Tertiary Care Centre In Mumbai Research Articles

Effectiveness of Immune Checkpoint Inhibitors in Various Tumor Types Treated by Low, Per-Weight, and Conventional Doses at a Tertiary Care Center in Mumbai.

The cost of immune checkpoint inhibitors (ICIs) limits their accessibility to a small number of patients with cancer in low- and middle-income countries. Early-phase clinical trials have shown target inhibition and high activity at doses lower than those registered and evaluated in clinical trials. Here, we report everyday experience of using ICIs in 100 Indian patients, many of whom received lower doses of ICIs. Consecutive patients who received at least one dose of an ICI irrespective of tumor type at a tertiary care hospital in Mumbai, India, that was able to access ICIs for its patients were enrolled. The objectives were to study the doses used over a 3-year time period, and the effectiveness of therapy, assessed primarily by the overall response rate (ORR), overall survival (OS), and progression-free survival were secondary end points. Twenty-five patients were treated with conventional doses of ICIs, 29 patients received lower doses per body weight, and 46 patients received low-dose treatment. The median number of cycles received was 5 (range, 1-28). Seventy-eight patients received ICIs in a palliative setting. The median follow-up time was 10.2, 9.8, and 3.9 months for those receiving fixed approved dosing, per body weight dosing, and low-dose treatment, respectively. There was a trend with time to prescribe lower doses. Response evaluation was available for 92 patients. Twenty-one (five-adjuvant and 16-palliative) patients received ICIs only. The ORR did not differ statistically among different dosing groups, but comparisons are confounded by inclusion of different ICIs, different tumor sites, and concurrent treatments. The median OS was 6.8 (range, 4.6-9.0) months. Adoption of per-body weight and lower dosing of ICIs appears to give acceptable outcomes. Lower dosing can improve access and timely delivery of ICIs in low- and middle-income countries.

Clinical and Demographic Profile of Patients with Juvenile Idiopathic Arthritis in a Tertiary Care Center in Mumbai, Western India

Abstract Background: Juvenile Idiopathic Arthritis (JIA) is the most common cause of chronic rheumatic disease affecting children younger than 16 years of age and lasting six weeks or longer. It causes both short-term and long-term disability. There are very few epidemiological studies from western India on JIA. The objectives of this study were to identify the clinical and demographic profile of JIA patients and compare to existing epidemiological data. Material and Methods: It was a retrospective observational study carried out at BJ Wadia Hospital for children in Mumbai, over a period of 30 months. The analysis of their clinical, demographic and treatment profile was done. Results: We had a total of 61 cases, 31 were male and 30 female. Maximum cases were of SoJIA and ERA (n=18 in each, 29.5%), followed by polyarticular JIA (n=16, 26.2%) and oligoarticular JIA (n=8, 13.1%). Knee (75.4%) was the commonest joint involved. Two patients had uveitis (one with chronic and other with acute anterior uveitis). The mean ESR was 72mm and CRP 45.87mg/dL. ANA was positive in 7 patients, whereas RF in 3 patients. There was a mean 6 months delay in their diagnosis, maximum being in polyarticular JIA with 11 months dealy. All patient were treated with NSAIDs (naproxen or indomathacin). cDmards were given for treatment - either methotrexate or sulfasalzine. Twelve were given biologicals DMARDs. Conclusion: SoJIA and ERA followed by polyarticular JIA were most common subtypes of JIA in our study. Uveitis and ANA positivity were rare findings in our subset of children.

A cross sectional descriptive study of dermoscopic features of clinical variants of cutaneous tuberculosis

Tuberculosis continues to be a major public health concern worldwide with almost 20–40% of the world's population being affected yearly. Cutaneous Tuberculosis (TB) is a rare and underdiagnosed entity that manifests in about 1–1.5% of extrapulmonary tuberculosis cases worldwide. Dermoscopy is a non-invasive tool which will be a useful aid to histopathology in the confirmation of the diagnosis alongside culture, and molecular techniques. This is a cross-sectional descriptive study that was conducted at a tertiary care center in Mumbai, India. A total of 31 patients were enrolled in this study; 14 males and 17 females. The mean duration of disease was 4.3 months and the average age was 31 years. There were 10 cases of lupus vulgaris, 7 scrofuloderma, 5 papulonecrotic tuberculid (PNT), 3 tuberculosis verrucosa cutis (TBVC), and 2 cases each of erythema induratum of Bazin, lichen scrofulosorum and resolved lupus vulgaris. All the lesions demonstrated orange yellow background suggestive of dermal granuloma. Other key dermoscopic features noted include yellowish-white scales, patulous follicles, white structureless areas, milia-like cysts, white streaks, pigment globules, hairpin and linear vessels. Newer findings such as the crown of vessels and perifollicular pallor in lichen scrofulosorum, and radiating white streaks in PNT were also noted. Dermoscopy of infective granulomas such as cutaneous tuberculosis is a less explored field of dermatology. Newer dermoscopic features of each clinical variant of cutaneous TB have been described.

