Tertiary Care Centre In Kerala Research Articles

Adverse Events Following Equine Rabies Immunoglobulin Administration among Category 3 Animal Bite Exposures

Abstract Introduction: Rabies is known to be 100% fatal. Equine rabies immunoglobulin (ERIG) recipients are prone to hypersensitivity reactions following administration. This study aims to estimate the adverse events following ERIG among category 3 animal exposures reported in a tertiary care centre in Kerala during the year 2022. Materials and Methods: A record-based descriptive study. Results: Among the 1504 cases, 557 (37.03%) developed sensitivity following the test dose of ERIG, of which 478 were administered with a full dose of ERIG after desensitisation. Human rabies immunoglobulin was given to 26 patients, and monoclonal antibodies were given to 53 patients. Among 1425 who received a full dose of ERIG, 21 (1.5%) developed sensitivity reaction during the observation period, of which 14 had developed sensitivity to the test dose. Of the 21 who developed sensitivity to full dose, 18 patients required only symptomatic management while 3 patients required admission. Conclusion: Testing for sensitivity to test dose will help to identify those in need of premedication with anti-allergic drugs, thereby reducing the risk of hypersensitivity to full dose of ERIG.

Intra Arterial Tirofiban in the Peri Operative Priming for Intracranial Stent Deployment in Aneurysms – A cross Sectional Study

Introduction: Tirofiban is a glycoprotein IIb/IIIa receptor antagonist that inhibits platelet aggregation. Primary and secondary objectives of this study were to determine the efficacy and to determine the safety profile of intra arterial tirofiban in the peri operative priming for intracranial stent deployment in aneurysms respectively. Materials and methods: This was a cross sectional study in a tertiary care centre in Kerala. Patient admitted with sub arachnoid haemorrhage/aneurysm posted for endovascular stent associated procedures and willing for the study were selected. The pre procedure assessment of neurological status was done. Patient underwent the procedure where peri operative priming with intraarterial tirofiban was given. The development of any neurological deficits within 24 hours was assessed using Glasgow coma scale and National Institute Health Stroke Scale. Laboratory blood parameters before and after procedure were also reviewed. Results: Study involved 58 patients with aneurysm who were given intraarterial tirofiban. No significant difference (p value 0.521) in Glasgow coma scale on admission (14.89 ± 0.462) and on discharge (14.74 ±1.650). Analysis was done using SPSS version 20.00. Paired samples T test and Wilcoxon Signed Rank Test were used. Conclusion: Results showed that intra arterial tirofiban is effective and the procedure was uneventful with no complications. Patients recovered well and the hospital stay was of minimum duration.

Prevalence of panic disorder among patients with non-cardiac chest pain attending cardiology outpatient department in a tertiary care centre in Kerala – A cross-sectional study

Prevalence of panic disorder among patients with non-cardiac chest pain attending cardiology outpatient department in a tertiary care centre in Kerala – A cross-sectional study

Socio-demographic factors and life events associated with high suicidal intent in youth with intentional self-harm: A cross-sectional study at a tertiary care centre in Kerala, India

Socio-demographic factors and life events associated with high suicidal intent in youth with intentional self-harm: A cross-sectional study at a tertiary care centre in Kerala, India

Characterisation of carbapenemase-producing Gram-negative bacilli among clinical isolates in a tertiary care centre in Kerala, South India

Background: Infections caused by carbapenem-resistant Gram-negative bacteria are a cause for concern due to the limited choice of antibiotics available for their treatment. Aims, Settings and Design: This study screened multidrug-resistant (MDR) Gram-negative bacilli isolated from clinical samples over a period of one year, for carbapenem resistance and characterised them using phenotypic methods such as combined disc diffusion test (CDDT), modified Hodge test (MHT), E-test for metallo-beta-lactamase (MBL) and molecular method, PCR. Materials and Methods: Two hundred and ten MDR Gram-negative bacilli were screened for carbapenem resistance using Imipenem and Meropenem disc diffusion. These were further checked for carbapenemase production by CDDT, MHT and E-test for MBL. Those positive by E-test were subjected to PCR. Uniplex PCR for New Delhi metallo-beta-lactamase-1 was used for Escherichia coli and Klebsiella pneumoniae , and multiplex PCR for Imipenemase and Verona imipenemase was used for Pseudomonas aeruginosa and Acinetobacter baumannii isolates. Results: Twenty-three (11%) isolates were found to be carbapenem-resistant and included E. coli (six) K. pneumoniae (three), P. aeruginosa (five) and A. baumannii (nine). Seventeen (74%) isolates were positive by phenotypic methods and were subjected to PCR. Out of eight Enterobacteriaceae isolates subjected to PCR, all were positive for bla NDM gene. All were negative for bla KPC gene. All five A. baumannii isolates subjected to PCR were found to contain bla VIM gene. Two out of four P. aeruginosa isolates were positive for bla IMP , one was positive for bla VIM gene. One P. aeruginosa isolate was positive for both bla IMP and bla VIM gene. Conclusions: In view of the increasing resistance of Gram-negative bacilli to carbapenems, rational use of antibiotics needs to be emphasised.

