Tertiary Care Center In India Research Articles

Survival and its determinants in a large cohort of cirrhosis in a tertiary care centre in India

Survival and its determinants in a large cohort of cirrhosis in a tertiary care centre in India

Visual Field Defects and Retinal Nerve Fiber Layer Thickness in Migraine Patients: A Study From a Tertiary Care Center in India.

Background This study aimed to analyze the visual field changes and retinal nerve fiber layer (RNFL) thickness during the headache phase of migraine attacks among migraine patients compared with controls. Methodology A prospective, case-control study was conducted at a tertiary care center in Palakkad, Kerala from January 2022 to August 2023. This study included 50 migraine patients and 50 age/gender-matched controls. Adults aged 20-40 years with a more than three-year history of migraine were included in this study and those who had systemic or ocular pathologies were excluded. All 100 subjects underwent complete ocular examination, including full threshold 24-2 automated perimetry for visual field analysis and optical coherence tomography for analyzing RNFL thickness. Statistical analysis was done using SPSS Statistics Version 25 (IBM Corp., Armonk, NY, USA). Results In this study, the average age for cases was 29.24 ± 5.10 years, and for controls was 30.12 ± 6.20 years. Gender distribution was identical between cases and controls with 29 (58%) females and 21 (42%) males. Among the 50 migraine patients, 22 (44%) had generalized, while 28 (56%) had localized field defects during the headache phase of migraine attacks. There was a statistically significant (p < 0.001) difference in superior quadrant RNFL thickness between cases (114.08 ± 12.25) and controls. Conclusions We found that RNFL thinning in the superior quadrant and non-specific localized visual field changes occur during migraine attacks. We conducted this study in a tertiary care center as very few studies in our country have revealed visual field changes during migraine headache attacks.

Expression of isocitrate dehydrogenase 1 and tumor protein 53 in high-grade glioma and its correlation with the outcome – A prospective study at a tertiary care center in India

Background: Central nervous system tumors are the 10th most prevalent cause of mortality worldwide. The 2016 World Health Organization (WHO) classification of high grade gliomas (HGG) has identified Isocitrate dehydrogenase 1 (IDH 1) mutation as one of the primary molecular markers. Tumor protein 53 (p53) mutation is also closely associated with HGG. Aims and Objectives: The current study intended to ascertain the expression of IDH1 and P53 in patients with HGG and correlate that expression with clinical prognosis. Materials and Methods: The study included 34 patients with histopathological proven HGG. Relevant clinical information was recorded. The immunostaining results with anti-mouse monoclonal antibody for IDH 1 (R132H) and rabbit polyclonal antibody for p53 (RP 106-05) were statistically analyzed. Patients were followed up through telephone for a period of 1 year. Mortality within 1 year was regarded as a poor outcome. Results: About 85.29% (29/34) of the patients had Grade IV glioma, while only 14.71% (5/34) had Grade III glioma. Most patients with Grade III (3/5) (60.00%) and Grade IV (21/29) (72.41%) gliomas had p53 positivity. The majority of the patients with grade-III glioma (3/5) (60.00%) had IDH1 positivity, while most of the patients (23/29) (79.31%) with Grade IV gliomas had IDH1 negativity (P=0.0658). Age, gender, WHO grade, and adjuvant therapy did not show significant association with the outcome except for the p53 expression (P=0.0011*) and IDH1 expression (P=0.0025*). Correlation analysis showed a significant positive correlation between p53 makers with poor outcome (r=0.4781) and glioma grade (r=0.4028). Further, a negative yet insignificant correlation was recorded between IDH1 with age (r=−0.2285), p53 expression (r=−0.2568), and grade (r=−0.2988), although it showed a significant correlation with poor outcome (P=0.0001). Conclusion: p53-positive and IDH1-negative HGG had a significant correlation with the poor outcome. Thus, IDH1 and p53 are reliable markers for prognostication of HGG.

Outcomes of endoscopic sub-mucosal dissection in laterally spreading colorectal polyps: A tertiary care centre experience from India.

