Tertiary Care Centre In Kerala Research Articles

Impact of COVID-19 pandemic on control of bronchial asthma in children attending the asthma clinic in a tertiary care centre in Kerala

Abstract BACKGROUND: COVID-19 pandemic led to widespread change in the life of people across the globe, including children, with far-reaching consequences. When control of disease is considered among children with asthma, a positive impact is to be expected. This study aimed to assess the impact of the COVID-19 pandemic on disease control among children with asthma. OBJECTIVES: The main objectives are (1) to compare the level of asthma control pre-COVID versus during the COVID pandemic in terms of exacerbations and short-acting beta agonist (SABA) usage and (2) to compare the use of inhaled corticosteroids (ICS) pre-COVID versus during the COVID pandemic. MATERIALS AND METHODS: Hospital-based study was conducted among children aged 5–15 years attending the asthma clinic of Government TD Medical College, Alappuzha, during the period May 2021–January 2022. Asthma control in terms of SABA usage, emergency visits, hospitalizations, and ICS usage was compared pre-COVID (before March 2020) to Complete lockdown (March 2020–May 2020), phased reopening (June 2020–May 2021) and after the lifting of major restrictions (June 2021–January 2022). Statistical analysis was done using IBM SPSS Statistics v.26. RESULTS: In total, 139 children were included in the study. A decrease was observed in the number of children requiring SABA as reliever therapy, with 18%, 25.9%, and 33.1% not requiring SABA during the complete lockdown, during phased reopening, and after the lifting of major restrictions, respectively, when compared to pre-COVID. A statistically significant decrease in hospitalizations and visits to the emergency department due to asthma exacerbations were also observed during various phases of the pandemic. ICS was stopped in 15.1%, 30.2%, and 35.3% of the study subjects during various phases of the pandemic without further exacerbations. CONCLUSION: There was a significant impact on asthma control during the pandemic, which was sustained during various phases of lifting restrictions.

Survival Analysis and Factors Affecting Treatment Outcome in Glioblastoma Multiforme: A Cohort Study

Introduction: High-grade gliomas, especially Glioblastoma Multiforme (GBM), are the most prevalent primary brain tumours in adults. Treating GBM is challenging due to resistant tumour cells, resulting in a dismal prognosis. While GBM often develops spontaneously, familial gliomas have also been identified in 1% of cases. Primary and secondary glioblastoma are the subtypes that affect patients of varying ages and develop via different paths. Aim: To estimate the two year survival and to assess factors affecting survival in patients diagnosed with GBM and to evaluate the “ability for self-care” following treatment. Materials and Methods: The cohort study investigated treatment outcomes in GBM using a sample of 65 patients from the Department of Radiation Oncology at Government Medical College Thrissur, a tertiary care centre in Kerala, India. The patients were diagnosed between January 2018 and December 2019. Survival and the factors determining survival were explored through case records and telephonic interviews with primary caregivers. Median survival and two year survival rates were calculated. The study examined possible associations of survival with patient-related, tumourrelated, and treatment-related factors. Patient-related factors assessed were age, gender, and Eastern Cooperative Oncology Group (ECOG) performance status at diagnosis. Tumour-related factors assessed included tumour location, laterality, and volume based on pretreatment Magnetic Resonance Imaging (MRI). Treatment-related factors such as extent of surgery, postoperative radiotherapy, and chemotherapy were also assessed. Data analysis was performed using the Statistical Package for Social Sciences (SPSS version 21.0). Qualitative variables were expressed in percentage and compared using the Chi-square test or Fisher’sexact test. Quantitative variables were expressed as mean and standard deviation and compared using unpaired t-tests. Telephonic interviews with primary caregivers were conducted to assess the “ability for self-care” following treatment. Results: The study included a total of 65 cases, with a mean patient age of 54 years. Out of the patients, 45 (68%) patients were male, while 20 (32%) patients were female. The median survival for GBM was found to be eight months. The one year and two year survival rates were 18.46% (12 patients) and 10.8% (7 patients), respectively. The survivors had a mean age of 48 years. There were no statistically significant differences in survival based on sex (p-value=0.527), tumour location (p-value=0.765), and laterality (p-value=0.596). Survival was found to be related to ECOG performance status at diagnosis (p-value=0.001) and tumour volume (p-value=0.002). Among the patients, 37 (58%) patients were able to perform self-care after treatment, while 28 (42%) patients were unable to do so. Conclusion: The survival of patients with GBM is related to ECOG performance status at diagnosis and the pretreatment volume of the tumour. The evidence was insufficient to establish a relationship between survival and the administration of postoperative radiotherapy and chemotherapy. Despite multimodality treatment protocols, the survival of patients with GBM remains dismal. A tailored treatment protocol that weighing morbidity of treatment and cost effectiveness on one side and survival on the other side is the need of the hour.

