Tertiary Care Center In India Research Articles

A deep dive into penetrating ocular trauma: Insights from a South Indian tertiary eye care center

Penetrating ocular trauma is a significant cause of visual impairment and blindness worldwide. In India, with its vast and diverse population, understanding the epidemiology and patterns of Penetrating ocular trauma is crucial for effective prevention and management. This study aims to investigate the prevalence, characteristics, and outcomes of penetrating ocular trauma in the South Indian population. By analyzing data from a tertiary eye care center in South India, this research seeks to contribute to the existing knowledge base and inform evidence-based interventions to reduce the burden of penetrating ocular trauma in this region.To analyze the clinical profile, management, and outcomes of penetrating ocular trauma cases at a tertiary eye care center in South India.A retrospective review of medical records from January 2024 to June 2024 was conducted. Data collected included demographic details, mode of injury, clinical presentations, management approaches, and visual outcomes.Out of 150 cases, 120 were male (80%) and 30 female (20%). The majority of cases occurred in the 20-40 age group (60%). Common causes included workplace accidents (45%), domestic injuries (30%), and road traffic accidents (15%). Initial visual acuity varied from no light perception to >6/18. Surgical intervention was required in 90% of cases. Post-operative follow-up indicated that 60% achieved a visual acuity of 6/60 or better, while 20% had no light perception.Penetrating ocular trauma predominantly affects young males in South India, with workplace injuries being a major cause. Early surgical intervention improves visual outcomes. Public awareness and safety measures could reduce the incidence of such injuries.

Cesarean Section Trends and Associated Factors at a Tertiary Care Center in India: A Retrospective Study

Cesarean Section Trends and Associated Factors at a Tertiary Care Center in India: A Retrospective Study

Increasing Trends of Syphilis and Histopathological Correlates: Study in a Tertiary Care Centre in India

Increasing Trends of Syphilis and Histopathological Correlates: Study in a Tertiary Care Centre in India

Which antidiabetic drugs do patients of T2DM prefer in India and why? A discrete choice experiment

ABSTRACT Background: Uncontrolled diabetes persists despite guideline-based treatment, partly attributed to inadequate patient involvement. This research addresses shared decision-making by eliciting patient preferences in Type 2 Diabetes Mellitus (T2DM) treatment based on certain key attributes and explores their correlation with socio-demographic-clinical profiles. Methods: A discrete choice experiment (DCE) was conducted among T2DM outpatients in an Indian tertiary care center. A choice card was developed using the contextual choice framework, having six second-line antidiabetic drugs (ADs) from different classes incorporating seven attributes. Face-to-face interviews were conducted with patients, and elicited preferences were analyzed using descriptive statistics, Chi-square analysis, and multinomial logistic regression. Results: Out of the 87 evaluated participant choices, the most preferred drug was Glimepiride (51.7%), followed by Dapagliflozin (22.9%) and Teneligliptin (17.2%). Overall, the most important attributes were the effect on weight (29%), followed by route of administration (24%), and additional benefits offered by the drug (18%). Significant associations were found between participants’ drug preferences and their age (P = 0.002), socioeconomic status (P = 0.04), occupation (P = 0.004), and monthly income (P = 0.03). Age was not a significant predictor of drug choice for any of the drugs. Multinomial logistic regression showed that the overall model was statistically significant (P = 0.025), and it correctly predicted drug choice for 58.6% of the participants. Conclusion: Glimepiride was the most preferred option overall while the effect on weight was the most important attribute for patients in determining their preference. The study highlighted the importance of shared decisions and can guide practitioners in considering patient preferences when prescribing antidiabetic drugs.

Clinical Course and Outcomes of Brain Tumor Patients Admitted to Medical Intensive Care Unit: A Descriptive Analysis