Endoscopic sub-mucosal dissection (ESD) is an established endoscopic modality for the management of colorectal polyps. However, there are no studies regarding the outcomes of ESD from India. In this study, we aimed at evaluating the outcomes of ESD in patients with adenomatous polyps in the colon and rectum. Data of consecutive patients who underwent ESD for colorectal polyps from 2018 to 2021 were analyzed, retrospectively. The primary outcome of the study was the technical success of ESD. The secondary outcomes included the rate of histologically complete resection (R0), adverse events and recurrence. Seventy patients (63.5 years, 60% males) underwent ESD for polyps in colon and rectum. A majority were located in rectum (80%) and sigmoid colon (15.7%). Narrow band classification of the polyps was Japanese Narrow Band Imaging Expert Team (JNET)-2a in 50 (71.4%) and JNET-2b in 13 (18.6%) patients. ESD was technically successful in 64 (91.4%) patients using conventional technique (72.8%) and pocket or tunnellingtechnique (18.6%). There wereno major adverse events. Histologically RO was achieved in 58 (82.8%) patients and deep sub-mucosal invasion was noted in 12 patients. At a median follow-up of 19 (interquartile range [IQR] 15-27) months, recurrence was noticed in four(5.7%) patients all of which could be managed endoscopically. ESD, performed at a tertiary care centre in India, yields high rates of technical success and histologically R0, with a relatively low incidence of adverse events and recurrences.

Outcomes of Resectable Gallbladder Cancer: A Retrospective Analysis From a Tertiary Care Centre in India.

Background Gallbladder carcinoma (GBC) has deleterious outcomes, but due to its reduced incidence in Western countries, there is a paucity of data on this disease. Here we report the outcomes of a retrospective analysis of resectable gallbladder cancer from a tertiary cancer centre in eastern India. The primary objective of this study is to evaluate the overall survival (OS) and relapse-free survival (RFS) rates among patients with resectable GBC. Methods A retrospective analysis was carried out on patients who underwent radical surgery between 2007 and 2022 and received various neoadjuvant and adjuvant chemotherapy methods. Patients who had adjuvant chemoradiotherapy concurrently or who did not receive adjuvant therapy were excluded. All the baseline clinicopathological characteristics were retrieved from electronic medical records. The survival data were collected from records of follow-up visits as well as telephonic calls to the patients who were lost to follow-up. Simple proportions were used for baseline characteristics, and the Kaplan-Meier method was used for survival analysis. Results A total of 161 patients were identified, and data were captured from electronic medical records. The included patients' ages ranged between 26 and 80 years, with a median age of 56 years. Among the participants, 103 were female (64%) and 58 (36%) were male. Among the 161 patients, the median number of lymph nodes harvested was nine (ranging from one to 43), and only three patients were margin-positive. The tumour, nodes, and metastasis (TNM) distributions were as follows: pT2 in 111 patients (70.25%), pT3 in 44 patients (27.85%), and pT4 in three patients (1.90%). The nodal statuses were pN0 in 91 patients (61.9%), pN1 in 51 patients (34.69%), and pN2 in five patients (3.4%). The majority (64%) received single-agent capecitabine, 27% received gemcitabine-based platinum doublet therapy, and 4.3% received neoadjuvant therapy. Of the full sample, 2.4% received concurrent adjuvant chemo plus radiation therapy, and three patients did not receive any adjuvant therapy. Additionally, among the 161 patients, 34.16% had a relapse, with 47% being local and 52% being distant relapses. The median follow-up was 49 months (interquartile range (IQR) 23-71 months). The 24-month RFS rate was 67.1% (SD+/- 4.3%), and the 24-month OS rate was 78.1% (SD+/- 4.1%). Conclusion Our data, which is from one of the largest samples from India, show that resectable gallbladder cancer has very good outcomes after radical surgery and adjuvant chemotherapy. There was a higher proportion of T2 and node-negative disease, which could have led to better survival compared to published literature.

Therapeutic plasma exchange in autoimmune neurological disorders: A comprehensive evaluation of clinical outcomes, safety, and long-term disability using the modified Rankin scale.