Seroprevalence of hepatitis B, hepatitis C, and human immunodeficiency virus in hemophilia A patients: A descriptive study

Background: Hemophilia A (Factor VIII deficiency) is a X-linked coagulopathy that affects approximately 1/10,000 male live births. In the past, the treatment of hemophilia A consisted of cryoprecipitated plasma and purified factor preparations. As a result, they experienced unusually high incidence of hepatitis and human immunodeficiency virus (HIV) seroconversion. Aims and Objectives: The aims of this study were to find out the seroprevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV infection, among hemophiliacs attending a tertiary care center in Kerala, southern India. Materials and Methods: A cross-sectional study was conducted on hemophilia A patients who attended the departments of medicine and pediatrics. Demographic details and treatment history were obtained by questionnaire. Enzyme-linked immunosorbent assay was used to detect HBV surface antigen, HCV antibodies, and HIV. The statistical data analysis was performed using SPSS software version. Results: Out of 90 hemophilia A patients who underwent testing for the seroprevalence of transfusion-transmitted viral infections, one (1.1%) patient tested positive for HIV, two (2.2%) for HCV, and one (1.1%) for HBV. Among patients with hemophilia A, the prevalence of transfusion-transmitted infection was 4.4%. Patients with HIV- and HCV-positive tests belonged to the severe hemophilia A group. Moreover, the HBV-positive patient belonged to moderate hemophilia A. Conclusion: The present paradigm of management of hemophilia A patients is with plasma-derived or recombinant Factor VIII concentrates, cryoprecipitates, and fresh frozen plasma. Due to the risk, however remote, of transfusion-transmitted viral infections, all hemophiliacs should receive the hepatitis B vaccine and undergo routine testing for HIV, HCV, and HBV viruses.

Thoracic radiological abnormalities in coir workers with respiratory symptoms in a tertiary care center in Kerala

Thoracic radiological abnormalities in coir workers with respiratory symptoms in a tertiary care center in Kerala

Clinical profile and outcome of children with diabetic ketoacidosis admitted in a tertiary care centre in kerala during the pre and post COVID period

Clinical profile and outcome of children with diabetic ketoacidosis admitted in a tertiary care centre in kerala during the pre and post COVID period

STAPLED VERSUS HANDSEWN INTESTINAL ANASTOMOSIS IN EMERGENCY SURGERY

Introduction The major problem following bowel anastomoses is the anastomotic failure leading to leakage peritonitis, fistula, abscess, sepsis, necrosis, stricture etc. adding to the morbidity and mortality. (e.g., 22% mortality in patients with a leak vs. 7.2% mortality in those without leak).The present study compares the complication rates of sutured and stapled anastomotic techniques in an emergency setting of a tertiary care institute in Kerala. Methodology The study evaluates the complications (leak /intra-abdominal abscess) of both stapled and hand-sewn techniques of intestinal anastomosis in emergency setting. The study is conducted in a tertiary care centre in Kerala and the data is collected from the medical records and emergency register. A total of 112 cases that meet the inclusion and exclusion criteria are included during the period from 2017 to 2021 Results Among the 61 patients who had undergone hand sewn anastomosis 7 (11.5%) had anastomotic leak and 54 (88.5%) patients had no leak. Among the 51 patients underwent stapled anastomosis, 6 (11.8%) had anastomotic leak and 45 (88.2%) patients developed no leak. This data is statistically analyzed using Chi Squared test and found that there is no significant difference between the occurrence of anastomotic leak between the two study groups irrespective of whether the anastomosis is hand sewn or stapled. The average time taken for surgery in the hand sewn group is about 192.1 minutes and in stapled group is 162.5 minutes. This difference in the average duration of surgery is analyzed statistically and it showed that the difference in of the duration of surgery is statistically significant. Conclusion There is no significant difference between the complication rates of both type of anastomosis is identified in the emergency setting. But there is a clear advantage of less operating time for stapled anastomosis.