Background: There is a shortage of data on brain tumor patients admitted in to intensive care unit (ICU) from developing countries. We aimed to assess the clinical course and 30-day mortality with factors affecting the mortality of brain tumor patients who were admitted to medical ICU.Methods: This study was a single-centre retrospective observational cohort study and was conducted in a medical ICU of a tertiary care center in India. We included 42 patients admitted in to the medical oncology ICU over 3 years. Data regarding demographics, baseline characteristics, clinical and laboratory data, need for organ support, and 30-day mortality were collected. Factors associated with increased mortality in these patients were determined.Results: Overall 30-day mortality was 30.95%. The most common indication for ICU admission was altered sensorium (57.1%) followed by sepsis (23.8%). Age [odds ratio, OR: 0.843 (95% confidence interval, CI: 0.721–0.986)], and need for invasive mechanical ventilator (IMV) support [OR: 484.62 (95% CI: 2.707–8676.02)] or vasopressor support [OR: 523.83 (95% CI: 2.12– 3,023.13)] were directly associated with 30-day mortality. Severity indices such as Sequential Organ Failure Assessment (SOFA) score, SAPS II (Simplified Acute Physiology Score II), and Acute physiology and chronic health evaluation II (APACHE II), APACHE III and APACHE IV scores were higher in non-survivors than survivors.Conclusion: Advancing age and need for IMV or vasopressor support may be associated with worse prognosis in brain tumor patients admitted in to ICU. A scoring system could be used along with clinical judgement to triage brain tumor patients for ICU admission.

Multicenter comparison of non-operative techniques of intussusception reduction: saline versus air versus barium

Purpose: Intussusception is a common pediatric surgical emergency and non-operative reduction is its first line of management. We aimed to compare 3 contemporary techniques of intussusception reduction.Methods: A retrospective study was performed in 3 tertiary care centers in India from January 2017 through December 2019. In the 3 centers, the primary reduction techniques were ultrasound-guided saline reduction (USR), fluoroscopy-guided pneumatic reduction (FPR), and fluoroscopy-guided barium reduction (FBR), respectively. As per these techniques used, we compared clinical characteristics, such as the successful reduction.Results: A total of 255 patients underwent one of the 3 reduction techniques in the study period. Reduction was successful in 90.3%, 85.1%, and 87.7% in the USR, FPR, and FBR groups, respectively (P = 0.961). Mean time to reduction was shorter in the FPR group (30.8 ± 8.9 seconds), compared with the USR (575.0 ± 242.3 seconds) and FBR groups (495.0 ± 118.4 seconds; P < 0.001). Recurrence rates were 11.8%, 20.3%, and 15.8% in the USR, FPR, and FBR groups, respectively (P = 0.522). No association was found between the patients’ age or symptom duration and the successful reduction. One patient in the USR group, 3 in the FPR group, and 4 in the FBR group reported second recurrences. Perforation occurred in 1 patient in the FPR group while no complications occurred in the other groups. There was no in-hospital mortality.Conclusion: All 3 techniques are equally effective, with FPR requiring a shorter time than the other 2 techniques. The reduction technique should be chosen based on the strengths and weaknesses of each technique, as well as local availability.

Xpert MTB/RIF Ultra as a diagnostic tool for pleural tuberculosis: a study at Indian tertiary care centre.

Despite the advent of Xpert MTB/RIF, pleural tuberculosis (TB) diagnosis in pleural fluid is still difficult. Hence, we assessed the diagnostic efficacy of its advanced version, Xpert MTB/RIF Ultra for pleural TB diagnosis using pleural fluid as sample. Tuberculosis pleuritis (TBP) suspects (n=261) were enrolled in the study of which 29 were excluded. The remaining patients (n=232) were categorized into definite TBP (n=31), probable TBP (n=28), and non-TB controls (n=173) based on composite reference standard consisting of smear, culture, histopathology, and Xpert MTB/RIF as well as follow up/clinical response to anti-tuberculosis therapy. Among the TBP suspects, 59 were diagnosed as TBP patients. The sensitivity of Xpert MTB/RIF Ultra (52.5%) using pleural fluid for TBP diagnosis was higher than sensitivity obtained with smear (22.4%), culture (17.6%), and Xpert MTB/RIF (25%) alone, carried using either pleural fluid or pleural biopsy or both the samples. In cases of probable TBP, where none of the laboratory tests were positive, Xpert MTB/RIF Ultra use led to an increased diagnostic percentage of definite TBP from 52.5% to 69.4% Overall, the Xpert MTB/RIF Ultra showed promising results for a definitive diagnosis of TBP in pleural fluid samples.

Use of fibrin sealant in vein anastomosis in renal transplantation and its effect in preventing blood loss and postoperative peri-graft collection.