Autoimmune neurological diseases (ANDs) involve the immune system attacking the nervous system, leading to various symptoms. Therapeutic plasma exchange (TPE) is used to remove pathogenic autoantibodies, aiming to improve clinical outcomes. This ambispective observational study included 99 patients with ANDs who underwent TPE from January 2018 to June 2022 at a tertiary care center in India. Clinical outcomes were measured using the modified Rankin Scale (mRS) scores at admission, post-TPE, at 3-months, 6-months, and 1-year follow-up post-discharge. Data were analyzed using Epi Info version 7.0. The median mRS score improved significantly from 5 (IQR 4-5) before TPE to 3 (IQR 2-4) post-TPE (p < 0.001). Complications occurred in 5.95% of procedures, with allergic reactions being the most common. The in-hospital mortality rate was 9%. TPE is a safe and effective treatment modality for autoimmune neurological diseases, especially in resource-constrained settings. It aids in both symptomatic relief and reducing long-term functional disability.

The High Burden of Asymptomatic Kidney Diseases in Individuals with HIV: A Prospective Study from a Tertiary Care Center in India

Background HIV infection is associated with a significant kidney disease burden. This study is aimed to screen for kidney disease in all HIV patients on highly active anti retroviral therapy (HAART), study clinico-histological correlation, and assess the impact of early diagnosis on the clinical course. Materials and Methods It was a prospective, longitudinal study done in a tertiary care hospital. Adult HIV-infected patients, on HAART for at least 3 months, were screened for kidney disease. Kidney biopsy was done if indicated. Patients were treated as per standard guidelines. Results were analyzed at 3 months. Results Among 1600 patients, 966 were compliant with HAART and were tested. Two hundred and sixty-two patients completed the study duration. Out of these 262 patients 78.2% were receiving tenofovir-based ART regimen. Around 31.2% were hypertensive and 19.8% were diabetic. The mean eGFR was 57.5 ± 24 mL/min/1.73 m2. Around 19.8% had asymptomatic urine abnormalities, 40.1% had proteinuria, and 27.1% had AKI. Acute nephritic syndrome was seen in 16.4%, rapidly progressive renal failure (RPRF) in 13.3%, and CKD in 10.6% patients. Out of 74 patients who underwent biopsy, histology showed chronic tubulointerstitial nephritis in 16 (21.6%), acute tubulointerstitial nephritis in 11 (14.8%), diabetic nephropathy in 10 (13.5%), and thrombotic microangiopathy in 7 patients (9.4%). Higher viral load levels, diabetes mellitus, and age above 60 years were associated with kidney disease. Conclusion Asymptomatic HIV infection has a significant burden of kidney disease. Kidney biopsy is crucial for correct diagnosis and management. The absence of HIV associated nephropathy in proteinuric HIV patients is notable in this study.

Additional yield of transbronchial cryo-node biopsy over endobronchial ultrasound-guided transbronchial needle aspiration for mediastinal lesions at a tertiary care center in India (COLD-FORCEPS-2 study)

Endobronchial ultrasound (EBUS)-guided mediastinal cryobiopsy is a new modality for sampling mediastinal lymph nodes. The data regarding the diagnostic yield and utility of mediastinal cryobiopsy is still limited. Consecutive patients who were undergoing EBUS-guided transbronchial needle aspiration (EBUS-TBNA) were recruited in this study. We subjected the enrolled patients to EBUS-guided mediastinal cryobiopsy after obtaining their informed consent. The final diagnosis was made with a clinical-pathological-radiological assessment and clinical-radiological follow-up. A total of 101 patients were enrolled in the study. Adequacy in sampling achieved in EBUS-TBNA was 92.07%, compared to 98.01% achieved in EBUS-TBNA with mediastinal cryobiopsy. Diagnostic yields achieved in EBUS-TBNA and EBUS-TBNA with mediastinal cryobiopsy were 67.32% and 86.13%, respectively (p=0.001). EBUS patterns failed to predict the utility of mediastinal crobiopsy. No significant complications were observed. To conclude, EBUS-guided mediastinal cryobiopsy improves yield in patients undergoing EBUS-TBNA.

Cervical Artery Dissection: Clinical Outcomes and Functional Outcome Predictors from a Tertiary Care Center in India.

Cervical Artery Dissection: Clinical Outcomes and Functional Outcome Predictors from a Tertiary Care Center in India.