Abstract 18

Background: Graves orbitopathy also referred to as thyroid-associated orbitopathy (TAO) is the extrathyroidal manifestation of Graves’ disease and the most common cause of exophthalmos. It is an immune disorder causing inflammation and expansion of orbital fat and muscle. It is seen in 25–50% of patients with Graves’ disease and hyperthyroidism. Though common in our population, only limited data were available on the demographic profile and clinical features of thyroid orbitopathy. This study is planned to fill the knowledge gap in this area from our region Aim: To describe the demographic, clinical, and therapeutic outcome of Thyroid associated ophthalmopathy in patients with proven thyroid-associated orbitopathy Methods: We carried out a retrospective and descriptive analysis of 30 patients with TAO. This study was conducted in the Endocrinology department of GMC Thiruvananthapuram, between January 2020 and October 2022. A total of 30 patients enrolled during the period who met the inclusion criteria were studied. A well-structured proforma was used to collect the data. All patients were subjected to detailed clinical evaluation and laboratory investigations. Results: 30 patients were included in the study. The mean age of patients was 48.7 ± 11.37 years. Female to male ratio was 1.6. 93.4% of the study population were non-smokers. 100% of patients had hyperthyroidism at presentation Orbitopathy was bilateral in all the patients. The most common ocular symptoms were prominent eyes (100% of patients), Proptosis, and upper eyelid retraction present in 100% of patients. Dysthyroid optic neuropathy and corneal ulceration were reported in one case. 16 of patients had Clinical Activity Score (CAS) ³3/7. Sight-threatening orbitopathy was present in 3 patients.16 patients with CAS ³ 3/7 were treated with Methylprednisolone pulse therapy (Total 12 doses- 4.5 g). 13 patients showed a significant improvement in signs and symptoms of orbital inflammation. 2 patients with refractory orbitopathy were given Rituximab infusion. Improvement in CAS scores was seen in both patients. One patient underwent Orbital radiation and decompression surgery Conclusion: TAO is a complex disease, which is associated with impaired quality of life and can potentially result in sight-threatening complications. This study conducted in GMC Thiruvanathapuram, a major endocrinology center in Kerala revealed that proptosis and upper eyelid retraction were the most common clinical feature associated with TAO. TAO can lead to significant visual impairment, as noticed among three patients in our study. 81.2% of patients with CAS) ³3/7 responded well to Methylprednisolone pulse therapy. Refractory Orbitopathy patients showed clinical improvement with the initiation of Rituximab therapy. Appropriate early diagnosis, convenient therapy, and regular follow-up are necessary to improve results and avoid the aesthetic and functional complications of TAO.