This study is to assess efficacy of fibrin sealant in vein anastomosis in renal transplantation in preventing blood loss and postoperative peri-graft collection. This is a retrospective analytical case-control study of renal transplantations done in a tertiary care center in India in a 1-year period. Fibrin sealant was randomly used in vein anastomosis during the period. All the data were extracted and retrospectively analyzed. Those with fibrin sealant use were the study group and without sealant use were the control group. Primary objective was to assess effectiveness of fibrin sealant in preventing blood loss and postoperative peri-graft collection. Secondary objectives were to evaluate patients' demographic profile, hospital stay and other intraoperative and postoperative characteristics. During the study, 163 patients were enrolled, 82 study group and 81 control group. Warm ischemia, cold ischemia and operative times of study group were 2.57 ± 2.03, 44.23 ± 8.89 and 189.6 ± 51.6min, respectively, and that of control group were 2.67 ± 2.07, 42.37 ± 8.5 and 178.8 ± 54.6min, respectively. The mean intraoperative blood loss in study and control groups was 124.83 ± 110.89 and 155 ± 50.27ml, respectively, and the difference was statistically significant (p .027). The mean peri-graft collection in study group and control group were 72.33 ± 29.18ml and 134.67 ± 102.84ml, respectively, but the difference was not statistically significant (p .086). The study also demonstrated that the duration of hospital stays significantly differed between two groups (p < .043). In this study, fibrin sealant has demonstrated both safety and efficacy in effectively managing bleeding, sealing vascular anastomoses, and mitigating peri-graft collection.

Prevalence of food-related misbeliefs among postoperative patients at a tertiary care health center: a pilot survey and future directions

Background: Effective postoperative recovery is significantly influenced by nutrition, yet pervasive food-related misbeliefs can impede this process. This is particularly prevalent in regions with high rates of medical misinformation and cultural dietary restrictions. Methods: A survey was conducted with 917 postoperative patients at a tertiary care center in India from July 2019 to December 2019. A structured questionnaire was used to identify prevalent dietary misconceptions and their potential impact on wound healing. Results: The survey revealed that 18.9% of patients harboured detrimental food-related misbeliefs, with the majority avoiding high-protein foods such as meat and dairy due to unfounded fears of adverse effects on wound healing. Conclusions: The findings highlight a critical need for targeted educational interventions to correct these misbeliefs and promote nutritional practices that support recovery. Given the scope of this issue, further research is recommended to explore the broader implications of dietary misconceptions on post-surgical outcomes across different regions and cultures.

A real-world study on the clinicopathological profile, treatment outcomes and health-related quality of life, anxiety and depression among patients with desmoid tumor at two tertiary care centers in India.

The medical management of DT comprises tyrosine kinase inhibitors (TKIs), hormonal agents, anti-inflammatory drugs with the recently approved gamma secretase inhibitor nirogacestat being the current standard of care. Real-world data on evolving treatment landscapes of DT remains scarce. This is a retrospective study of patients with DT registered between 1995 and 2020 at All India Institute of Medical Sciences, New Delhi and Tata Medical Center, Kolkata. Baseline characteristics were analyzed in form of median values and interquartile range. Categorical and continuous variables were compared by chi square and independent samples T- tests respectively. Anxiety, depression and QoL were prospectively measured among 30 patients using Hospital Anxiety and Depression (HADS) and Functional Assessment of Cancer Therapy-General (FACT-G) scales respectively between 2022 to 2023. 200 patients were included with a male-predominant (n=111, 55.5%) population and median age 26.5 (2.5-75) years. Extremity (n=100, 50%) and abdomen (n=65, 32.5%) were commonest primary sites and median of 2 (1-4) lines of treatment were received. First-line included surgery (n=116, 58%), systemic therapy (n=67, 33.5%), radiotherapy (10, n=5%) and active surveillance (n=7, 3.5%). First-line systemic agents included tamoxifen (n=55, 27.5%), imatinib (n=7, 3.5%), sorafenib (n=1, 0.5%) and chemotherapy (n=4, 2%). 2019 onward, 3% and 63% underwent active surveillance and surgery respectively. Best radiological response obtained with tamoxifen was stable disease (SD) (n=76, 59%) and partial response (PR) (n=31, 24.2%). Best radiological response obtained with sorafenib was PR (n=17, 60.7%) and SD (n=9, 32.1%). Thirty patients underwent HADS and FACT-G scale assessment. Mean HADS-Anxiety subscale score was 3.6 (+/-3.9 SD) and HADS-Depression sub-scale score was 2.6 (+/-3.5 SD) with clinically significant anxiety and depression in 2 (6.7%) patients each. The overall mean FACT-G score was 87.5 (+/-12.6 SD) and lower mean physical well-being (p=0.006) and emotional well-being (0.017) scores were significantly associated with higher HADS-anxiety (>/=8) scores. Assessment of anxiety, depression and QoL are paramount to gauge the psychological impact of DT. This study gives an overview of clinical and management profile of patients with DT in India, with limitations of selection bias, heterogeneous population and small sample size for QoL assessment.

