter placement technique, as well as the post-operative patient care algorithm.

Experience of Island Nasolabial Flap for Patients with Oral Cavity Cancer.

To find out the utility of the island nasolabial flap in patients with oral cavity malignancy. This was an observational study conducted at a super-specialty hospital in Maharashtra from October 2019 to December 2021. Patients with oral malignancy planned for island nasolabial flaps were only considered. A total of 20 patients were operated on, out of which 16 were males and 4 were females. All the patients were followed up for a minimum period of 6 months. The hospital's online reporting system is used for the data collection including the post-operative assessment. Out of the 20 patients, 10 patients were suffering from tongue carcinoma, 6 patients from buccal mucosal carcinoma, two from hard palate carcinoma and one patient each from the floor of the mouth and lip carcinoma. The mean age of the series was 52.3 years, the average duration of the surgery is 169.4min and the average hospital stay in the series was 4.35 days. The Ryle's tube was removed on an average of 4.35 days. No flap-related complications were noted during the series, and healing of the donor site was uneventful. The functional outcomes after the reconstruction are acceptable in all the cases except in the lip reconstruction patient where there was post-operative drooling. The island nasolabial flap is relatively easy to harvest and less time-consuming. The other advantages include the post-operative surgical scar falls along the nasolabial fold, long pedicle length with preservation of the facial pedicle for future microvascular use, early transfer to the oral feed from the nasogastric feed, and early de-cannulation. In our small study, we observed that the island nasolabial flap is a very useful flap for the small to moderate-sized defects of the oral cavity. We feel, one of the disadvantages of this flap is that it is not an ideal flap for lip reconstruction.

Targeted Sanger Sequencing of a Cluster of COVID-19 Cases in the Surgical ICU of a Non-COVID Hospital: Lessons Learned.

Small clusters of infection due to SARS-CoV-2 in a non-COVID-19 healthcare facility can disrupt services. Here, we investigated a cluster of SARS-CoV-2 cases by targeted Sanger sequencing and clinical epidemiological methods in a non-COVID-19 super-specialty hospital. Epidemiological data were collected in a blinded manner using a proforma to find the risk factors associated with infection. Targeted Sanger sequencing of the spike protein receptor binding domain (RBD) coding region was performed on all the available real-time reverse transcription polymerase chain reaction (RT-PCR)-positive samples that included a patient, his mother, and 11 healthcare workers (HCWs) to determine any genomic variations in the samples from the cluster. All positive cases were due to the Delta variant. However, it detected a unique mutation, N501I, in the RBD region of the SARS-CoV-2 strains. The viral genome extracted from the mother's sample lacked the mutation, thus excluding her from the cluster and pointing out that the outbreak was nosocomial, leading to a focus on infection control measures. Though whole genome sequencing is more universally accepted, in this study, targeted sanger sequencing provided a rapid and cost-effective solution to correctly delineate between the actual cases that form the cluster and other community cases in a pandemic situation.

A cross-sectional study of neonatal hearing impairment: understanding its prevalence and risk factors in a tertiary care hospital in Kerala, India

Background: Congenital hearing loss is one of the most prevalent sensory impairments with severe consequences when undetected. The objective of neonatal hearing screening is to identify hearing impairments shortly after birth to initiate treatment as soon as possible and to allow affected children to enjoy normal development. The aim of the study was to determine the prevalence and identify the predisposing factors of HI among neonates in a tertiary care centre in Idukki district of Kerala using a universal neonatal hearing screening (UNHS) program, in an attempt to initiate early interventions in affected neonates. Methods: This was a cross-sectional study conducted in the department of ENT, Al Azhar Medical College and Super Specialty Hospital, Thodupuzha, Kerala over a period of 1 year involving 646 neonates. The study excluded any newborn whose parent/guardian did not give consent for the study, or neonates with microtia grade II and above. Results: The overall prevalence of HL in neonates in our study was 3.1 in 1000 live births out of which 61% were males and 39% females. The risk factors found in our study were preterm babies, maternal age >35, low birth weight, teenage pregnancy, primigravida, and neonatal jaundice requiring blood transfusion. Conclusions: In a standard neonatal population, both at-risk and non-at-risk neonates warrant the immediate adoption of a universal hearing screening program for all neonates in India. Hence, we would like to stress the importance of identifying infants with HL, administering early treatment and performing appropriate screening tests in infants at the right time period.