Healthcare workers infected with COVID-19 in a tertiary care center in Kerala

Background: Health care workers are at the forefront of the fight against COVID-19. There is a high risk of them contracting the infection and then transmitting it to vulnerable patients and colleagues. Therefore, it is critical to investigate the prevalence and risk factors among HCWs. This study describes the characteristics of healthcare workers who tested positive for COVID-19 in a tertiary care hospital in India.Methods: A cross-sectional study was conducted among HCWs from a tertiary care center with a real-time - polymerase chain reaction (RT-PCR) test positive for COVID-19 on a nasopharyngeal swab from July 2020 to January 2021. All healthcare workers with confirmed SARS-CoV-2 infection were contacted over the telephone to collect data regarding their probable source of contact, usage of personal protective equipment, and clinical course. Their treatment history was extracted using electronic health records.Results: During the study period, 192 HCWs were RT-PCR positive for COVID-19. The mean age of the study participants was 34.01 years. Among the infected, 23.4% were male employees, while the remaining 76.6% were female employees. Nurses were most commonly affected (36.5%), followed by doctors (22.9%) and housekeeping staff (15.6%). Infected HCWs acquired the infection from the hospital in 73.4% of cases, while 38.6% had direct contact with patients or colleagues.Conclusions: HCWs have an increased risk of COVID-19 infection at the workplace. Strengthening of infection control measures as well as strict follow-up of precautionary measures needs to be ensured, even during break time and work hours.

Clinical and functional outcome of total knee arthroplasty in osteoarthritic patients at a tertiary care center in Kerala: a prospective study

Background: Osteoarthritis affects the knee joint more frequently than any other joint. Osteoarthritis is a chronic joint disease that affects the older age group, women more frequently, and is associated in 90% of cases with a varus deformity of the knee. The following study was conducted to evaluate the functional outcome of total knee arthroplasty in osteoarthritis using the knee society score.Methods: The study was conducted in patients treated for osteoarthritis of the knee joint at Jubilee Mission Medical College and Research Institute, Thrissur, Kerala during the period from December 2019 to March 2022. Thirty patients diagnosed with osteoarthritis of the knee joint were taken into the study, all were undergone total knee arthroplasty. Patients were followed up at 4 weeks, 12 weeks, and 24 weeks.Results: The sample consisted of thirty osteoarthritic patients with 8 males and 22 were females. The patients' ages ranged from 45-75 years. Among these 30 patients, 14 involved the right side, and 16 involved the left knee joint. The mean pre-operative knee clinical score was 36.93 which was improved to post-operative 84.70 following total knee arthroplasty. The mean pre-operative knee functional score was 16.83 which was improved to post-operative 71.17 following total knee arthroplasty. The outcome was rated as per knee society score. We got excellent results in 25 cases (83%), good in 3 (10%), and fair in 2 patients (7%) according to knee clinical score whereas 8 excellent (27%), 16 good (53%), 5 fair (17%) and 1 poor (3%) results were found according to knee functional score.Conclusions: Total knee arthroplasty shows drastic improvement in the functional ability of the patient and the ability of the patient to get back to a pre-disease state, which is mainly because of pain-free joint movements, reflected by the improvement in the post-operative knee clinical score and knee functional score.

Pattern of Tooth Mortality in Patients Attending a Tertiary Dental Care Center: A Descriptive Study

Background: Tooth loss is a cumulative index of oral health impairment and an integral part of the decayed, missing, and filled teeth index used to assess oral health status. In spite of the increased awareness of oral hygiene and preventive dental treatments, tooth extraction remains to be the most common procedure in the Indian population following a toothache. The study aims to assess certain demographic characteristics and patterns of tooth loss among patients who underwent extraction from the department of oral and maxillofacial surgery in a dental tertiary care center in Kerala, India. Materials and Methods: A retrospective cross-sectional survey was conducted during 2017–2021 time period in all the patients who underwent permanent teeth extraction from the oral and maxillofacial surgery department. Results: A total of 9673 patients underwent tooth extraction during the study period. Among them, 68.4% were adults (18–59 years) and 27.7% were senior adults (above 60 years). More than half of the patients underwent single-tooth extraction (55%), two (24%), and three in 10%. The most frequent tooth extraction was the first molar (30%), followed by the third molar (27%) and second molar (26%). Among children, the most common pattern of tooth extraction was first molars both in the maxilla and mandible (25%). In adolescent age groups, premolars were extracted frequently along with first molars. In adults and senior adults, the premolar and molar extractions were performed commonly. Conclusion: The mean tooth loss for the cohort was 1.7 ± 1.1 (range 1–12) indicative of good dental hygiene practice. The trends noticed in teeth extraction pattern provide baseline data about the access and availability of dental care in that region.