Etiological profile of cirrhosis in patients admitted in a tertiary care centre in kerala

Etiological profile of cirrhosis in patients admitted in a tertiary care centre in kerala

Bile duct tumors masquerading as cholangiocarcinoma: case reports from a tertiary care center in Kerala

Bile duct tumors masquerading as cholangiocarcinoma: case reports from a tertiary care center in Kerala

A Study on the Clinical Profile of Cholinergic Insecticide Poisoning in a Tertiary Care Centre in Kerala

Introduction In India, insecticides pose a significant risk of poisoning, particularly in rural households where they are readily accessible and frequently employed for deliberate self-harm. Acute organophosphate (OP) poisoning represents a critical medical emergency and stands as a significant contributor to both mortality and morbidity rates. Among the various insecticides, OP poisoning stands out as the most commonly encountered. Patients afflicted with OP poisoning may experience respiratory failure due to several factors, including the aspiration of gastric contents, excessive secretions, pneumonia, and septicemia, which can further escalate into acute respiratory distress syndrome1 . Objectives To determine the clinical profile of cholinergic insecticide poisoning at the Government Medical College, Alappuzha, in both medical wards and the ICU.

Comparison of pain relief among patients with chronic plantar fasciitis treated with intralesional platelet-rich plasma injection versus corticosteroid injection in a tertiary care centre in Kerala - a prospective study

Background: Aim of the study was to compare pain relief and functional outcome and between intralesional autologous platelet rich plasma injection (PRP) versus corticosteroid injection in the treatment of plantar, and fasciitis by using visual analogue score and American Orthopaedic Foot and Ankle Society (AOFAS) score. Methods: The sample size for the study was 30 patients attending Dr. Somervell Memorial CSI Medical College. Patients were divided into two groups (PRP versus steroid) of 15 each. The study follows a prospective observational design with follow up at 2 weeks, 2 months and 3 months post procedure. The functional outcome of patients in each group was assessed using the visual analog scale and AOFAS score. Results: Post-procedure, a significant decrease in VAS score was seen in patients treated with PRP injection (8.73 to 2.27) than those treated with Steroid injection (8.8 to 3.53). Also, there was a significant improvement in the AOFAS score from 72.73 to 88.67 while for those patients treated with steroid injection, the AOFAS score was comparatively low (65.87 to 82.2). Conclusions: Plantar fasciitis is a prevalent condition in our community, and many treatment options typically offer only temporary relief from symptoms. Intralesional PRP injection emerges as a dependable treatment method that fosters the healing process of the affected fascia, resulting in improved functional outcomes. Our study indicates that a singular administration of platelet-rich plasma injection for plantar fasciitis yields substantial pain relief compared to the local steroid injection.

Health-related quality of life among patients undergoing hemodialysis in a tertiary center in South Kerala