Efficacy of HPV E6/E7 mRNA assay, HPV DNA test and cytology in detection of high grade cervical lesions and invasive cancer at a tertiary care center in India

Efficacy of HPV E6/E7 mRNA assay, HPV DNA test and cytology in detection of high grade cervical lesions and invasive cancer at a tertiary care center in India

Clinical and demographic characteristics of mucous membrane pemphigoid in India: A retrospective analysis.

Background Mucous membrane pemphigoid (MMP) is a rare subepidermal autoimmune blistering disorder. The clinical and demographic parameters of this disease in Indian patients have not yet been elucidated in detail. Objective We aimed to study the clinical and demographic characteristics, disease course, and treatment aspects of MMP patients. Methods The data for this study were obtained by reviewing the case record forms of patients registered in the Autoimmune Bullous Disease (AIBD) Clinic of the Department of Dermatology, Venereology & Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, a tertiary care centre in India. The diagnosis of MMP was established on the basis of clinical and immune-histopathological features which are consistent with standard diagnostic criteria for the disease. Results A total of 52 patients with MMP registered in the AIBD clinic were included. The mean age at disease onset was 50 years and the average age at presentation was 56 years. Females outnumbered males in the study with a ratio of 1.36:1. The oral and ocular mucosae were the most commonly affected sites (82.6% and 63.4% respectively). Visual difficulty was reported by half the patients (26 of 52 patients). IgG, C3, and IgA deposits were detected on direct immunofluorescence (DIF) in 29, 21, and 11 patients, respectively. Serologic analysis was performed in only 7 of the patients and of these, just 1 exhibited a positive result on multivariant ELISA and epidermal pattern of binding on salt split skin indirect immunofluorescence. Most patients were treated with prednisolone (44 of 52). Steroid-sparing adjuvants were used in combination including cyclophosphamide, azathioprine, methotrexate, dapsone, and colchicine. Rituximab was administered in 7 patients with severe or refractory disease. Limitations This is a retrospective analysis of data available from a clinic registry. In patients with negative direct immunofluorescence on biopsy, the diagnosis was based on clinico-pathologic consensus. Conclusion MMP is not as uncommon in India as the paucity of reports suggest. Visual complications are frequent in Indian MMP patients. A high index of suspicion is required for early diagnosis and appropriate treatment to prevent ocular complications.

Clinical Spectrum of Atopic Dermatitis in Pediatric Age Group from a Tertiary Care Center in India: A Cross-sectional Study

Introduction: Atopic dermatitis (AD) is a chronic, inflammatory, relapsing skin disorder with early age of onset in infancy and early childhood. A gradual increase in the prevalence of AD has been observed recently, especially in low-income countries like ours. Objective: We aimed to study the epidemiology and clinical profile of AD among pediatric age group in a tertiary care hospital in North India. Materials and Methods: A hospital-based cross-sectional study was conducted over 1 year in the department of dermatology and sexually transmitted diseases in a tertiary care center in India. All children diagnosed with AD, aged 0–18 years, were recruited, and their clinical and demographic data were recorded. Results: In the 62 children having AD, the mean age was 7.7 ± 6.3 years. Majority of children belonged to the age group of 1–5 years. The mean age of onset of AD was 2.3 ± 2.2 years. A personal history of atopy was present in 53.2% of children, whereas 48.3% of children had a family history of atopy. Acute AD was the most common clinical type that was noted in 43.5%. Hyperlinearity of palms, keratosis pilaris, pityriasis alba, and periorbital darkening were found in 59.6%, 33.8%, 24.1%, and 29% of children, respectively. Conclusion: The prevalence of AD is low in developing countries like India, but it is slowly rising due to rapidly evolving urbanization and environmental changes. Disease manifestation is usually mild to moderate in Indian patients; hence, vigilant eyes and high clinical suspicion are required for accurate diagnosis and efficient management of AD in Indian settings.