Incidence, severity and risk factors of retinopathy of prematurity in a tertiary care centre in Kerala

Background: To study the incidence, severity and risk factors of retinopathy of prematurity (ROP) in neonates delivered in or referred to neonatology and paediatrics department of a tertiary care hospital in Kerala.Methods: Cohort study in the department of neonatology and paediatrics, of a tertiary care hospital in Kerala. There were 56 newborns satisfying the inclusion criteria. Data was collected and entered in the standardized data collection chart, and analysed.Results: Out of the 56 newborns studied, 12 babies developed ROP, and the incidence was found to be 21.4% (12/56). 41.6% (5/12) each developed stage 1 and stage 2 disease, 16.66% (2/12) developed stage 3 disease whereas no one developed stage 4 or stage 5 disease. Multiple maternal risk factors were studied showed no statistical association. Incidence of ROP was found higher in lower gestational age group and low birth. Surfactant administration, longer duration of oxygen therapy, anemia, need for blood transfusion, sepsis and phototherapy were significantly associated with development of ROP.Conclusions: Incidence of ROP was found to be 21.4 % (12/56) with higher proportion of neonates developing early stages of ROP. The incidence of ROP in the present study is comparable to most of the national and international studies, but some studies showed increased incidence of ROP also. Most of the risk factors associated with ROP arise during the stay in neonatal intensive care unit and some of them are avoidable. The incidence of ROP can be decreased by monitoring the risk factors, timely screening, regular follow up and appropriate interventions.

A dermoscopic study of nail involvement in chronic plaque psoriasis at a tertiary care center

Background: Psoriasis is a chronic inflammatory disease that affects millions of people throughout the world. Nail involvement is a common feature in psoriasis which is often overlooked despite causing significant functional impairment, disfigurement, and psychological stress to the patient. Dermoscopy is a non-invasive novel tool that enables a rapid and magnified visualization of the nail changes which are often imperceptible to the unaided eye. Aims and Objectives: To study the dermoscopic profile of nail changes in patients with chronic plaque psoriasis. Materials and Methods: The study was conducted from December 2018 to May 2020, in the Department of Dermatology of a tertiary care center in Kerala, including 155 patients of clinically diagnosed chronic plaque psoriasis who had nail involvement. A detailed history was noted along with a clinical and dermoscopic examination of all 20 nails of each patient. Results: The most common finding on dermoscopic examination of the nails was onycholysis seen in 91%, followed by pitting (78.8%) and subungual hyperkeratosis (78.1%). Other findings noted in our study which are not commonly described are wavy lamellar microsplitting (41.9%), cuticular hypertrophy (18.1%), pseudofiber sign (16.1%), dilated nailfold capillaries (12.3%), capillary prominence at onychodermal band (7.7%), dilated hyponychial capillaries (7.7%), and fuzzy lunula (7.1%). Conclusion: Nails are frequently involved in psoriasis but often overlooked. Dermoscope is an effective tool that facilitates the assessment of nail changes in psoriasis.

Catheter Associated Urinary Tract Infections: A Cross-sectional Study from a Tertiary Care Centre in Kerala, India