Clinico-epidemiological profile of dermatology patients: a one-year study at a newly established tertiary care centre in India

Background: Dermatology is predominantly an outpatient specialty focused on the diagnosis and treatment of dermatoses affecting the skin. We conducted a study on the demographic and clinical characteristics of patients attending the outpatient clinic to better understand the clinico-epidemiological profile and to predict morbidity patterns within the specific geographical region. Methods: A retrospective study was conducted over the past year, encompassing all patients who visited the outpatient dermatology clinic at AIIMS, Raebareli. The study systematically documented a range of dermatoses, including disorders affecting the skin, hair, and nails. Results: A total of 4,188 patients were included in the study, comprising 2,681 (64%) adults, 978 (23.4%) geriatric patients, and 529 (12.6%) pediatric patients. Among these, 1,311 patients primarily suffered from infections, followed by 752 patients with dermatitis. Of those with infections, 1,024 (78%) were diagnosed with fungal infections, while scabies was observed in 126 patients (9.6%). In the adult group, 756 (28.2%) patients had infections, while 429 (16%) patients were affected by dermatitis. Similar patterns were observed in both the geriatric and pediatric groups, with infections being the most prevalent, affecting 214 and 341 patients, respectively. Conclusions: Based on the findings of this study, it can be concluded that infections, particularly fungal infections, are the most prevalent dermatological conditions across all age groups in the population studied. Dermatitis also emerged as a significant concern, particularly among adult patients. The high prevalence of infectious dermatoses, especially in geriatric and pediatric patients, highlights the need for targeted public health interventions and preventive measures.

Emerging Colistin Resistance: Experience from an Intensive Care Unit of a Tertiary Care Center in India.

Resistance to the currently available classes of antimicrobials has emerged as a major health concern, with a growing number of isolated organisms demonstrating resistance to available antimicrobials. With the escalation of carbapenem resistance, the use of polymyxin B/E (colistin) has increased over the years, which has, in turn, contributed to the worldwide emergence of colistin resistance. The available data on colistin resistance from Southeast Asian nations, including India, is limited, especially in intensive care unit (ICU) settings. The primary objective of our study was to analyze the clinical profile of patients with polymyxin B/E (colistin) resistant positive cultures and to study their outcome in terms of length of ICU stay and outcome at discharge. This observational, single-center, prospective study was conducted in a 20-bed adult ICU serving both medical and surgical patients at a 1,600-bed tertiary care institute in northern India between Jan 2020 and Dec 2021. In this study, all adult patients, defined as individuals older than 18 years of age, admitted to our ICU with cultures detecting polymyxin B/E (colistin) resistant organisms were included as cases, and all adult ICU patients (age >18 years) with polymyxin B/E (colistin) sensitive cultures were taken as controls. Clinical, laboratory, and demographic parameters, along with ICU variables like severity of illness, length of ICU stay, mechanical ventilation, days of shock, renal replacement therapy (RRT), etc., and outcome at discharge were collected. Identification of resistance to colistin and minimal inhibitory concentration (MIC) of colistin is based on Clinical and Laboratory Standards Institute (CLSI) guidelines. For statistical analysis, Mann-Whitney U test, Fisher's exact test, and binary logistic regression were used. Twenty-eight cases and 55 controls (n = 83) were included for analysis. Abdominal [gastrointestinal (GI)] sepsis was the most common diagnosis (41.8%) at admission to the ICU, and Klebsiella pneumoniae was the most common species isolated in both the cases (96.4%) and the controls (50.9%). The most common site of isolation of Gram-negative bacteria in both cases and controls was blood (71.4 vs 74.5%), followed by deep-seated pus (21.4 vs 23.64%). The most common class of drugs to which the cases were sensitive was tetracyclines in 60.7%, followed by ceftazidime-avibactam. Factors such as prior exposure to colistin, exposure to monobactams in the ICU, and ICU stay in days were identified as independent predictors for colistin resistance. Overall mortality was not statistically different between cases and controls (p -value 0.38). Factors like prolonged ICU stay, exposure to monobactams in the ICU, and a history of prior exposure to colistin in the previous 90 days are independent predictors of colistin resistance. The most common organism to develop colistin resistance identified was K. pneumoniae, and the most common site of isolation was blood. There was no difference in mortality between colistin-resistant and colistin-sensitive patients.