Prognostic utility of B-type natriuretic peptide and 6-min walk test in patients with acute decompensated heart failure

BackgroundWe aimed to assess the utility of B-type natriuretic peptide (BNP) and 6-min walk test (6 MWT) together as predictors of re-hospitalization and mortality in acute decompensated heart failure (ADHF) patients. MethodsThis prospective, observational, comparative study was conducted at a tertiary care center in India between October 2016 and March 2018. Patients (aged≥18 years) with ADHF and left ventricular systolic dysfunction were included in this study. The study group (N = 100 patients) consisted of patients undergoing a second BNP test along with the 6 MWT at the time of discharge and at 3-months of discharge. The control group (N = 100 patients) consisted of patients who did not undergo these tests at discharge and/or at 3-months of discharge. Study endpoints were re-hospitalization within 6-months, and in-patient and 6-month mortality. ResultsTotal 200 patients diagnosed with ADHF were enrolled. Mean age was 53.46 ± 10.12 years in the study group and 52.98 ± 9.88 years in the control group. ROC analysis of BNP level to predict re-hospitalization revealed AUC of 0.935 (p < 0.001) at admission, 0.915 (p < 0.001) at discharge, and 0.783 (p < 0.001) at 3-months. Similarly, at discharge, ROC analysis of 6 MWT to predict death gave AUC of 0.670 (p = 0.011), and at 3-months, it was 0.838 (p < 0.001). ROC analysis of BNP level to predict mortality showed AUC of 0.960 (p < 0.001) at admission, 0.947 (p < 0.001) after discharge, and 0.960 (p = 0.002) at 3-months. ConclusionBNP levels and 6 MWT have good prognostic utility in ADHF patients, and thus may be beneficial in making therapeutic adjustments and taking precautionary measures in these patients.

Lifestyle Practices of Adolescents in a Tertiary Care Centre in India

Introduction: Adolescents are individuals in the 10–19year age group; there are 253 million adolescents in India. Growth and development are predominant during adolescence, a relatively healthy time. Good diet, physical activity, sleep, and screen time are pillars of good health. Aims &amp; Objectives: To identify lifestyle practices such as diet, physical activity, sleep, and screen time among adolescents in the outpatient and inpatient services, Departments of Paediatrics and Paediatric Surgery, Christian Medical College, Vellore. Methods: A descriptive study design employing a non-probability purposive sampling technique was used to recruit 1420 adolescents. Written consent and assent were obtained, demographic and clinical variables were collected using interviews, and the lifestyle practice was assessed using a modified YRBS questionnaire. Results: 70.8% of the adolescents were in the age group of 10-14 years; males and females were almost equal (46.2 and 53.8%), 73.6% lived in nuclear families, and 19.4% had a BMI of 23 adult equivalent. Regarding diet in the past 7 days, 41.3% did not consume green/vegetable salads, and 89.7% of the adolescents ate breakfast daily, but the meals of 81.4% did not contain 25% carbohydrates. 42.2% did not meet the recommended 60 minutes of daily physical activity, and 51% were not a part of any sports team in the past year. Most (33.8%) of the adolescents slept for about 8 hours during the school days, but 68% reported difficulty falling asleep. Most participants (58.7% and 59.2%) stopped screentime just before sleep on weekdays and weekends. Conclusion: Adolescence is when lifestyle behaviours that affect present and future health begin. Therefore, helping adolescents establish healthy lifestyles and avoid developing health risk behaviours is crucial and should be started before these behaviours are firmly established. Keywords: Adolescents, Lifestyle, Diet, Physical Activity, Sleep, Screen time.

Assessment of Severity of Substance use for Outcomes Research and Treatment (ASSORT): A substance use severity scale developed and validated across six tertiary care centers in India.

Assessment of the severity of substance use disorders (SUDs) in a culture-sensitive manner can help gauge the current condition of the substance user and assess change with time. The present study aimed to develop a scale for the assessment of the severity of SUDs in the Indian clinical context. Based upon the review of literature on previously available instruments and a consultative meeting of experts, a clinician-rated scale was developed that finally comprised 41 items. A briefer 5-item scale with current and lifetime versions was also developed. The scales were applied to patients with SUDs at six different clinical sites. The instrument was applied to 720 patients (98.2% males, mean age: 34.6 years). The Cronbach's alpha of the full scale was 0.852. The inter-rater reliability Pearson correlation coefficient of the full-scale was r = 0.821 (P < 0.001), and the intra-class correlation coefficient single measure was 0.800 (95% confidence interval: 0.724-0.956). A four-factor solution was suggested to be the most tenable. The mean application duration of the full scale was 13.4 minutes, and that of the briefer version was 2 minutes. This validated scale could be a potentially useful assessment measure for the severity of SUDs in the Indian context. The utility lies in the simplicity of administration and scoring and the balance between brevity and thorough assessment.