Introduction: Catheter Associated Urinary Tract Infections (CAUTIs) are the commonest nosocomial infection and may lead to serious medical complications. An early detection and appropriate antimicrobial therapy based on antimicrobial susceptibility testing together with infection control practices play a key role in management of CAUTI. Aim: To identify the aetiological agents causing CAUTI and to understand the antimicrobial susceptibility pattern of the isolates. Materials and Methods: A prospective cross-sectional study was conducted in the Department of Microbiology of a tertiary care centre in Kerala, India for the duration of six months from January- June 2014. Urine samples were collected from patients with urinary catheters in situ for more than three days, admitted in Intensive Care Unit (ICU) and wards. Urine samples were subjected to wet mount, culture and susceptibility testing. Responsible pathogens and their antimicrobial susceptibility pattern were obtained by using Vitek 2 automated system based on Clinical and Laboratory Standards Institute (CLSI) standards. Data was analysed using the International Business Machines Statistical Package for the Social Sciences (IBM SPSS) version 27.0. Descriptive analysis was used. Results: Among 150 catheterised patients included, 36 cases (24%) developed CAUTI. The overall rate of CAUTI was 7.03 per 1000 catheter days in present study. The gram negative bacilli were the major isolates comprising Enterobacteriaceae 32 (87.5%) and Non fermenters 4 (12.5%). Escherichia coli was the predominant 19 (53%) organism followed by Klebsiella pneumoniae, Pseudomaonas aeruginosa, Enterococcus faecalis. Extended Spectrum Beta Lactamase (ESBL) producing gram negative bacteria 19 (67.8%) were isolated. The isolates in CAUTI were found to be susceptible to cefoperazone sulbactam combination 21 (65.6%), amikacin 22 (68.7%), piperacillin+ tazobactam 24 (75%), nitrofurantoin 27 (84%), imipenem 27 (84%) and tigecycline 27 (96.4%). All were susceptible to colistin. The gram positive isolates were susceptible to nitrofurantoin 3 (75%), vancomycin and linezolid (both 100%). Conclusion: CAUTI is a preventable Hospital Acquired Infection (HAI) seen worldwide, but the incidence can be lowered by reducing the catheter procedures, the duration of catheterisation and taking aseptic precautions and by appropriate prophylactic antibiotics.

A comparative study on the renal function parameters and serum C reactive protein levels in relation to the severity of preeclampsia

Background: Preeclampsia is one of the major complications affecting the pregnancy. It is an important cause of both maternal and fetal morbidity and mortality worldwide. Aims and Objectives: The aim of the study was to assess the renal function and serum C reactive protein (CRP) levels in pre-eclampsia. Materials and Methods: Our study was a cross-sectional study conducted among 90 pregnant women in a tertiary care center in Kerala. The Institutional Ethics Committee approved the study. Blood urea, serum creatinine, and serum CRP levels were estimated in 30 normotensive pregnant women, 30 mild preeclamptic, and 30 severe pre eclamptic women. Statistical analysis was done. Results: The mean values of all the three parameters were highest in severe pre-eclampsia when compared to the normotensive pregnant women. The mean values in mild pre-eclampsia lies in between the values of other two groups. The results were statistically significant. Conclusion: Significant alteration in renal function tests and serum CRP levels prove to be an important indicator in assessing the severity of preeclampsia.

Histopathological characterization of carcinoma breast with BRCA1/2 sequence variation in a Tertiary Care Center in Kerala, South India

Background: Hereditary breast cancers constitute around 5%–10% of all breast cancers. The most commonly mutated genes in hereditary breast and ovarian cancer syndrome are the BRCA1 and BRCA2 genes. There has not been any research into the histopathological features of BRCA1/2 mutations in breast cancer in Kerala. The goal of this work was to use next-generation sequencing to look into the range of BRCA1/2 genetic variants and to discover characteristic histopathologic features associated with BRCA1/2 sequence variations. Methods: Fifty female patients diagnosed with carcinoma breast were screened for BRCA1/2 variants by next-generation sequencing. Patients were selected irrespective of age or family history of breast or ovarian cancer. The histopathological features of BRCA1/2 associated breast cancer cases were also studied. Results: We identified sequence variants in BRCA1 and BRCA2 genes in 6 women (6/50, 12%). The sequence variants included two deleterious mutations and five variants of uncertain significance. It was observed that most of the patients with BRCA1/2 sequence variants presented with aggressive tumor characteristics. Statistical significance was noted in BRCA1/2 carriers with tumors of higher histologic grade (P = 0.048). Conclusion: Morphological and immunohistochemical features of BRCA1/2-associated breast cancer may be valuable to predict mutation carrier status for appropriate therapeutic decision-making.

Covid-19 and leptospirosis, pulmonary involvement and response to steroids: A comparative observational study from a rural Tertiary care center in Kerala.

