Tertiary Care Center Research Articles

Impact of Moderate or Severe Mitral and Tricuspid Valves Regurgitation after Transcatheter Aortic Valve Replacement

BackgroundTricuspid regurgitation (TR) and mitral regurgitation (MR) are common valvular conditions encountered in patients undergoing transcatheter aortic valve replacement (TAVR). This retrospective study investigates the impact of moderate or severe TR and MR on all-cause mortality in one-year post-TAVR patients. MethodsConsecutive patients who underwent TAVR at the 3 academic tertiary care centers in our health system between 2012 and 2018 were identified. Patients were stratified into 2 groups based on valvular regurgitation severity: moderate/severe MR vs. no/mild MR, and moderate/severe TR vs. no/mild TR. Primary outcome was all-cause mortality at 1-year and 5-year follow up, and secondary outcome was in-hospital death. Logistic regression analysis was conducted to assess the relationship between moderate/severe MR or TR and all-cause mortality at 1-year and 5-year follow-up. ResultsWe included a total of 1,071 patients who underwent TAVR with mean age 80.9 ± 8.6 years, 97% white, and 58.3% males. Moderate or severe MR group included 52 (4.88%) patients while mild or no MR group included 1,015 (95.12%) patients. There was no significant difference between both groups in TAVR procedure success rate (100% vs. 97.83%, p=0.283), in-hospital mortality (0 vs. 1.08%, p=0.450), or mortality at 1-year follow up (15.38% vs. 14.09%, p=0.794). At 5-year follow up, moderate/severe MR group had higher mortality (61.4% vs. 49.5%, p=0.046). In multivariable logistic regression analysis, moderate or severe MR did not show significant correlation with all-cause mortality at 1-year and 5-year follow up. Moderate or severe TR group included 86 (8.03%) patients while mild or no TR group included 985 (91.97%) patients. There was no difference between both groups in TAVR procedure success (98.8% vs. 97.9%, p=0.54) or in-hospital mortality (0% vs. 1.1%, p=0.33). At 1-year follow up, patients with moderate or severe TR had higher mortality (26.7% vs. 13.2%, p=0.001) compared to patients with mild or no TR. Same finding was noted with extended follow up at 5-years (68.3% vs. 48.7%, p<0.001). In multivariable cox regression analysis, moderate/severe TR was associated with higher all-cause mortality at 1-year (OR 1.94, 95% CI [01.09, 3.44], p=0.0.023) and at 5-year (OR 1.46, 95% CI [1.092, 1.952], p=0.0.011) follow up. Patients with combined moderate/severe MR and TR have even higher mortality compared to either moderate/severe valve regurgitation alone or mild/no valve regurgitation at 5-year follow up. ConclusionAt long term follow up, moderate/severe TR, but not MR, is associated with higher mortality in patients underwent TAVR. Combined moderate/severe TR and MR had even worse mortality. Careful assessment of multi-valvular heart disease prior to the procedure is warranted.

Biochemical profile of term neonates with perinatal asphyxia and their correlation with severity of asphyxia

ABSTRACT Background: Birth asphyxia is a major cause of neonatal mortality and neurological morbidity. This study was aimed to determine biochemical (sodium, potassium, and calcium) abnormalities and their correlation across different severities of perinatal asphyxia in term neonates. Methods: This observational analytical study was conducted in term neonates with perinatal asphyxia admitted at the neonatal intensive care unit of a tertiary care centre for a period of 18 months. Blood collection was done at baseline, 24 hours, and 48 hours of treatment to evaluate electrolyte abnormalities. The abnormality in serum electrolytes was correlated across different stages of hypoxic ischaemic encephalopathy (HIE) as per severity and at different time intervals. Results: A total of 74 neonates were included in the study and classified into HIE stage 1 (n = 37), stage 2 (n = 18), and stage 3 (n = 19). At baseline, hyponatremia, hyperkalaemia, and hypocalaemia were observed in 36.5% (n = 27), 20.3% (n = 15), and 10.8% (n = 8), respectively. The difference between mean serum sodium (p: 0.007), potassium (P: 0.004), and calcium levels (p: 0.001) at baseline in stage 1 and stage 3 was statistically significant. The degree of hyponatremia and hyperkalaemia was more and statistically significant as per increasing severity of HIE. All the deaths (n = 6.8.1%) belonged to stage 3 of HIE. Conclusion: The degree of hyponatremia, hypocalaemia, and hyperkalaemia in the asphyxiated newborns correlated with the severity of birth asphyxia. The mortality rate was greater in asphyxiated neonates with severe HIE and electrolyte abnormality. Effective perinatal care and meticulous management of dyselectrolytemia are crucial for improving neonatal outcomes.