Analysing Competencies of Health Care Workers of Private Multispecialty Hospital toward Responsibility of Job the Training Need Analysis Approach

The healthcare and hospital industry in India has grown rapidly. People are conscious about their health and well-being. Multi-specialty and super-specialty hospitals have been established in many urban and semi-urban areas of our country. Several and super hospitals offer quality medical and technological services. There is no doubt that these hospitals have highly qualified doctors, but the support staff has been neglected. Nursing plays a key role in this hospital industry. The need for training, which is the skills of the employee and the required training skills, has never been evaluated for nursing staff. A Training Needs Analysis (TNA) is a job needs analysis that aims to identify which training needs are truly a priority. Roles and responsibilities must be considered when assessing these training needs. Communicating these needs helps the organization use resources effectively and efficiently. It also helps to avoid unnecessary exercise. Analysis of training needs can also mean a systematic and comprehensive study of various problems to accurately identify the dimensions of any organizational problem. Therefore, the organization will determine whether the problem will be solved through a training program or in some other way. Organizational problems refer to a lack of skills or knowledge when normal results cannot be achieved; the above explanation explains the difference between real and situational performance.

Intraoperative Squash Cytology and Histopathological Correlation of Glial Tumors at a Tertiary Care Hospital

Abstract Introduction Central nervous system (CNS) tumors account for around 1 to 2% of all neoplasms, commonest of them being gliomas. Gliomas constitute a large, heterogenous group of tumors known for a wide variation in clinical presentation, gross and microscopic features, and biologic behavior. Squash cytology can be a great asset in the intraoperative diagnosis of CNS pathology. In this article, we correlate it with the histopathology of gliomas. Methods A prospective analytical study was conducted at the Department of Neuropathology, Super-Speciality Hospital, NSCB Medical College, Jabalpur, India. A total of 75 samples were collected for intraoperative squash cytology. The biopsy samples were collected subsequently after surgery for histopathological correlation. Statistical analysis was done using SPSS software to calculate the sensitivity, specificity, and diagnostic accuracy of squash cytology. Results Of the total 75 patients clinically and radiologically suspected of having gliomas, 43 (57.33%) were males to give a male-to-female ratio of 1.34:1. The mean age at presentation was 36.50 ± 16.87 years. Right-sided tumors were more common. The most common location was the frontal lobe (46.66%). Concordance with squash cytology was found in 81.33% of cases. Sensitivity, specificity, and diagnostic accuracy of squash cytology in the diagnosis of gliomas were found to be 98.61, 66.66, and 97.33%, respectively. Conclusion Squash cytology is a rapid, inexpensive, and accurate diagnostic method for intraoperative diagnosis of gliomas that can guide the surgeon on the extent of tumor resection.

A Study to Assess the Knowledge and Attitude Regarding Care After Coronary Angioplasty and its Importance Among Care Givers of Coronary Angioplasty Patients at Mamata Super Specialty Hospital, Khammam, Telangana, India

after coronary angioplasty and its importance among care givers of coronary angioplasty patients at Mamata super specialty hospital, Khammam, Telangana”. The objectives were to describe the socio demographic variables of care givers, to assess the levels of knowledge and attitude regarding care after coronary angioplasty and its importance among care givers, to find out the association between the levels of knowledge and attitude scores of care givers with their selected socio demographic variables, to develop and distribute an information booklet regarding care after coronary angioplasty and its importance. Methodology: The study was conducted with a survey research approach for a sample of 50 care givers of coronary angioplasty patients at Mamata super specialty hospital, Khammam, Telangana. Sample was selected by Nonprobability Convenience Sampling technique. The data was collected by Structured Interview schedule. The collected data is analyzed by using descriptive and inferential statistics. Results: The study results revealed that levels of knowledge of care givers regarding care after coronary angioplasty and its importance among 50, majority of care givers 33 (66%) had moderately adequate knowledge 14(28%) had inadequate knowledge and 3(6%) adequate knowledge. Regarding attitude scores among 50, Majority of care givers 28 (56%) had favorable attitude and 22(44%) had moderately favorable attitude. Conclusion: The study concluded that the majority of the care givers had moderately adequate knowledge and favorable attitude. So, it is indicated that there is a need to increase the knowledge of care givers regarding care after coronary angioplasty and its importance.