Background:COVID-19 is an emerging infectious disease with a global outreach. Leptospirosis is a zoonotic disease mainly confined to tropical areas. In both cases, most of those affected are asymptomatic or have only mild respiratory disease. Those who turn critical develop acute respiratory distress syndrome (ARDS) and/or multiple-organ failure occurs rapidly, with high fatality.Methodology:This is a retrospective observational study from 2020 involving COVID-19 and leptospirosis patients. The data were collected using a semi-structured proforma, and analysis was performed using Easy R (EZR) software.Results:There were five patients with COVIDC-19 and four patients with leptospirosis; with pulmonary involvement. All the patients were males. There was no significant difference in age, the onset of pulmonary involvement, time of initiation of steroids, duration of steroids, and outcome between the two groups. However, in the case of COVID-19, it took a longer period for clearing of infiltrates.Conclusion:Though COVID-19 and leptospirosis are two different diseases, both of them show a similar life-saving response to steroids, the common factor in the pathogenesis being cytokine storm. Primary care physicians in tropical areas of the world should be aware of the similarities between these two diseases, especially the initial clinical presentation, the pathogenesis, and the response to steroids.

Prevalence of Anxiety, Depression and Stress among Antenatal Women attending a Tertiary Care Centre in Kerala during COVID-19 pandemic

Introduction: Anxiety, depression and stress can cause negative impacts on the foetus and pregnancy. The COVID19 pandemic provides a unique stressor requiring an assessment of its impact in the Indian set up. Objectives:1. To assess prevalence of anxiety and depression among antenatal women attending the antenatal OP at a tertiary care centre during COVID 19 pandemic using Hospital Anxiety and Depression Scale (HADS). 2. To determine stress perceived by antenatal women using the Perceived Stress Scale (PSS). Method: Antenatal women attending the outpatient clinic between November 2020 and January 2021 were consecutively enrolled into the study after obtaining consent and a semi-structured interviewer administered questionnaire was used to collect data. The outcome variables, including sociodemographic details, HADS and PSS scores, were analysed using SPSS software, and results expressed appropriately, with quantitative variables expressed as mean and standard deviation, and qualitative variables as proportions. Results: Prevalence of anxiety among antenatal mothers was estimated to be 39%, of which 87.8 % had income below the poverty line. Prevalence of depression was estimated to be 11.4 %. Stress levels were high in 41.9 % of the women. Anxiety showed a positive correlation with stress (correlation coefficient of 0.711). Conclusion: High prevalence of anxiety and stress among antenatal women, especially from poor income backgrounds, points to an urgent need for reassurance and counselling.

Pilot Nanostring PanCancer pathway analysis of colon adenocarcinoma in a tertiary healthcare centre in Kerala, India.

The prevalence of microsatellite instability and deoxyribonucleic acid mismatch repair deficiency in colorectal adenocarcinoma (CRC) cases is higher in India compared to western populations. No major study on the molecular pathogenesis is currently available in the Indian population. We conducted a pilot study to explore the differences in molecular pathogenesis of microsatellite stable (MSS) and microsatellite unstable CRC from a tertiary care centre in Kerala, South India. Using Nanostring PanCancer panel assay in Stage II colorectal adenocarcinoma, tumour tissues (n = 11) were compared against normal colon tissues (n = 4). Differentially expressed (DE) genes were identified and super-imposed onto colon adenocarcinoma cohort of The Cancer Genome Atlas (TCGA) data (TCGA Colon Adenocarcinoma (TCGA COAD)), from the Genome Expression Profiling Interactive Analysis and Tumor Immune Estimation Resource (TIMER) to compare the gene associations. Significant DE genes were 59 out of 730 (false discovery rate adj. p-value < 0.05), 18 of which had a fold-change |FC(log2)| ≥ 2. On superimposition to TCGA COAD, 33 genes were significant in both TCGA and current study. ETV4 was expressed significantly higher in MSS with no immune cell infiltration. Other significant DE genes with high FC(log2), unique to the study were INHBA, COL1A1, COL11A1, COMP, SFRP4 and SPP1, which were clustered in STRING network analysis and correlated with tumour-infiltrating immune cells in TIMER, suggesting a specific interaction pathway. The preliminary study suggests a distinct pathogenesis of MSS CRC involving ETV4 in the Indian population and warrants further clinically extensive and high-dimensional expression studies.