IntroductionHealth-related quality of life is essential for evaluating treatment quality in chronic diseases, providing valuable patient perspectives for medical decisions. Chronic kidney disease and end-stage renal disease significantly affect Health-related quality of life. The study aimed to assess the Health-related quality of life and the factors affecting it in end-stage renal disease patients on maintenance hemodialysis. MethodsA cross-sectional study was conducted in a tertiary care center in Kerala from November 2021 to December 2022.A validated Kidney Disease Quality of Life in the local language Malayalam was used for data collection. Patients over the age of 18 who have end-stage renal disease and have been on maintenance dialysis for at least 3 months and agreed to participate were included in the study by consecutive sampling method. ResultsAmong the 124 patients studied, the physical component had the lowest mean score (38.11 ± 20.87), mental component displayed a higher score compared to the physical (47.33 ± 16.88), indicating moderate level of mental well-being. Kidney Disease Component Summary had the highest mean score (61.73 ± 9.42).Younger patients had better mental-health related quality of life, while age did not significantly affect physical or disease-specific health related quality of life. Gender differences appeared, with males reporting higher physical-health related quality of life. Discussion and conclusionThe study highlights the quality of life and its association with socio-personal variables. To enhance the well-being of end-stage renal disease patients in Kerala, public health initiatives should prioritize elderly females with limited education, tailoring interventions to address their specific issues.

Impact of conducting hand hygiene audits during the COVID-19 pandemic in an intensive care unit at a tertiary care centre in Kerala, India.

The COVID-19 pandemic era had witnessed an upsurge of healthcare-associated infections (HAI) in COVID intensive care units (ICUs), which can be reduced by following proper hand hygiene (HH) practice. Performing HH auditing in COVID ICUs and providing timely feedback to the stake holders is crucial to reduce HAIs. From July 2021 to December 2021, HH auditing was conducted in COVID ICUs. Hand hygiene (HH) complete adherence rate (HHCAR), HH partial adherence rate (HHPAR) and HH total adherence rate (HHTAR) were analysed. Profession-specific HHTAR and moment-specific HHTAR (for each WHO moment) were also calculated. HHCAR, HHPAR and HHTAR were found to be 47%, 19% and 66%, respectively. There was a significant increase in the monthly HHTAR from 62.2% to 72.2% (p<.001). The profession-specific hand-hygiene adherence rate (HHAR) was found to be highest among nurses (67%), and the moment-specific HHAR of WHO-moments 2 (90%) and 3 (94.8%) had the highest HH adherence. Auditing HH and providing timely feedback significantly improved HH adherence. The greatest need now is to regularly conduct HH auditing in COVID locations of all healthcare facilities to reduce the HAI rate among the COVID-19 infected patients in ICUs.

Diagnostic Validity of Urinalysis in Comparison with Urine Culture Prior to Micturating Cystourethrogram in Children: A Retrospective Observational Study at a Tertiary Care Centre in Kerala, India

Introduction: Micturating Cystourethrogram (MCUG)-triggered Urinary Tract Infections (UTIs) are well-known, but the risk factors that trigger infections are not well studied. Even though MCUG being invasive, there is no general consensus regarding the use of peri-procedural antibiotic coverage and screening for sub-clinical UTIs just before MCUG. Aim: To determine the diagnostic validity of Urinalysis (UA) when compared with the gold standard, Urine Culture and Sensitivity (UCS), to exclude pre-procedure infections. Materials and Methods: This retrospective observational study involved paediatric patients who underwent MCUG from January 2021 to December 2022, at Kozhikode Government Medical College (Kerala) to exclude urological anomalies. All children were tested with UA and UCS before MCUG, which was done under antibiotic coverage. A positive UCS was defined as a significant growth of a single organism (&gt;100,000 for mid-stream urine or &gt;50,000 for catheterised sample), while a positive UA was defined as pus cells &gt;5/high power field on microscopy. After exclusions, the authors analysed 300 patients. The diagnostic validity of UA was assessed using the Pearson Chi-square test, by Statistical Package for Social Sciences (SPSS) version 16.0. and a p-value less than 0.05 was considered significant. Results: The median age was nine months (IQR 13 months) with 68% being male. The most common indication for MCUG was evaluation for recurrent/febrile UTIs (n=171, 56.6%). Both Pre-MCUG, UA and UCS were documented as positive in eight patients (2.6%), and pre-MCUG, UCS alone was positive in two patients. The diagnostic validity of UA when compared with UCS showed high specificity and positive predictive values at 100% (p&lt;0.05). Conclusion: A simple UA, when compared with UCS (the gold standard investigation for UTIs), has high specificity and positive predictive value in excluding sub-clinical UTIs prior to MCUGs. It may be preferable as it yields quick and reliable results.