Prevalence of germline mutations in women with breast and/or ovarian cancer in a tertiary care center in Pune, India

In India, the incidence of breast cancer accounted for 1,78,361 cases, whereas ovarian cancer accounts for 45,701 cases, according to Globocan Report 2020. These cancers are known to have a hereditary basis, and >10% of them are associated with pathogenic BRCA1 and BRCA2 mutations. The prevalence of BRCA1 and BRCA2 varies across various Indian studies and is reported to be 2.9–28%. However, gene mutations other than BRCA1 and BRCA2 which are shown to increase the risk of hereditary breast and ovarian cancer (HBOC) are underreported. Objectives: The objective of this study was to estimate the prevalence of deleterious germline mutations among women with breast and/or ovarian cancer. Material and Methods: A cross-sectional study was conducted in the department of oncology at a super specialty hospital. Patients were enrolled based on the current National Comprehensive Cancer Network guidelines for genetic risk and evaluation of HBOC. Demographic and clinical information was extracted from the electronic medical records of the hospitals from 2018 to 2021. Next-generation sequencing (NGS) was performed on the extracted DNA using a custom capture kit and classified based on the American College of Medical Genetics. Results: A total of 94 patients suspected of having HBOC were examined for deleterious germline mutations. The median age of the patient was 46 years (range: 38–57 years). Breast and ovarian cancer patients constituted 64.9% and 35.1%, respectively. The overall mutation detection rate was 25.5%. The positive mutation detection rate was 26.2% and 24.2% in breast and ovarian cancer, respectively, whereas the variant of uncertain significance rate was 18.03% and 24.2%, respectively. Among the pathogenic mutations, BRCA1 was the most common mutation in women with breast cancer (81.3%). In ovarian cancer, it was 50%. BRCA2 mutation was more prevalent in ovarian cancer (50%). Conclusion: Our study reports a higher prevalence of germline BRCA1 and BRCA2 mutations in breast and ovarian cancer as compared to other studies. Genetic testing can be offered to high-risk women regardless of family history. This will be useful during diagnosis and help physicians in planning subsequent treatment.

Extracorporeal Membrane Oxygenation for Severe COVID-19 in Indian Scenario: A Single Center Retrospective Study.

Initial reports from Wuhan (China) suggested poor outcomes for severe COVID-19 patients treated with Extracorporeal Membrane Oxygenation (ECMO). Extracorporeal Life Support Organization (ELSO) interim 2019 guidelines also recommended using ECMO only when all conventional therapies are exhausted. However, later studies showed that delayed ECMO initiation may lead to longer ECMO runs, offsetting any benefit from resource conservation by delaying the initiation. Hence, this study was intended to analyze the sociodemographic characteristics, type of ECMO, and complications of its outcome in the Indian scenario. Demographic and patient clinical outcome data of all the patients of severe ARDS due to COVID-19 being treated with ECMO from 1st June 2020 to 31st May 2021 at Medica Super-specialty Hospital (Kolkata, India), were retrospectively compiled and analyzed. Total number of patients treated was 79 with 10% female representation. The mean age was 43 ± 3.2 years and the mean body mass index 37 ± 4.3. Fifty percent of the patient survived. The mean duration of the ECMO run was 17 ± 5.2 days. Sepsis (65%) was the commonest complication observed followed by acute kidney injury (39%). This study provides significant insight into the outcomes of patients of COVID-19 treated by ECMO in the Indian scenario. Mortality rates of COVID-19 patients on ECMO were comparable to the non-COVID-19 patients, although the ECMO run time was relatively longer. Our study concluded that ECMO should be considered as a treatment option in appropriate COVID-19 cases. However, if the capacity diminishes in a pandemic situation, ECMO consideration should be based on more stringent criteria. Sulakshana S, Chatterjee D, Chakraborty A. Extracorporeal Membrane Oxygenation for Severe COVID-19 in Indian Scenario: A Single Center Retrospective Study. Indian J Crit Care Med 2023;27(6):381-385.