Registry-based pilot epidemiological study of traumatic brain injury in a tertiary trauma care center in Kerala, India - Difficulties encountered during data collection warranting the need for standardized electronic database.

Background: Head injury is referred to as a “silent epidemic” globally. Studies regarding epidemiology of head injury are very few especially in Kerala and most have conflicting reports. Unlike developed countries, there is no well-established system for collecting and managing information on traumatic brain injury (TBI) in India, especially in Kerala. The present study shares the difficulties encountered and the insights acquired by conducting a registry-based epidemiological pilot study for collecting a baseline data of traumatic head injury patients in a tertiary care center in Kerala.Methods: The pilot study was conducted to know the efficiency of present reporting system of a tertiary hospital in Kerala. We tried to collect retrospective data from December 2018 to December 2019 in the department of neurosurgery. As there was no standardized protocol or electronic database for data collection in hospital, we made a sample proforma for data collection. The patient details were obtained from medical records (case sheets), resident doctor’s, and staff nurse’s notes which included demography, clinical details, and radiological findings which were analyzed.Results: We were not able to fill the full details regarding demography, prehospital data, and clinicoetiological details which are important as far as head injury management is considered. The hospital records were grossly inadequate for full retrieval of information. Inadequate case definition and lack of centralized electronic reporting mechanisms were some of the major difficulties we faced obviating the need for collecting, managing, and utilizing epidemiological data using an electronic database.Conclusion: We believe that the present pilot study will give an insight regarding the difficulties encountered in collecting data regarding TBI. This study will be the first of its kind in Kerala highlighting the importance of maintaining a proper head injury electronic registry. The data from this study would definitely guide future experimental operational research on these unexplored areas which will be relevant in head injury policy-making in Kerala as well as in India.

English

BACKGROUND Suicide attempts in young adults in the age group 18 - 25 years have grown exponentially across the globe in the last three decades. Suicide is the third leading cause of death among young adults worldwide and is the second leading cause of death in 15 – 29-year-olds. The studies on the factors affecting suicidal intent among young adult suicide attempters are few from the Indian context and young adult group is of utmost importance. So, this study was done to estimate the suicidal intent among young adult suicide attempters and to assess the various factors associated with suicidal intent among young adults. METHODS The study was an analytical cross-sectional study, which was carried out at the Suicide Prevention Clinic of the Department of Psychiatry at a Tertiary Care Centre in Kerala, India over a period of 1 year from October 2015 to September 2016. The consecutive 160 young adult suicide attempters were interviewed. Beck’s suicide intent scale was used to assess the severity of suicide attempts. Statistical significance of socio-demographic factors and suicidal intent score was assessed by independent student t test and one way analysis of variance (ANOVA). RESULTS Out of the 160 participants, 50 (31.2 %) had low suicidal intent, 71 (44.4 %) had medium suicidal intent and 39 (24.4 %) had high suicidal intent. The study showed significant association between marital status (t = 2.515, P = 0.011), Occupation (F = 7.991, P &lt; 0.001), previous suicide attempt (t = - 2.586, P = 0.011), mode of attempt (F = 7.228, P &lt; 0.001) and psychiatric disorder (F = 11.218, P &lt; 0.001) with the suicidal intent score. The study has found a significant association between the caregiver and suicidal intent score (F = 4.339, P = 0.006) which needs to be researched further. CONCLUSIONS Our study showed significant association between the socio-demographic variables like occupation, marital status, caregiver, mode of attempt, previous attempt and psychiatric diagnosis with the suicidal intent scores of young adult suicide attempters attending the suicide prevention clinic. This finding throws light to the factors contributing to high suicidal intent among young adults. The suicidal rates among the young adults are on the rise and we as the health professionals should be aware of these factors which will help in preventing young adult suicides. KEYWORDS Suicidal Intent, Young Adults, Suicide Prevention Clinic, Suicidal Behaviour, Kerala