Neurocognitive Disorders in HIV-positive Patients.

(1) To know the prevalence of HAND in HIV-infected patients of a multi-ethnic population. (2) To describe various types of neurocognitive impairment among patients of HAND and study the factors affecting HAND. This study was a cross-sectional descriptive study conducted on 250 HIV-positive patients in outpatient department (OPD) of a tertiary care center in Mumbai, conducted over a period of 12 months. Patients with HIV-1 attending the OPD and having a minimal formal education of 4 years were included. Patients with concomitant delirium, any known central nervous system (CNS) disorder, any psychiatric disorder, and pregnant females were excluded. Outcome measures-the test batteries used were (1) International HIV Dementia Scale (IHDS) and (2) Addenbrookes cognitive examination-revised (ACE-R) scale. Of 250 subjects studied, 55.6% (139) were males and 44.4 % (111) were females. The mean age of study population was 39.42 years. The mean years of education were 8.32 years. The mean duration of infection (diagnosis of HIV-positive state) was 64.49 months and the mean duration of HAART intake in our patients was 52.30 months. The mean cluster of differentiation 4 (CD4) counts of our subjects were 527.13 per cumm [standard deviation (SD) of 234.13]. The mean nadir CD4 counts were 224.35 per cumm (SD of 115.09). Using the ACE-R scale, the prevalence of HAND was 71.60%, of which 37.20% had an asymptomatic neurological impairment, 29.60% had mild cognitive dysfunction, and 4.80% had HAD. Memory, verbal fluency and visuospatial abilities were the most affected domains on the ACE-R and memory recall and psychomotor speed were affected more on the IHDS. The prevalence of HAND was more with increasing age (p = 0.020), lesser education (p < 0.00) and lesser nadir CD4 counts (p < 0.00). However, it was not affected by the duration of the disease and the current CD4 counts (p > 0.05). Human immunodeficiency viruses (HIV) associated neurocognitive disorders HAND is common in HIV-positive patients, most of whom are asymptomatic. Older patients with less education and severe disease, having lower nadir counts are at the highest risk of HAND. Memory, verbal fluency, and visuospatial abilities were the most commonly affected domains.

Prevalence of hypocalcemia in term newborns requiring phototherapy

Background: Neonatal hyperbilirubinemia in the first week of life is one of the most prevalent clinical entity observed, affecting 60% of term-babies and 80% of preterm newborn babies, many requiring intervention in the form of phototherapy. The effect of phototherapy on serum calcium levels has not been studied much in Indian literature. The objectives of this study was to evaluate the prevalence of hypocalcemia in healthy, term newborn babies receiving phototherapy for unconjugated hyperbilirubinemia and to determine the association, if any between serum calcium and birth weight, postnatal age at start of phototherapy, weight at enrolment, gestational age at birth, maternal age and duration of phototherapy. Methods: This was a prospective observational study conducted over a period of 10 months among 80 term neonates admitted to the inpatient department at a tertiary care centre in Mumbai. Total serum calcium and ionised calcium levels were measured at the start of phototherapy and on stopping phototherapy/discharge. Data were analysed using statistical package for social sciences (SPSS) version 21 software. Results: Two (2.5%) out of the 80 neonates were found to have hypocalcemia after phototherapy with serum ionic calcium levels less than 1 mmol/l. Even though a larger proportion of neonates showed a decrease in the serum total calcium (56.25%) and serum ionic calcium (58.75%) levels after phototherapy, none of the neonates developed symptomatic hypocalcemia at those levels. A statistically significant association was found between maternal age in years with the serum total calcium levels after phototherapy and age at starting phototherapy (in hours) with the serum ionic calcium levels after phototherapy. Conclusions: The present study concludes that there is significant decrease in the levels of ionised calcium after phototherapy, however there was no significant decrease in the total serum calcium levels and none of the neonates were symptomatic. Hence, we do not recommend regular serum calcium monitoring in healthy term neonates receiving phototherapy and find no indication for the prophylactic use of calcium supplementation in these neonates.