Clinical and Biochemical Profiles of Hospitalized Patients with Hypercalcaemia from a Tertiary Care Centre in North India.

Background and aims: The profile of hypercalcaemia in hospitalized patients in India seems to be changing. However, studies evaluating the profile of hypercalcaemia in hospitalized settings in India are extremely limited. This prospective study aims to evaluate the clinical and biochemical profile of hospitalized patients with hypercalcaemia from a tertiary care centre in north India. Materials and methods: Clinical and biochemical profiles of subjects with hypercalcaemia detected during hospitalization/hospitalized with hypercalcaemia were assessed. A total of 91 subjects with sustained hypercalcaemia, who were eligible, underwent further investigation as per the institutional protocol and the data collected were analyzed. Results: The mean age of participants was 57.88 ± 14.23 years, with 62.64% of participants being females. The most common symptoms were nausea and anorexia, which were observed in all patients. The most common clinical sign was dehydration, which was observed in 32.97% of subjects. Primary hyperparathyroidism was the most common cause (41.76%), followed by suspected or confirmed malignancy/solid tumours in 15.38% of subjects. Other causes were advanced chronic liver disease (10.99%), multiple myeloma (9.89%), vitamin D toxicity (8.79%), granulomatous disorders (2.20%) and drug-i nduced disorders (1.10%). Forty-one subjects (45.05%) developed acute kidney injury and 14 subjects (15.38%) developed acute pancreatitis as a complication. Six subjects (6.59%) died during the course of hospitalization because of either primary disease or other secondary complications. Conclusions: Clinicians should be aware of changing patterns of hypercalcaemia in a hospital setting. Hypercalcaemia in hospitalized patients is associated with significant complications and mortality. Further large-scale prospective studies are needed to understand the changing pattern of hypercalcaemia in hospitalized patients from India.

Children with Developmental Dysplasia of Hip - Our Experience of Outcome at a Tertiary Care Centre

Objective: To assess the operative outcome of children who underwent surgical management for developmental dysplasia hip at a tertiary care center. Study Design: Case series. Place and Duration of Study: Pak-Emirates Military Hospital, Rawalpindi Pakistan, from Jan to Oct 2021. Methodology: This case series included 25 children who underwent triple procedure encompassing open reduction, femoral shortening and Salter’s pelvic osteotomy. Post-operative analysis of the clinical outcome was done using McKay’s classification and radiological assessment done using Severin’s classification. Results: Age of enrolled participants ranged from 02 to 07 years, mean age being 4.3±1.45 years, of which 8(32%) were male and 17(68%) were female. Mean pre-operative acetabular index was 40.3±3.38 while the mean post-operative acetabular index was 25.1±3.10. On follow-up, one child had subluxation while another had complete dislocation of the hip joint. Conclusion: Triple procedure with open reduction, femoral shortening and Salter’s osteotomy gives satisfactory results in patients aged 2 to 7 with substantial reduction in post-operative acetabular index.

Thyroid Dysfunction in Postmenopausal Women Attending General Health CheckUp at a Tertiary Care Center in Kathmandu: A Cross-Sectional Study

Introduction: Thyroid disorders are increasingly prevalent, with a higher incidence in women, particularly postmenopausal women. Symptoms of menopause, such as irritability, hot flushes, fatigue, and weight gain, often overlap with those of thyroid dysfunction, complicating diagnosis. Identifying thyroid dysfunction in this population is crucial for improving their overall health and preventing complications like cardiovascular diseases, which are associated with untreated thyroid disorders. Methodology: A hospital-based, retrospective, cross-sectional study was conducted involving 170 postmenopausal women attending a general health check-up at a tertiary care center in Kathmandu. Ethical approval was obtained from the IRC, and data were collected on thyroid function, including the incidence of subclinical hypothyroidism, overt hypothyroidism, subclinical hyperthyroidism, and overt hyperthyroidism. Data were analyzed using SPSS, with descriptive and inferential statistics used to assess the prevalence of thyroid dysfunction and its potential impact on cardiovascular risk and overall health. Results: The average age of participants was 60.59 years. Among the study population, clinical thyroid disorders were observed in 3.53% of participants, with clinical hyperthyroidism at 1.18% and clinical hypothyroidism at 2.35%. Subclinical thyroid disorders were more prevalent, with subclinical hypothyroidism affecting 11.76% and subclinical hyperthyroidism 4.12% of the participants. Conclusion: The study highlights the importance of screening for thyroid disorders in postmenopausal women, as 3.53% of participants had clinical thyroid conditions and 15.88% had subclinical disorders. Early detection and treatment of these conditions are crucial for improving patient outcomes and preventing related health complications.