Diagnostic Utility of the "Lancet Consensus Scoring System" in Suspected Cases of Tuberculous Meningitis in Patients Attending a Tertiary Care Hospital in Central India.

Tuberculous meningitis (TBM) is a challenging condition to diagnose, and current laboratory methods have limitations, especially in developing countries. This study evaluated the diagnostic utility of the Lancet consensus scoring (LCS) system in suspected TBM cases at a tertiary care center in India. The clinical manifestations of 75 patients with suspected TBM were prospectively evaluated using the LCS system, which categorizes cases as "definite" (laboratory confirmed), "probable" (>10 points without imaging or > 12 points with imaging), and "possible" (6-9 points without imaging or 6-11 points with imaging). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the LCS system were compared to GeneXpert and mycobacterial growth indicator tube (MGIT) liquid culture, which are considered the gold standard tests. Out of 75 recruited cases, 11 were confirmed as definite TBM cases. The LCS system correctly identified 8 of these as "probable" and 3 as "possible" cases. Compared to GeneXpert, the LCS system had a specificity of 100%, sensitivity of 54.55%, NPV of 92.7%, and PPV of 100%. Compared to MGIT liquid culture, the LCS system had a specificity of 100%, sensitivity of 81.82%, NPV of 96.97%, and PPV of 100%. The diagnostic accuracy was higher for MGIT liquid culture (97.33%) than GeneXpert (93.33%). The LCS system is a practical and easily applicable tool that can aid the diagnosis of suspected TBM cases, particularly in resource-limited settings. Despite some limitations, the LCS system demonstrated good diagnostic performance, suggesting its potential utility in improving TBM diagnosis and management.

Pediatric Solid Pseudopapillary Neoplasm of the Pancreas.

Solid pseudopapillary neoplasm (SPN) of the pancreas in children is a rare tumor with low malignant potential. Some tumors, however, behave aggressively. There is very little literature on managing these variants, especially in children. We share our experience of managing large and recurrent SPN and explore the clinicopathological findings correlating to the risk of recurrence. This is a retrospective study of children treated for SPN between 2012 and 2022 at a tertiary care center in India. The clinicopathological features and management strategies in these children were evaluated. Sixteen children with SPN were treated during this period (88% of girls). The median age of presentation was 12 years (interquartile range [IQR]: 9-14). All children presented with abdominal pain. Computed tomography gave a definitive diagnosis in 81% of cases. The tumor predominantly involved the head of the pancreas (n = 9, 56%). Eight of nine children classified as high-grade (HG) malignant had a benign course. One child had a recurrence of the tumor 4 years after the initial resection and further recurrence on chemotherapy. She required radiation therapy in addition to reoperation following which she was disease free for 77 months. The overall median follow-up was 46 months (IQR: 18-72 months). Complete resection of the tumor provides a cure in most patients with SPN. Recurrent tumors require a multi-modality approach. Long-term survival is good. There is a need for clear definitions of the components within the WHO criteria for HG malignancy.

Long-Term Follow-Up Data of Tumor-Induced Osteomalacia Managed with Surgery and/or Radiofrequency Ablation from a Single Center.