Functional assessment of bipolar hemiarthroplasty versus total hip replacement in trans cervical neck fracture of femur in elderly patients a prospective observational study

Background: Bipolar hemiarthroplasty and total hip arthroplasty are widely accepted methods of treatment for displaced femoral neck fracture in elderly patients. This study is to compare the functional outcomes of bipolar hemiarthroplasty and total hip arthroplasty in such patients. Methods: This is a prospective study in which data of all patients with age more than 60 with trans cervical neck of femur fracture undergoing total hip arthroplasty and bipolar hemiarthroplasty in a tertiary care centre in Mumbai is studied. They were followed up and compared with the Modified Harris Hip Score. The results were compared between the two groups for statistical significance. Results: There was a significant difference seen in pain and gait at 6 and 12 months between two groups with better scores in the total hip arthroplasty group. Better functional activities were seen at 3 and 6 months in the total hip arthroplasty group. A significant difference was seen in the Total Modified Harris Hip Score at 3, 6 and 12 months and was better in the total hip arthroplasty group as compared to the hemiarthroplasty group. Conclusions: Bipolar hemiarthroplasty is the preferred approach after a displaced femoral neck fracture in the elderly population, but due to potential complications like inguinal pain and low functional outcome, total hip replacement should be considered as the first line of surgical management for the neck of femur fracture in such patients. It has been found to have a good functional outcome, fewer gait disturbances and less post-operative pain.

DETERMINATION OF SENSITIVITY TO LINEZOLID IN DRUG-RESISTANT TUBERCULOSIS CASES

Introduction: Tuberculosis is caused by Mycobacterium tuberculosis and remains a leading infectious cause of mortality globally. Linezolid, an oxazolidinone, has strong in vitro evidence of action against drug resistant isolates of M. tuberculosis. It can be administered orally or intravenously and has been shown to be highly benecial if used for at least six months. Aim: To determine the sensitivity of linezolid in patients with Drug-resistant tuberculosis. Methods: An 18-month observational study was conducted in the TB Culture and Drug Sensitivity Screening lab of the Department of Microbiology at the Tertiary Care Center in Mumbai on a sample size of 1031 patients. Samples from pulmonary and extrapulmonary tuberculosis patients of MDR/XDR (conrmed by LPA) cases were collected for phenotypic DST for Linezolid utilizing the automated BACTEC MGIT 960 system in a biosafety level 3 lab. Results: Out of 1031 patients, 88.9% were sensitive to Linezolid, and 11.1% were resistant. Linezolid sensitivity for MDR-TB patients was 88.72% of the cases being sensitive, and 11.28% resistant. Linezolid sensitivity in pre-extensively drug-resistant tuberculosis was 88.27% and 11.73% were resistant. Among 1031 samples, 50 samples taken for Linezolid and Bedaquiline liquid DST, of which 15 were XDR and 4 samples among these 15 XDR samples were sensitive to Linezolid Conclusion: The study concluded that Linezolid is an effective drug used in the NTEP for the treatment of M/XDR-TB, H mono/poly DRTB, as well as the newer BPaL regimen. The results showed an overall sensitivity of 88.9%.

Outcome of Precontoured Titanium Mesh in the Reconstruction of Orbital Blowout Fractures.