Study on Risk Factors Associated with Severity of Diabetic Retinopathy in Type-2 Diabetic Patients, Attending a Tertiary Care Centre in Kerala

Introduction: Diabetic retinopathy (DR) is a significant public health concern affecting individuals with diabetes mellitus (DM). Despite treatment advances, a substantial proportion of patients do not respond adequately. This study investigates risk factors associated with the progression of non-proliferative diabetic retinopathy (NPDR) to proliferative diabetic retinopathy (PDR) in type-2 diabetes patients. Methods: A retrospective case-control study was conducted on diabetic patients older than 40 years with at least 5 years of Type-2 Diabetes Mellitus history, attending ophthalmology clinic in Government Medical College, Thrissur, a tertiary care hospital. Data from patients with retinal examination showing diabetic retinopathy were analyzed. Records with missing data were excluded. Patients with Proliferative Diabetic Retinopathy (n=153) were compared with those having Non- Proliferative Diabetic Retinopathy (n=230). Various risk factors were assessed using statistical analysis. Results: Among the studied variables, sex, duration of diabetes, serum urea, serum creatinine, serum triglycerides, and chronic kidney disease were significantly different between Proliferative Diabetic Retinopathy and Non-Proliferative Diabetic Retinopathy patients. Binary logistic regression revealed that duration of diabetes (OR = 1.8, 95% CI = 1.1 - 2.39) and serum creatinine (OR =1.8, 95% CI = 1.1 - 2.39) independently influenced Proliferative Diabetic Retinopathy development. Conclusion: This study highlights that longer diabetes duration and elevated serum creatinine levels independently increase the risk of Non- Proliferative Diabetic Retinopathy progressing to Proliferative Diabetic Retinopathy in type-2 diabetic patients. Other factors such as age, gender, hyperlipidemia, systemic hypertension, type of diabetic treatment, and history of ischemic heart disease did not show significant associations with disease progression. These findings emphasize the importance of close monitoring, early detection, and intervention in patients with Non- Proliferative Diabetic Retinopathy, particularly those with a longer diabetic history, to prevent Proliferative Diabetic Retinopathy development. Further research should explore the causal relationship between serum creatinine and diabetic retinopathy progression and evaluate the impact of renal disease management on disease outcomes. Keywords: Diabetic Retinopathy, diabetes mellitus (DM), Type-2 Diabetes Mellitus (T2DM).

A Study on the Clinical Profile and Outcome of Cerbera Odollam Poisoning in a Tertiary Care Centre in Kerala

Background: Cerebera Odollam is a small plant/shrub which grows wild over many parts of Kerala. It is the most common plant suicidal agent in the coastal areas of southern Kerala. This is an attempt to study the clinical profile and outcome of C.odollam poisoning in my institution. Objectives: To study the clinical profile with respect to age, sex, methods of self-administration, circumstances of poisoning, dosage, clinical features, ECG changes, treatment and various determinants of outcome of Cerebera Odollam poisoning in a tertiary care centre in Kerala.

A predictive score for severity in patients with confirmed dengue fever in a tertiary care hospital in Kerala, India.

The study aimed to identify predictors of severe dengue during the 2017 epidemic and to develop and validate a simple predictive score for severity. A retrospective analytical study was conducted using clinical and laboratory data from adult dengue patients with a confirmed microbiological diagnosis. The study included patients who presented to a tertiary care centre in Kerala, India, during the febrile phase (≤4d) between June 2017 and February 2019. Using appropriate statistical tests, we derived predictors of severe disease and computed a risk score model. Of the 153 patients (mean age 50±17y; 64% males), 31 (20%) had severe dengue and 4 (3%) died. Petechial lesions, hypoalbuminemia (<3.5 g/dl), elevated alanine aminotransferase (>40IU/l) and urea >40IU/l were significant predictors. Our scoring system (cut-off: 2) showed excellent performance, with an area under the receiver operating characteristics curve of 0.9741, sensitivity of 100%, specificity of 96% and accuracy of 98%. The risk score was secondarily validated on 48 patients hospitalized from March 2019 to June 2019. Our scoring system is easy to implement and will help primary healthcare practitioners in promptly identifying severe dengue cases upon hospital presentation.

Delays in Lung Cancer Diagnosis: Observations from a Tertiary Care Centre in Kerala, India.