Data on radiofrequency ablation (RFA) in tumor-induced osteomalacia (TIO) are restricted to case reports (~ 11 patients) and long-term follow-up data are further scarce. We describe our experience on managing TIO from a tertiary care center in India. Retrospective study of patients with localized TIO was performed and clinical, biochemical, treatment and follow-up details were retrieved. Normalization of serum phosphorus in absence of phosphate supplementation was defined as remission. Of 33 patients (23 males), 24 patients underwent surgery as first-line treatment, and early remission, delayed remission (> 1month for phosphorus normalization) and persistence were observed 12, 3, and 9 patients at a median follow-up of 5 (4-9) years. The gender, age, tumor size, location of tumors and FGF23 levels were not statistically different in patients who were in remission after surgery versus those with persistent disease. Second/third line treatment included conventional medical treatment and/or repeat surgery (n = 3), radiotherapy (n = 3), peptide receptor radionuclide therapy (n = 1), RFA (n = 1). Two patients had transient worsening (weeks) of weakness post-surgery. 10 patients underwent RFA (first-line n = 9); at the last follow-up 5 (4-10) years, 7 are in remission. Two of three persistent disease patients had large tumors (5.6 and 3.6cm). There were no RFA-related complications except local ulcer in one. Although persistent disease was present in a few patients in both arms, there was no recurrence in either RFA or surgical cohort. RFA provide durable response similar to surgery, persistence requires multi-modality treatment.

Troponin-I as a Prognostic Marker in Patients with Coronavirus Disease 2019: Insights from a Single-center Investigation

Background: Troponin-I is conventionally correlated with myocardial injury, but its relevance in assessing the severity of coronavirus disease 2019 (COVID-19) and its implications for patient management remains an area of ongoing investigation. This study was designed to assess the correlation between troponin-I levels and the disease severity among patients with COVID-19. Materials and Methods: This retrospective study was conducted at a tertiary care center in India between April 2020 and November 2021. The patients with reverse transcription-polymerase chain reaction who tested positive for COVID-19 infection, and who underwent troponin-I examination at presentation were included in the study. A comparison of baseline clinical characteristics among patients who survived and who did not survive post-COVID-19 was done, and risk factors associated with mortality among hospitalized patients were analyzed. Results: A total of 1673 patients were enrolled in this study. Of these, 1431 patients survived, and 242 patients did not survive post-COVID-19. The mean age of the patients with troponin-I levels ≤0.06 ng/ml was 49.66 ± 17.88 years and that of patients with troponin-I levels &gt;0.06 ng/ml was 60.13 ± 20.04 years. The nonsurvival rate was high in patients aged &gt;50 years compared to the patients aged ≤50 years (81.4% vs. 18.6%; P &lt; 0.001). The mortality rate was high in patients with troponin-I levels &gt;0.06 ng/ml compared to the patients with troponin-I levels ≤0.06 ng/ml (51.7% vs. 48.3%; P &lt; 0.001). Breathlessness (odds ratio [OR]: 26.901; P &lt; 0.001), cut-off troponin-I levels (OR: 8.246; P &lt; 0.001), and other comorbidities (OR: 8.246; P &lt; 0.001) were independently correlated with mortality among hospitalized patients with COVID-19. Conclusion: This study demonstrated that elevated troponin-I level at presentation was associated with disease severity and increased mortality in patients with COVID-19.

Status Epilepticus in Children at a Tertiary Care Center in India: Etiology, Preventable Risk Factors, and Short-Term Outcome

Abstract Introduction Status epilepticus (SE) is a common neurological emergency in children. Recent guidelines suggest initiating treatment after 5 minutes of seizure activity. Objective This study analyzes the clinical, laboratory parameters, and treatment outcomes of children with SE to identify preventable risk factors. Materials and Methods Prospective observational study of 150 children. They were evaluated for relevant history, clinical features, laboratory investigations, treatment, course, and outcome. Results The risk factors that had an impact on outcome in children with SE were identified as red flag signs on initial pediatric advanced life support (PALS) assessment, malnutrition, abnormal head circumference and number of seizures before child presented to hospital. The strongest predictor of outcome was stable status of children on initial PALS assessment (odds ratio = 20.174 [1.117, 364.393], p = 0.042). Presence of abnormal head size was 86% less likely to have favorable outcome and if the child had lesser number of seizures before child presented to hospital (single), it was 3.7 times likely that it would yield a favorable outcome. Conclusion Aggressive treatment of seizures, identification of red flag signs on initial PALS assessment, identification and treatment of malnutrition, anemia, hypocalcemia, and sodium derangements, strengthening vaccination to prevent central nervous system infections, and early intervention for developmental delay, can all help to combat morbidity and mortality in children with SE.