Background Orbital blowout fractures are peculiar injuries causing disruption of both ocular function and symmetry. We present our experience with the use of a precontoured titanium mesh in orbital blowout fractures. Methods A retrospective study of patients undergoing correction of orbital blowout fractures with a precontoured titanium mesh was done at a tertiary care center in Mumbai. Data regarding demographics and pre- and postoperative clinical and radiological attributes were retrieved and compared. Results A total of 21 patients (19 males and 2 females) underwent correction of blowout fractures with a precontoured titanium mesh. The follow-up period ranged from 6 to 10 months. Road traffic accident (76%) was the most common etiology. Twenty (95%) patients had impure blowout fractures and 1 (5%) patient had a pure blowout. The orbital floor was most commonly fractured (16 [76%]). Associated fractures of the zygomaticomaxillary complex were found in 71% of patients. All patients were operated on within 3 weeks of trauma. A comparison of the operated and uninjured sides on coronal views of computed tomography (CT) scan in nine patients by Photopea application revealed a correction of the increased cross-sectional area in all cases. Enophthalmos was completely corrected in 94% patients, while 92% patients had complete correction of diplopia. One patient with a comminuted zygomatic fracture had persistent diplopia and mild enophthalmos. Infraorbital paresthesia persisted in 58% patients at 6 months of follow-up. No significant postoperative complications were noted. Conclusion The precontoured titanium mesh restores orbital wall anatomy and is safe, quick, fairly easy, and reproducible with a shorter learning curve. With proper patient selection and execution, prefabricated titanium mesh can serve as an excellent reconstructive option in blowout fractures of the orbit.

Pharmacokinetic analysis of linezolid for multidrug resistant tuberculosis at a tertiary care centre in Mumbai, India.

Linezolid is an oxazolidinone used to treat multidrug-resistant tuberculosis (MDR-TB), including in the recently-endorsed shorter 6-month treatment regimens. Due to its narrow therapeutic index, linezolid is often either dose-adjusted or discontinued due to intolerance or toxicity during treatment, and the optimal balance between linezolid efficacy and toxicity remains unclear. India carries a significant burden of MDR-TB cases in the world, but limited information on the pharmacokinetics of linezolid and minimum inhibitory concentration (MIC) distribution is available from Indian MDR-TB patients. We enrolled participants from a tertiary care centre in Mumbai, India, treated for MDR-TB and receiving linezolid daily doses of 600 or 300mg. Pharmacokinetic visits were scheduled between 1 and 15 months after treatment initiation to undergo intensive or sparse blood sampling. Linezolid concentration versus time data were analysed using non-linear mixed-effects modelling, with simulations to evaluate doses for different scenarios. We enrolled 183 participants (121 females), with a median age of 26 years (interquartile range [IQR] 21-35), weight 55.0kg (IQR 45.6-65.8), and fat-free mass 38.7kg (IQR 32.7-46.0). Linezolid pharmacokinetics was best described by a one-compartment model with first-order elimination allometrically scaled by fat-free mass and transit compartment absorption. The typical clearance value was 3.81L/h. Simulations predicted that treatment with 300mg daily achieves a high probability of target attainment (PTA) when linezolid MIC was ≤0.25mg/L (61.5% of participant samples tested), while 600mg daily would be required if MIC were 0.5mg/L (29% of samples). While linezolid 300mg daily is predicted to achieve effective targets for the majority of adults with MDR-TB, it failed to achieve the therapeutic target for 21% participants. A dose of 600mg had a PTA >90% for all susceptible samples, but with a higher likelihood of exceeding toxicity thresholds (31% vs 9.6%). These data suggest potential benefit to individualized dosing taking host and microbial characteristics into account to improve the likelihood of treatment efficacy while minimizing risk of toxicity from linezolid for the treatment of MDR-TB. Further prospective evaluation in different clinical settings is urgently needed to inform safety and efficacy of these lower doses.

Different presentation of autoimmune hepatitis in children: Case series.

Autoimmune hepatitis (AIH) is a disorder causing chronic hepatic inflammation. Its clinical presentation is highly variable from the affected child might have only biochemical evidence of liver dysfunction or present in hepatic failure. It is important to distinguish AIH from other forms of chronic hepatitis because a high percentage of cases respond to immunosuppressive therapy. In this article, we describe the clinical presentation, biochemical and histological findings, treatment, and clinical outcome of the four children with AIH in a tertiary care center in Mumbai. Most patients with AIH have high levels of immunoglobulin. All four cases showed high serum Ig G levels and responded to oral prednisolone only. AIH should be excluded for all patients with symptoms or signs of prolonged, relapsing, or severe liver disease so that treatment can be promptly initiated and morbidity can be reduced.

Prevalence of pre-extensively drug-resistant tuberculosis (Pre XDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) among extra pulmonary (EP) multidrug resistant tuberculosis (MDR-TB) at a tertiary care center in Mumbai in pre Bedaquiline (BDQ) era.