Fecal occult blood test and its correlation with Gastrointestinal parasites

Stool specimens from – patients in Janakpuri superspeciality hospital were obtained and investigated for gastrointestinal parasites and same were tested for occult blood to analyse the possibility if occult blood corelates with the gastrointestinal parasites. Direct wet mount and iodine wet mounts were examined for detection of gastrointestinal parasites. Fecal occult blood was tested by a commercially available test based on gum guaiac.

Retrospective Analysis of Management of Zygomatic Complex Fractures

Introduction Zygomatic bone and its surrounding bony anatomy are essential for maintaining facial contour—cheek prominence and orbital integrity. Management of the zygomatic complex (ZMC) fractures are important in the maintenance of function and facial integrity. Aim and Objectives To analyze the incidence, aetiology, surgical management, and complications encountered in the treatment of ZMC fractures in our super-specialty hospital, and to compare the number and location of fixation points and surgical access in our patient cohort with the literature. Materials and Method Retrospective analysis of all operative cases (Open Reduction and Internal Fixation) of ZMC fractures over a 3-year period (2017-2021) were reviewed. Craniofacial maxillofacial trauma patient’s medical records were collected and out which only the ZMC fracture cases were reviewed. Only the medical records from the period from 2017 to 2021 were included. The parameters such as etiology, site of the ZMC fracture, type of fracture, associated injuries, clinical findings, treated with conservative or surgical intervention, type of incisions used, number of fixation used, and any complications encountered were reviewed and analyzed. Results Out of 428 cases of craniofacial injury, 96 cases were ZMC fractures, isolated ZMC fractures accounted for 43%, 33% with associated injuries, 13% isolated arch, while 11% accounted isolated infraorbital rim fracture. Most common clinical findings were subconjunctival ecchymosis (71%), flattening of cheek (39%), malocclusion (22%), and so on. Buccal sulcus incision (66%) was mainly used, followed by upper blepharoplasty incision (59%). Depending on degree of displacement of fracture 1-point fixation (8%), 2-point fixation (30%), or 3-point fixation (27%) was performed. About 33% of cases were conservatively managed and followed up on regular intervals. Lymph edema, infra orbital paresthesia, temporary blindness, diplopia, hemianopsia were some of the complications encountered which were managed successfully and followed up. Conclusion ZMC fractures are most commonly occurring midface fractures with variable etiologies. The most common ZMC fracture pattern was tripod type of fracture. Greater portion of the patient were treated with 2-point fixation. Most of the complications were due to the impact and velocity of trauma.

Validation of 'Quick Sequential Organ Failure Assessment Score' as a Screening Tool for Early Identification of Sepsis Patients in the Emergency Department.

Sepsis and septic shock are major healthcare problems, affecting millions of people around the world each year. The speed and appropriateness of therapy administered in the initial hours of treatment are likely to influence the outcome. We conducted a study to validate the clinical assessment score named'quick sequential organ failure assessment' (qSOFA) score for use in the early identification of sepsis patients in the emergency department. Our primary objective was to see the sensitivity and specificity of the qSOFA-score for diagnosing sepsis in the emergency department and our secondary objective was to compare the sensitivity of the qSOFA score with the National Early Warning (NEW) score in patients with sepsis. A prospective observational study was conducted at Max Super Speciality Hospital Saket, New Delhi, from July 2016 to January 2017. Adult patients presenting to the emergency department with clinical signs and symptoms suggestive of infection were enrolled as per the eligibility criteria and divided into two groupson the basis of their qSOFA score at presentation. Out of 120 patients who had a positive qSOFA score 30 were subsequently confirmed as having sepsis whereas in qSOFA negative group 14 patients were subsequently diagnosed as having sepsis. This leads to the fact that although the test has near-acceptable specificity, the sensitivity is quite low. Calculations of the secondary outcome, that is 28-day mortality, revealed that 17 patients out of 120 who had a positive qSOFA score died within 28 days of first presentation whereas in the control group, nine patients had died. This means it successfully predicted mortality in only 17 patients and failed to predict mortality in nine patients out of 26 patients that died. The p-value is 0.097 which indicates both poor sensitivity as well as specificity for predicting mortality. We also compared qSOFA with the NEW score and found the latter to have a better sensitivity for detecting sepsis. This study shows that the qSOFA score, which has been specifically designed for early detection of sepsis patients in the emergency department or a pre-hospital setting in whom infection is suspected on a clinical basis, does not seem to be a good screening tool for early detection of sepsis patients in the emergency department.