Common Echocardiographic Diagnoses in Patients at Tertiary Care Center: An Observational Study

Introduction: Echocardiography is an indispensable tool for the diagnosis and management of cardiac patients. It is important to know the spectrum of cardiac abnormalities detected by echocardiography for the proper management of patients. The aim of this study was to evaluate the echocardiographic diagnosis of patients at a multispecialty tertiary care hospital and find out the prevalence of various cardiac diseases diagnosed via echocardiography.Methods: This was a retrospective cross sectional study carried out at the Echocardiography lab of National Academy of Health Sciences. Records of all patients who had done Echocardiography from February 2024 to April 2024 were analyzed. Ethical approval was obtained from Institutional Review Committee (Reference Number:1231/2080/81).Results: Out of 3593 cases, there were 1750 (48.71%) female and 1843 (51.29%) male. Normal echocardiographic study was seen in 1184 (32.95%). Mean age was 56.13±17.38 years. Left ventricle diastolic dysfunction was seen among 1428 (39.74%), followed by tricuspid regurgitation 1026 (28.55%) and pulmonary hypertension 497 (13.83%). Other findings were, left ventricular hypertrophy 204 (5.67%), Left ventricular systolic dysfunction 165 (4.59%), rheumatic heart disease 102 (2.83%) and, congenital heart disease was the lowest documented finding, seen in 30 (0.83%).Conclusions: Most common diseases diagnosed by echocardiography in our study were, diastolic dysfunction, tricuspid regurgitation and pulmonary hypertension.

A Retrospective Analysis of Intestinal Helminthic Infestations at a Tertiary Care Center in South India

A Retrospective Analysis of Intestinal Helminthic Infestations at a Tertiary Care Center in South India

SACROCOCCYGEALTERATOMA

INTRODUCTION Sacrococcygeal teratomas are the most common of all the GCTs in pediatric age group that originate from the totipotent cells from Hansen\\\'s node or primitive germ cells.(1) incidence is approximately 1 in 40,000 live births with a male to female ratio of 1:3–1:4.Huge and highly vascular SCTs,may result in massive hemorrhagic complications. CASE REPORT A 5 day old male baby delivered via LSCS at 36 WOG was admitted to NICU due to large sacrococcygeal teratoma (20X15cms). The neonate had no other congenital abnormality. Total weight of neonate was 2.7kgs of which tumor was approximately 700gm. Ct Abdomen and pelvis Revealed Type 2 Mature sacrococcygeal teratoma with intrapelvic and large extrapelvic component with Spina bifida occulta and surgical removal of tumour was performed DISCUSSION: Sacrococcygeal tumors can be diagnosed antinatally,the cases with antenatal diagnosis are at a high risk of perinatal complications and fetal death from high output cardiac failure. Early surgical Management in above case and Good postoperative care, minimal blood loss during procedure resulted in Good outcome (2) CONCLUSION Mature sacrococcygeal teratoma appear to be benign in nature and complete surgical resection is main stay of treatment REFERENCES 1)Yadav DK, Acharya SK, Bagga D, Jain V, Dhua A, Goel P. Sacrococcygeal Teratoma: Clinical Characteristics, Management, and Long-term Outcomes in a Prospective Study from a Tertiary Care Center. J Indian Assoc Pediatr Surg. 2020 Jan-Feb;25(1):15-21. 2) Shrestha HK, Shrestha RG. Sacrococcygeal Teratoma: A Case Report. JNMA J Nepal Med Assoc. 2020 Jul 31;58(227):508-511

Effectiveness of Transforaminal Epidural Steroid Injection and Lumbar Traction in Lumbar Radiculopathy Due to Intervertebral Disc Herniation: A Comparative Study

Background: Lumbar radiculopathy, commonly caused by intervertebral disc herniation, leads to severe pain and disability. Various non-surgical treatments, including Transforaminal Epidural Steroid Injection (TESI) and lumbar traction, are employed to alleviate pain and improve functionality. Objective: The study aimed to compare the effectiveness of TESI and lumbar traction in managing lumbar radiculopathy. Methods: This study was designed as a prospective, randomized, comparative trial conducted over 12 months at a tertiary care center, involving 100 patients diagnosed with lumbar radiculopathy due to intervertebral disc herniation (IDH). Eligible patients, aged 18 to 65 years with MRI-confirmed disc herniation causing radiculopathy, were randomly assigned to either the TESI group (n=50) or the lumbar traction group (n=50). Exclusion criteria included patients with prior lumbar surgery, spinal infections, or tumors. The TESI group received a single transforaminal epidural steroid injection under fluoroscopic guidance, while the lumbar traction group underwent mechanical traction therapy for 30 minutes per session, three times a week for six weeks. Outcome measures included pain intensity, assessed using the Visual Analog Scale (VAS) at baseline, two weeks, and six months post-intervention, functional outcome using the Oswestry Disability Index (ODI) at the same time points, and patient satisfaction using a five-point Likert scale at six months. Statistical analyses were conducted using SPSS software, with significance set at p-values &lt;0.05. Results: The results of this study demonstrated that both the TESI and lumbar traction groups experienced significant improvements in pain and functional outcomes; however, the TESI group showed more pronounced results. In terms of pain reduction, the TESI group’s mean VAS score decreased from 7.5 at baseline to 3.2 at two weeks and 2.8 at six months, while the lumbar traction group saw a decrease from 7.6 to 5.1 at two ........