Drug-resistant tuberculosis (DR-TB) is the most exigent and calamitous challenge encountered in treatment of TB. Extra pulmonary (EP) DR-TB poses a complex diagnostic and therapeutic challenge owing to myriad of presentations and paucibacillary nature. Data available on this subset is limited. We studied the prevalence of EPDR-TB cases among the total DR-TB cases visiting our Programmatic management of Drug-Resistant TB (PMDT) site. We also studied the demographic and microbiological profile of these cases and analyzed the prevalence of pre-extensively drug-resistant TB (pre XDR-TB) and extensively drug-resistant TB (XDR-TB) among patients of EPDR-TB in pre Bdq era. Of the 1086 DR-TB patients, 64 (5.89%) were cases of EPDR-TB. Seven out of 64 (10.93%) were primary EPDR-TB. The site wise distribution of cases was 34 (53.125%) lymph node DR-TB, 18 (28.125%) pleural DR-TB, 9 (14.0625%) spinal DR-TB/paraspinal abscess/psoas abscess, 1 case (1.5625%) each of abdominal DR-TB, sternal and gluteal abscess. On the basis of the second-line drug susceptibility testing (DST), patients were grouped into: (1) multidrug-resistant TB (MDR-TB), (2) MDR-TB with fluoroquinolone (FQ) resistance {pre XDR XDR-TB (FQ)}, (3) MDR-TB with second-line injectable (SLI) resistance {pre XDR XDR-TB (SLI)}, (4) XDR-TB. Of the 64 patients, 43 (67.185%) had MDR-TB, 19 (29.687%) had preXDR-TB (FQ), none had preXDR-TB (SLI) and 2 (3.125%) had XDR-TB. Gastro esophageal reflux disease (GERD) was the most common comorbidity seen in 26 (40.6%) patients, followed by anemia in 5 (7.8%), psychiatry problems 5 (7.8%), hypertension in 3 (4.6%), renal disorders in 2 (3.1%) while thyroid disorder, HIV and thalassemia in 1 each (1.5%). EPDR-TB forms a small but significant proportion of total DR-TB. Lymph node DR-TB is its most common subclass. Our study emphasises the momentousness and essentiality of baseline DST to FQ and SLI in patients of DR-TB. This enables an appropriate modification of therapy at baseline itself to better the treatment outcomes. We observed a strikingly high proportion of preXDR-TB (FQ) in our study group.

Drug resistance patterns and treatment outcomes in DR-TB patients at a tertiary care centre in Mumbai

BackgroundDrug-resistant tuberculosis (DR-TB) is a major health problem and threatens Tuberculosis (TB) control and outcomes globally. India holds one-fourth of global DR-TB burden.1 Aims1- To study drug resistance patterns and outcomes in DR-TB patients under National Tuberculosis Elimination Programme (NTEP) at a tertiary care-centre. 2- To correlate outcome of DR-TB with drug resistance patterns. MethodsIt is a retrospective study of 302 Drug Resistant Tuberculosis patients from Jan 2020 to May 2022. Common mutations of drug resistance, pyrazinamide resistance in DR-TB patients, correlation of High dose Moxifloxacin sensitivity by Line Probe Assay (LPA) and drug sensitivity test (DST), outcome of DR-TB patients with drug resistance patterns and correlation of outcome of DR-TB patients with their initial body-weight were studied. ResultsKat G was the most common mutation in Isoniazid (96%) resistance for MDR TB as well as Isoniazid Mono-resistance TB (p = 0.001). 91% cases with MDR-TB were resistant to pyrazinamide. 51.2% cases had low dose Fluroquinolone resistance. 18.8% cases had low and high dose Fluroquinolone resistance. 8.5% cases had resistance to injectables. 21.7% of cases who were resistant to High dose Moxifloxacin on second line LPA were found to be sensitive on DST. Outcomes were not dependent on the LPA resistance patterns. Body-weight greater than 45 Kg at the time of initiation of treatment was associated with better outcomes (p = 0.007). ConclusionDR-TB patients are resistant to pyrazinamide in nearly all cases; hence pyrazinamide is not suitable for initial replacement sequence. Second line resistance doesn't impact outcome in DR-TB patients.

Nail Changes in Immuno-Bullous Disorders: A Cross-Sectional Study.