A Long-Term Retrospective Real-World Evidence to Understand the Pattern of Insulin Prescription in Patients with Type 2 Diabetes Mellitus: Evaluating the Role of Insulin Initiation

Abstract Aims and Objective: To evaluate the prescription pattern of insulin and oral antidiabetic drugs (OADs) and the trend of glycemic control in people with diabetes (PwD) with type 2 diabetes mellitus attending a tertiary care center in India. Materials and Methods: This retrospective, cross-sectional observational study included clinic records of 647 PwD collected at three different time points (2011, 2015, and 2019). Population characteristics, patterns of glycemic parameters, and trends of antidiabetic medication were analyzed. Results: PwD population was similar in terms of anthropometric and clinical variables. Dysglycemia was observably higher in the 2015 population (mean HbA1C = 8.37 ± 1.8%) compared with the 2011 population (6.4 ± 0.4%) and stabilized in the 2019 population (8.35 ± 1.9%) compared with the 2015 population. This correlated with the trend of increase in basal and bolus insulin prescriptions as more subjects were initiated on insulin to address the higher dysglycemia in 2015 than in 2011 and were later titrated in 2019. The proportion of subjects with uncontrolled diabetes increased marginally in 2015 (50.9%) compared with 2011 (45.6%) and decreased significantly in 2019 (34.1%) compared with 2015. This correlated with the additive increases of premix insulin, sodium-glucose transport protein 2 inhibitors (SGLT2i), and dipeptidyl peptidase 4 inhibitors (DPP4i) prescriptions. Conclusion: We observed a judicious usage of insulin prescriptions correlating with the higher need for PwD to be initiated with basal insulin to counter the increasing trend of dysglycemia, followed by more premix insulin prescriptions to address stabilized dysglycemia. Optimal diabetes control can be partly attributed to dysglycemia stabilization by insulin initiation and usage of newer OADs, such as SGLT2i and DPP4i.

EP.14A.14 Clinical Insights and Survival Outcomes of Malignant Pleural Mesothelioma: An Experience from a Tertiary Care Centre in India

EP.14A.14 Clinical Insights and Survival Outcomes of Malignant Pleural Mesothelioma: An Experience from a Tertiary Care Centre in India

Avoidant Restrictive Food Intake Disorder: A Case Series

Abstract Avoidant restrictive food intake disorder (ARFID), a recently described eating disorder categorized under DSM-5, has varied clinical presentations. The primary eating disorders have well-established practice parameters for management. However, there is no evidence-based first line of management for ARFID. There is a significant gap in this evolving construct and clinical practice. We present a case series from a tertiary care center in India, focusing on clinical management. Four adolescents with 3 girls and 1 boy between 12 and 17 years of age were included in the study. Diagnosis and management were delayed in all. Mean body mass index was 15.36 (5.26) kg/m2 at the time of diagnosis. Key drivers were dread of choking, sensory characteristics, and avoidance of unpleasant upper and lower gastrointestinal symptoms. This series supports a culturally cognizant hypothesis, an evidence based, viable management model for ARFID in low- and middle-income countries (LMIC). A combination of family-based treatment (FBT) and cognitive behavior therapy is an effective treatment model for India and other LMICs.