Merin YohannanIntroduction Timely diagnosis of lung cancer is critical because treatment outcomes correspond to the stage of disease. This study identified patient and physician determined reasons for diagnostic delays. Materials and Method s This was an observational cross-sectional study, conducted at a tertiary care institution in South India, for 12 months. From 207 consecutively selected patients, with a presumptive lung cancer diagnosis, 150 were enrolled utilizing a prefixed questionnaire. The time intervals from appreciation of initial respiratory symptoms to a final tissue diagnosis were defined sequentially as approach interval, referral interval, and diagnostic interval and factors causing delay in each interval were identified. Results In a state with 100% literacy, the mean time to approach a doctor was 8 weeks (range: 0-336 days; SD: 7.95) with a delay seen in 52% of the study group. Referring a suspect lung cancer diagnosis to a specialist, took an average of 4.98 weeks (range: 1-26 weeks; SD: 5.64) with referral delays in 47.3% of patients. The mean diagnostic interval was 9.21 days (range: 3-41 days; SD: 7.18) and 16.7% of cases had diagnostic delays in spite of a definite procedure. Conclusion In a tuberculosis endemic location, empirical treatment with anti-tuberculosis therapy and prolonged antibiotic courses without serially monitoring the course of disease are responsible for referral delays. Also, 88.2% of the total females studied, presented late due to family and work pressures, fear of being stigmatized and being on prolonged home remedies. A wider dissemination and awareness on lung cancer are needed especially among females. A low threshold to reinvestigate and an early referral to a pulmonary or lung cancer specialist, when expected clinicoradiological improvement is lacking, in microbiologically negative tuberculosis should be highlighted.

A Brief Report on Telerehabilitation During COVID-19 Outbreak at a Tertiary Care Center in Kerala, India

The unanticipated lockdown following the COVID-19 outbreak significantly impacted the field of rehabilitation, compelling the professionals to switch to tele-mode to continue providing their service without interruption. This article aims to highlight the steps taken to overcome the various challenges that were encountered in this period and to strengthen the opportunities in telerehabilitation services at a tertiary care center in Kerala, India. An average of 1000 clients were served monthly through telerehabilitation in various units at the selected institute during the COVID-19 pandemic. The telerehabilitation services included assessments, intervention, and counseling for clients of all ages with various types of disabilities. A high literacy rate and better access to technology among the general population in Kerala, India were identified as advantages for the rapid implementation of telerehabilitation as a viable form of service delivery.

Patient-reported Outcome of Mild Coronavirus Disease 2019 Infection in Patients diagnosed from a Tertiary Care Center in Kerala: A 1-year Follow-up Study.

The coronavirus disease 2019 (COVID-19) infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus had a huge burden on asymptomatic or mildly symptomatic persons who may have only briefly been associated with healthcare delivery systems during their illness. The knowledge about patient perception of disease outcomes is important in deciding future programs for dealing with pandemics in the community. The objectives of the study were to determine patient-reported outcomes (PROs) 30 days and 1 year after the initial diagnosis of mild COVID-19 infection and to determine any factors associated with PROs. Patients who attended the fever screening clinic and were diagnosed with mild COVID-19 infection were contacted telephonically as they completed 30 days after their initial diagnosis, and their responses to the EuroQoL five-dimensions 5-level (EQ-5D-5L) questionnaire were recorded. The patients were again contacted 1 year after the initial diagnosis and the same process was repeated. A total of 237 patients were contacted telephonically and 167 patients responded to the call. The domain most affected at 30 days was usual activities, and at 1 year, it was anxiety and depression. The mean utility score at 30 days was 0.9347 and at 1 year was 0.9801. The factors associated with worse utility scores were age &gt;45 years and comorbidities. There is a significant proportion of patients who had restrictions in performing their usual activities 30 days after a mild COVID-19 infection, whereas the domain which showed the least improvement after 1 year was anxiety or depression. Even mild COVID-19 infection had an impact on the health-related quality of life (HRQOL) of people with the elderly and those with comorbidities affected more.

CLINICO-PATHOLOGICAL PROFILE OF BLADDER CANCER PATIENTS IN A TERTIARY CARE CENTRE.