Autoimmune blistering (AIBD) disorders affect mucosae, skin, and appendages. Appendageal involvement has not been studied extensively to date. However, they are important as nail changes are commonly encountered during a flare-up of the disease. To determine the prevalence and patterns of nail changes in various Immunobullous disorders and to study the relationship between the nail changes and the disease duration and severity. A cross-sectional study was conducted at the Department of Dermatology, venerology, and leprosy at a tertiary care center in Mumbai. A cross-sectional study including a total of 74 cases of Immunobullous diseases was conducted and the prevalence of nail changes was determined. The association between the mean number of nail changes and the disease duration and severity was analyzed using ANOVA (Analysis of variance) and unpaired t-test. The Statistical Package for Social Studies (SPSS) software was used for statistical evaluation. We found that the prevalence of nail changes was 91%. There was a significant difference in the mean number of nail changes with respect to the severity grades of mucosal involvement in AIBD (P value < 0.05). There was no significant difference in the mean number of nail changes with respect to the severity grades of Pemphigus vulgaris (PV), Pemphigus foliaceous (PF), subepidermal blistering diseases, and the duration of AIBD. Nails are frequently affected in AIBD. The number of nail changes is related to the severity of mucosal disease but not to duration.

Study of fetomaternal outcomes in eclampsia in correlation to coagulation profile in a tertiary care center in Mumbai

Background: Eclampsia is the leading cause of maternal and perinatal mortality as well as morbidity. The present study was conducted to assess the severity of eclampsia and coagulopathy by a method that is rapid, cheaper, and easily available and to assess the clinical evaluation and comparison of the fetomaternal outcomes in eclampsia with normal and deranged coagulation profiles. Aims and Objectives: This study aims to assess the severity of eclampsia and coagulopathy by a method that is rapid, cheaper, and easily available and to assess the clinical evaluation and comparison of the fetomaternal outcomes in eclampsia with normal and deranged coagulation profiles. Materials and Methods: A hospital-based prospective case–control study was done at tertiary care institute in the department of obstetrics and gynecology over a period of 1½ years from February 2018 to August 2019. Template was generated in MS Excel sheet and analysis was done on SPSS software. Results: Overall incidence of eclampsia was found to be 2.4%. Majority of the eclampsia patients in both normal coagulation profile group and deranged coagulation profile group were in the age group of 21–25 years (42.8% and 46.6%, respectively). The most common maternal outcome in the eclampsia patients with both normal (50%) and deranged (36.6%) coagulation profile was operative intervention, that is, lower segment cesarean section, followed by the requirement of maternal intensive care in critical care unit or medical intensive care unit. The least common fetal outcome among those with normal coagulation profile being neonatal death and still birth accounting for 2.85% of cases each whereas among those with deranged coagulation profile, the least common outcome being very low birth weight accounting for 3.33% of cases. Of the 46 eclampsia mothers who underwent operative intervention, 93.47% had normal platelet counts and 6.52% had thrombocytopenia. Of the eight neonatal deaths, 50% were among those of eclampsia mothers with normal platelet count and 50% among those with thrombocytopenia. Conclusion: In the present study, eclampsia accounted for 2.3% of all deliveries. Hence, relevant investigations need to be promptly done to identify the derangement of the coagulation profile in cases of eclampsia and pre-eclampsia which can alert the obstetrician of the severity of the disease so that appropriate and timely management can be initiated to prevent adverse outcomes.

Risk of Surgeon Contracting COVID-19 while Operating on COVID-19-Positive Patient, Impact of Safety Measures: Lessons Learnt.

Risk of Surgeon Contracting COVID-19 while Operating on COVID-19-Positive Patient, Impact of Safety Measures: Lessons Learnt.

IMPACT OF COVID-19 PANDEMIC RESPONSE ON THE UPTAKE OF ROUTINE CHILDHOOD IMMUNISATION AT A TERTIARY CARE CENTRE IN MUMBAI.