Long Term Effects Of Covid-19 Pandemic On Management And Outcomes Of Distal Radius Fractures

Purpose: The purpose of this study was to assess the long-term effects of conservative orthopaedic practice during Covid-19 pandemic on management and long-term outcomes. Methods: Current longitudinal retrospective cohort study included patients at a single tertiary care center in India. Successive distal radius fractures of patients in pre-COVID (2018-19), COVID (2020-21) and postCOVID (2022-23) time period groups were treated and analysed. The primary outcome was the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, and secondary outcomes included wrist range of motion, grip strength and pain. Cohort findings were compared employing Repeated-measures analysis of variance. Results: In pre-COVID group 97(82.4%) patients presented within 3 days of injury which significantly declined to 48(49%) in COVID and 94(71.2%) in post-COVID group. There was a significant reduction in admissions for inpatient care (p&lt;0.05). The mean QuickDASH score at 1 year follow-up was 7.2(8.6) in COVID group that was clinically better than pre-COVID [8.5(9.2)] and post-COVID [9.7 (12.4)] cohorts. The number of reoperations or secondary surgeries required were significantly lower in the COVID group [1 (1%) patient]. Conclusions: COVID-19 pandemic had minimal long-term effects on results of distal radius fractures as the conservative treatment approach utilised was realistic and beneficial to patients as well as to the treating surgeons. Timely corrections of arising early treatment complications through efficient virtual clinics/telemedicine kept the prevalence of major late complications minimal. Comparatively minimal complications and prompt recovery were seen in patients being operated by percutaneous Kirschner wires fixation. Categories: Infectious Disease, Orthopaedics, Trauma

Do Anatomical Variations of Sphenoid Sinus Influence Sella Exposure and Residual Disease in Pituitary Surgery? - A Study in an Indian Population.

Introduction Endoscopic transsphenoidal surgery (ETS) is the standard practice in pituitary surgeries. The sellar exposure becomes the main factor which determines the residual disease in ETS. Not many studies can be found in the literature on the influence of anatomical variations of the sphenoid on intraoperative sella exposure. Objective The aim of the current study is to ascertain whether sphenoid sinus variations play a role in sellar exposure and residual tumor volume. Methods This is a prospective study conducted in a south Indian tertiary care center between June 2020 to June 2022, with 21 study participants who were scheduled to have ETS. The relation of preoperative computed tomography (CT) and magnetic resonance imaging (MRI) parameters with the intraoperative area of sellar exposure and residual tumor volume was evaluated. Results Sphenoid sinus dimensions, like presellar width (mean = 1.89 ± 0.51 cm), maximum width (mean = 2.94 ± 1.09 cm), presellar depth (mean = 1.14 ± 0.55 cm), suprasellar depth (mean = 1.08 ± 0.24 cm), infrasellar depth (mean = 2.36 ± 0.92 cm), presellar height (mean = 2.22 ± 0.47 cm), or the 9 internal carotid artery (ICA)-related measures, did not have any correlation with the mean intraoperative area of sellar exposure (0.57 ± 0.28 cm 2 ). Also, the adequacy of sellar exposure did not relate to the residual tumor. Preoperative tumor volume was found to be higher (20.2 [55.3-13.2] cm 3 ) in patients with residual tumor compared with those with no residual tumor (5.9 [6.8-5.2] cm 3 ). Tumor extension had a significant association with the residual tumor volume. Conclusion According to the present study, anatomical variations of the sphenoid sinus do not influence the adequacy of sellar exposure. Further studies need to be undertaken concerning residual tumor volume as well as preoperative tumor volume and extension.

“An Analytical Study To Compare The Effectiveness Of P-Possum And Possum Scores In Predicting Mortality And Morbidity Following Emergency Laparotomy"

Background: Surgical outcomes are increasingly scrutinized as part of efforts to ensure accountability and improve the quality of care. The Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM) and its modification, the Portsmouth POSSUM (P-POSSUM), are widely used tools for predicting surgical outcomes. Objective: This study aimed to assess the accuracy of POSSUM in predicting morbidity and P-POSSUM in predicting mortality for patients undergoing emergency laparotomies in a North Indian tertiary care center. Methods: A hospital-based, analytic observational study was conducted at S.M.S. Medical College and Hospital, Jaipur, involving 160 patients who underwent emergency laparotomy. Preoperative physiological and intraoperative data were collected and used to calculate POSSUM and P-POSSUM scores. Mortality predictions were compared using linear and exponential analyses, and the observed-to-expected (O:E) mortality ratio was calculated. Statistical significance was determined using the Chi-square test. Results: The mean age of the cohort was 49.65 years, with males comprising 64.37% of the population. Peptic perforation (20.6%) was the most common cause of surgery. POSSUM significantly over-predicted mortality (O:E ratio = 0.26, p=0.04), while P-POSSUM provided a more accurate prediction (O:E ratio = 0.45, p=0.81). POSSUM also overestimated morbidity (O:E ratio = 0.8, p=0.51). Conclusion: While POSSUM tends to over-predict both mortality and morbidity, P-POSSUM offers a more accurate prediction of mortality in patients undergoing emergency laparotomy. These scoring systems can serve as valuable tools for surgical audits and improving the quality of care, though careful selection of the appropriate predictive model is essential