Introduction: Bladder cancer (BC) is one of the most common urological malignancies.With Industrialisation, increasing exposure to occupational hazards and ever increasing use of tobacco in various forms, more and more of these BCs are being diagnosed nowadays. Objectives of the study: To study the clinical and histo-pathological prole of bladder cancer patients attending a tertiary care centre in Kerala in southern part of india. Materials and methods: A prospective observational study of 90 patients with bladder cancer was conducted in department of Urology at a tertiary care centre over a period of 1 year from Feb 2020 to Feb 2021. Patients presenting to department of urology, undergoing surgery for BC were studied by demographic parameters (age,gender) detailed history, clinical examination, cystoscopy ndings and cytopathology results and results analyzed. Results: A total of 90 patients were evaluated in the study. Highest number was found in patients of 60-80 years age group, with males &gt; females. Most patients presented with haematuria (88.89%), some with pain (18.89%) and irritative voiding complaints (12.22%) and 5.56% were incidental detection. Of all patients, 70% had history of smoking. Transitional Cell Carcinoma (TCC) was most common histology found in 92.22% of study population followed by Adenocarcinoma (4.44%), Squamous cell carcinoma (2.22) and leiomyosarcoma(1.11%). Among TCC, 54.22% had low grade, 33.73% were high grade and rest of them were PUNLUMP. Most of the lesions were unifocal polypoidal growths. High grade cancers were found predominantly in patients with age&gt;60 and history of tobacco smoking. Conclusion: Bladder cancer is predominantly a disease of older men. High index of clinical suspicion, as well as thorough exploration of all possible epidemiological factors will help clinician diagnose bladder malignancies. Awareness among the public should also be emphasized to make them understand the deleterious consequences of exposure to risk factors like smoking.

Outcome of Concurrent Chemoradiation after Induction Chemotherapy in Locally Advanced Head and Neck Squamous Cell Carcinoma - A Prospective Study among Patients Attending a Tertiary Care Center in Kerala, India

BACKGROUND&#x0D; Concurrent chemoradiation (CCRT) is the standard of care for locally advanced head and neck squamous cell carcinoma (LAHNSCC). In settings with considerable waiting period for radiation, institutional protocols advocate induction chemotherapy before CCRT. This study aimed to assess the outcome of concurrent chemoradiation after induction of chemotherapy among patients with LAHNSCC attending a tertiary care radiotherapy center in Kerala, India.&#x0D; METHODS&#x0D; Patients with non-metastatic LAHNSCC (stage 111 and 1V) with good performance score of 0-1 who received induction chemotherapy (with docetaxel 75mg/m2and cisplatin 75 mg/m2, day 1 and 5-fluorouracil 750 mg/m2, day 1 and 2 as infusion every 3 weeks for 3 cycles) followed by CCRT (with concurrent cisplatin 40 mg/m2 weekly) were selected for the study. CCRT was administered only to those patients who showed more than 30 % response to induction chemotherapy. They were followed up for 24 months. The primary end point was the clinical response assessed by ENT evaluation 8 weeks after the completion of CCRT.&#x0D; RESULTS&#x0D; 117 patients with LAHNSCC were enrolled. Four patients (3.4 %) dropped out after induction therapy. Out of 113 patients who initiated concurrent chemo radiation, two patients (1.7 %) dropped out while on CCRT, two patients (1.7 %) were intolerant to CCRT and two patients (1.7 %) left soon after CCRT. 107 patients were available for follow up after treatment completion. Acute toxicities were noticed in 9 (7.7 %) while on induction treatment. Mucositis occurred in 1 (0.9 %), haematological toxicities in 4 (3.4 %), gastrointestinal toxicities in 2 (1.7 %) and fatigue and malaise in 2 (1.7 %). In patients who underwent concurrent chemo radiation, 53 (49.03 %) had acute mucosal, skin, GIT and haematological toxicities. On treatment completion, 82 patients (70.1 %) had complete response, 24 (20.5 %) had partial response and one (0.9 %) had stable disease. During the follow up period of 24 months, locoregional failure (relapse) was noted in 15 patients (12.8 %) while 61 patients (52.1 %) remained disease free. Organ preservation rate was 53.4 % for laryngeal primaries. 4 patients (3.4 %) developed distant metastases during the follow up.&#x0D; CONCLUSIONS&#x0D; Induction chemotherapy with docetaxel containing regime followed by concurrent chemoradiation was associated with good clinical response and acceptable toxicity profile.