Background The COVID-19 pandemic response has impacted the delivery of healthcare, including routine childhood immunisation. This manuscript studies the extent of this impact. To assess the decline in daily average routine childhood immunisation uptake compared toObjectives the baseline level and to assess the problems faced by the beneciaries in accessing the immunisation services during the pandemic period at a tertiary care centre in Mumbai. Data of daily routine childhood immunisations in the year 2019 and 2020 was collected from theMethods immunisation records register of Child Welfare Centre (CWC) of the tertiary care centre. The baseline (2019) and the COVID-19 lockdown period data were compared to analyse the impact on daily routine childhood immunisation uptake. Guardians of beneciaries visiting the CWC from 24 December 2020 to 23 January 2021 were interviewed using a questionnaire to study the causes of delayed/missed immunisations. ThereResults was 24.62% decline (p&lt;0.05) in the number of immunisations administered in 2020 compared to 2019. Fear of COVID-19 infection (45.9%), migration to hometown due to lockdown (13.11%), travelling restrictions during lockdown (9.84%) and miscellaneous reasons (31.15%) were the reasons given by the 93 guardians interviewed for delayed/missed immunisations (63.16%). COVID-19 pandemic response has led toConclusion a disruption in immunisation services, leading to a drop in uptake. Childhood immunisation and implementation of strategies to achieve signicant immunisation coverage should be prioritised during pandemics.

Hematological and hepatic profile of dengue patients presenting to a tertiary care hospital in Mumbai

Objective: To assess the pattern of hematological and hepatic involvement in patients of dengue fever. Methods: This study was performed in a tertiary care center in Mumbai, India. 142 patients diagnosed with dengue who were admitted between January 2016 to December 2017 enrolled for the study. Patients Demographic data, clinical history, examination findings, and investigations including complete blood count and liver profile were done. Results: Highest incidence of dengue was seen in the age group of 21-30. More males were affected than females. Highest incidence was seen in monsoon months in Mumbai (August-September). Commonest symptom was fever followed by rigor, chills, bodyache and headache. Altered sensorium was the rarest. In investigations thrombocytopenia was the commonest followed by raised AST and ALT. Conclusion: As Dengue causes significant mortality and morbidity,there is excess burden on healthcare infrastructure of metro cities in India, knowing about the disease behavior is of paramount importance. Doing simple and easily available investigations can be vital in predicting disease severity and need of inpatient and intensive care in Dengue patients.

Trends of a syndromic approached based respiratory PCR during the second wave of the COVID 19 pandemic in a tertiary care center in Mumbai

PurposeThe clinical presentation of COVID 19 disease caused by Severe Acute Respiratory Syndrome Related Coronavirus – 2 (SARS-CoV2) is similar to other causes of upper respiratory viral infections caused by influenza, epidemic corona viruses, Parainfluenza virus etc. This study was undertaken to study the presence of different pathogens in the nasopharyngeal samples of symptomatic patients visiting the COVID OPD or the Emergency services over six month duration.Methods & MaterialsThis was a prospective study from Dec 2020 to May 2021 conducted in a 220 bed tertiary care hospital in Mumbai. We are a designated COVID care hospital with 55 isolation beds including 16 beds in the COVID ICU, a dedicated OPD for symptomatic patients and Emergency services (EMS). The test was performed on a syndromic approach based respiratory PCR with 22 targets inclusive of SARS-CoV2. Nasal and a pharyngeal swab samples (NPS) were collected and the results of the test were available in 1.5 hours from sample receipt to the lab.ResultsA total of 335 patient samples were received during the study period for the syndromic approach based PCR. 133 (39.7%) of the symptomatic patients had a positive test result. 87(26%) SARS-CoV2 and 27(8.05%) Rhinovirus/Enterovirus (RhV/EV) were the two common viruses that were identified during the study duration. Other viruses, like Parainfluenza 3 (PIV3), Coronavirus 229E (229E), Coronavirus HKU1 (HKU1), Influenza AH3 (AH3), H1N1, Coronavirus OC43 (OC43) and Adenovirus were also identified. We observed co-infections 1 each of RhV/EV+AH3, RhV/EV + OC43, SARS-CoV2 +PIV3 and 2 cases of SARS-CoV2+HKU1. The trend indicated the appearance of the 2nd wave of SARS-CoV2 infection that Mumbai experienced between 1st March to 15th May 2021. Other pathogens were mostly seen in the symptomatic population especially before and after the 2nd wave.ConclusionOur study documented the appearance of the second wave in Mumbai between 1st March to 15th May 2021. Approximately,34.5% of patients has other respiratory pathogens detected in the syndromic PCR. This is the 1st study from Mumbai documenting the types of respiratory pathogens and co infections seen during the 2nd wave of the COVID 19 pandemic in Mumbai.