Diagnostic Utility of Squash Smear Cytology in Chordoma: A Tertiary Care Center Experience

Abstract Background and Aims: Chordomas are rare notochordal tumors. They are suitable candidates for squash smear cytology (SSC) owing to their gelatinous consistency and destructive nature. SSC is an important tool for making a quick intra-operative preliminary diagnosis and taking real-time surgical and further management decisions. This study aimed to evaluate the diagnostic accuracy of SSC for chordoma cases. Materials and Methods: This retrospective study conducted in a North Indian tertiary care center enrolled chordoma cases histopathologically diagnosed between 01.01.2013 and 31.07.2023, for which SSC was also performed. SSC smears and their corresponding histopathology slides (±immunohistochemistry [IHC] slides) were retrieved. Histo-cytological correlation was performed. Results: In total, 13 such cases were retrieved. The mean age was 34.4 + 5.6 years. The male–female ratio was 1:1.6. The most common location was the spheno-occipital region (10 cases), followed by sacro-coccygeal (two cases) and vertebral regions (1 case). The SSC was positive for chordoma in 10/13 cases. Thus, the calculated accuracy of SSC in chordoma diagnosis was 76.9%. A total of 3/13 (23.1%) cases where SSC was inconclusive for chordoma were difficult to diagnose cases, requiring IHC for ultimate diagnosis. Cytological features such as abundant myxoid matrix and physaliphorous cells help in correct diagnosis of chordoma on SSC. Conclusions: We found the diagnostic accuracy of SSC in chordoma diagnosis to be 76.9%. Features such as abundant myxoid matrix and physaliphorous cells are helpful in correct diagnosis on SSC. Thus, even though chordomas are rare, one should consider them among the differential diagnoses in cases presenting with appropriate clinico-radiological features and characteristic cytological findings.

Role of empirical antitubercular therapy for chronic mastitis—A prospective study

Objectives Chronic mastitis (CM) is an uncommon inflammatory condition of the breast, clinically mimicking malignancy with variable etiological factors. It often recurs, causing cosmetic disfigurement and hampering the quality of life of affected females. Limited literature reveals underlying bacterial infection as causative agents in a few cases, while the majority belong to idiopathic entities. CM can be seen as two histological types—chronic granulomatous mastitis (CGM) and chronic nonspecific inflammatory infiltrates (NGM). Etiological and ethnic variations exist globally, and there is lack of information from India. Understanding this entity is important for undertaking etiology-based therapy and preventing unnecessary mismanagement. Materials and Methods We evaluated the demographic, imaging profile and management protocol of CM patients presenting to a tertiary care center in India. Clinically suspected CM patients were prospectively evaluated by mammography and ultrasound (USG). USG-guided biopsy was performed for histopathological and microbiological analysis and treatment was administered accordingly. Response assessment was conducted at six months through USG and clinical evaluation. Results Out of the 53 clinically suspected CM patients, 48 biopsy-proven CM patients were enrolled (five breast carcinoma cases were excluded). All 48 patients were females, with a mean age of 36 ± 9 years. The most common symptom was a unilateral painful lump with skin discoloration. The etiology was idiopathic in 58.3% of cases, tuberculosis in 29%, and bacterial in 4%. Mammography revealed focal asymmetry, architectural distortion, and trabecular thickening. USG showed tracking fluid collections, microlobulated hypoechoic masses, and skin thickening. Etiology-based treatment was administered, and all patients showed 90–100% resolution between four and six months. Conclusion Mammography and USG are important for raising the suspicion while histopathology and microbiological analysis are mandatory for accurate treatment of CM. In India, idiopathic and tubercular etiology of CM is encountered and patients respond well to therapy.