Timed Up and Go as a predictor of mortality in older Indian patients with cancer: An observational study

Background: Therapeutic decision-making in older patients with cancer is challenging, and there is a need for a clinical parameter that can guide these decisions. The Timed Up and Go (TUG) test is an easy-to-administer tool that measures physical performance and may help to identify vulnerable patients.Objectives: We aimed to study the association between the TUG and overall survival in older Indian patients with cancer. We also aimed to evaluate the factors that were associated with a poor TUG score, to define the optimal cut-off score for older patients with cancer, along with the sensitivity and specificity.Materials and Methods: This prospective observational study was conducted in the geriatric oncology clinic at the Tata Memorial Hospital, a tertiary care center in Mumbai, India, between June 2018 and January 2022. We included adults aged 60 years and above, who had a diagnosis of malignancy, and had undergone a multidimensional geriatric assessment. Patients without a TUG score and for whom survival information was not available were excluded. Using the Short Physical Performance Battery (SPPB) as the gold standard, Receiver Operating Characteristic (ROC) curves with Area Under the Curve (AUC) were used, and the cut-off score with optimum sensitivity and specificity was derived. Mean values between two and more groups were compared using t test and analysis of variance, respectively. Categorical variables were compared using Fisher's exact and Pearson's Chi-squared test. The Kaplan–Meier survival estimate, and the unadjusted and adjusted Cox proportional-hazards model were used for survival analysis.Results: We enrolled 851 patients in the study. The median age was 69 (IQR, 65 to 73) years; 544 patients (76%) were men. We found that the TUG in women (median TUG, 11 seconds; IQR, 9.5 - 13.7) was longer than in men (median TUG, 9.6 seconds; IQR, 8.2 -11.6); P < 0.01. The TUG score increased significantly with increasing age in both sexes. Presence of comorbidities impaired cognition, poor nutritional status, depression, and anxiety were significantly associated with higher TUG scores. TUG was a significant predictor of mortality on both the univariate (HR, 1.056; 95% CI, 1.037–1.075) and multivariate models (HR, 1.058; 95% CI, 1.039–1.078). The median survival of patients with TUG <12 seconds was 13.9 months (95% CI, 11.2 to 16.5), compared to 8.5 months (95% CI, 6.6 to 10.3) in those with a TUG ≥ 12 seconds (P = 0.002). The TUG cut-off score of 10 seconds had an AUC-ROC, sensitivity of 62.32% and specificity of 80.58%.Conclusion: TUG can be a reliable tool in a busy outpatient setting to identify vulnerable patients who require a detailed geriatric assessment. A TUG score of ≥ 10 seconds is a good predictor of impaired mobility. Further 0.78 interventional studies are required to identify the benefits of physical therapy in older patients with cancer.

Pattern of liver function test variations in COVID-19 infection & its clinical significance: A study from a dedicated COVID-19 tertiary care centre from India.

Coronavirus disease 2019 (COVID-19) affects respiratory, gastrointestinal, cardiovascular and other systems disease. Studies describing liver involvement and liver function test (LFT) abnormalities are sparse from our population. This study was undertaken to estimate the LFT abnormalities in patients with COVID-19 in a tertiary care set up in India. In this retrospective study conducted at a tertiary care centre in Mumbai, India, all consecutive patients with proven COVID-19 by reverse transcriptase-PCR from March 23 to October 31, 2020 were enrolled. Of the 3280 case records profiled, 1474 cases were included in the study. Clinical characteristics, biochemical parameters and outcomes were recorded. Overall 681 (46%) patient had deranged LFTs. Hepatocellular type of injury was most common (93%). Patients with deranged LFTs had more probability of developing severe disease (P<0.001) and mortality (P<0.001). Advanced age (P<0.001), male gender (P<0.001), diabetes mellitus (P<0.001), lower oxygen saturation levels at admission (P<0.001), higher neutrophil-lymphocyte ratio (P<0.001), history of diabetes mellitus and cirrhosiss were associated with deranged LFTs. Acute liver injury was seen in 65 (4.3%) cases on admission and 57 (3.5%) cases during hospital stay. On multivariate analysis for predicting mortality, age >60 yr serum creatinine >2 mg%, PaO2/FiO2 ratio ≤200 and raised AST >50 IU/l (OR: 2.34, CI: 1.59-3.48, P<0.001) were found to be significant. In COVID-19, LFT abnormalities were common, and derangement increased as severity progressed. The presence of deranged LFT worsens the clinical outcome and predicts in-hospital mortality.