Haemorrhoids among Patients Visiting the Department of Surgery in a Tertiary Care Military Hospital of Nepal: An Observational Study

Introduction: Haemorrhoids is a common issue in the anorectal region and involves venous engorgement in the region. It greatly diminishes the overall quality of life of affected individuals by disrupting their physical and mental health. This descriptive cross-sectional study aimed to ascertain the prevalence of haemorrhoids and the associated risk factors among patients visiting a tertiary care center's surgery department. Methods: A descriptive cross-sectional study was conducted in the Department of Surgery of a tertiary care center from July 2023 to November 2023 after obtaining ethical approval. Convenience sampling method was used. The total sample size included in the study was 385. The data was analyzed in IBM SPSS Statistics software. Point estimate was calculated at 95% confidence interval. Results: Among 385 patients included in the study, haemorrhoids was prevalent in 53 (13.76%, 95% CI: 8.76%-18.76%). Internal haemorrhoids was most prevalent with 30 (56.60%) cases. 22 (41.51%) cases presented with Grade 1 haemorrhoids. The most prevalent symptoms were bleeding in 29 (54.72%) cases, perianal pain in 25 (47.17%) cases, itching in 28 (33.96%) cases and burning sensationin 15 (28.30%) cases. Conclusions: The prevalence of haemorrhoids in our center was found to be higher as compared to similar studies done in Southeast Asian region but similar with studies done in other region.

Prevalence and Risk Factors of Diabetic Retinopathy in a Tertiary Hospital in Padang, Indonesia

Background: Diabetic retinopathy (DR) is a prevalent microvascular complication of diabetes, leading to vision impairment and blindness. This study aimed to determine the prevalence and risk factors associated with DR among patients attending a tertiary care center in Padang, Indonesia. Methods: A cross-sectional study was conducted at the eye polyclinic of Dr. M. Djamil General Hospital, Padang, Indonesia, from October 2020 to March 2021. Patients diagnosed with diabetes who underwent a comprehensive ophthalmological examination were included. Data collected included demographics, duration of diabetes, cholesterol levels, and DR status (classified as non-proliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR)). Results: A total of 200 patients with diabetes were included. The prevalence of DR was 55%, with 40% having NPDR and 15% having PDR. Multivariate analysis revealed that longer diabetes duration (odds ratio [OR] 1.8, 95% confidence interval [CI] 1.2-2.7, p=0.004), higher cholesterol levels (OR 2.5, 95% CI 1.5-4.1, p=0.001), and older age (OR 1.1, 95% CI 1.0-1.2, p=0.03) were independently associated with the presence of DR. Conclusion: DR is highly prevalent among diabetic patients in tertiary care center Padang, Indonesia. Longer diabetes duration, elevated cholesterol, and older age are significant risk factors for DR. Early detection and management of these risk factors are crucial to prevent vision loss in this population.

A Five-year Study of Spinal Disorders among Patients Presenting to the National Trauma Center of Nepal: An Observational Study

Introduction: Spinal cord injuries result in severe neurological impairments and disabilities. With an estimated 15.4 million cases globally in 2021, spinal cord injuries are more common in low- and middle-income countries, yet research in these areas is limited. This study aimed to find the pattern of spinal injuries and outcomes associated with spine injuries over a five-year duration at a tertiary trauma care center. Methods: This observational cross-section study was conducted at the National Trauma Center, Kathmandu from 2075 to 2080 B.S. with ethical clearance from the Nepal Health Research Council (Reference number: 968). Total-population sampling was used. A structured proforma was employed as the primary data collection tool. Data was analyzed using SPSS. Results: Of the 20843 patients, 2070 (9.93%) had spinal injuries. The median age was 43 (IQR 32-56) years, with 1391 (67.20%) male patients. The median hospital stay was 12 (IQR 7-20) days. Falls accounted for 1221 (58.99%) cases, and road traffic accidents for 195 (9.42%). Spinal fractures were present in 1076 (51.98%) patients with 456 (42.38%) in lumbar vertebra. There were 225 (10.87%) cases of subluxation with 214 (95.11%) in cervical level. Conclusions: The study provides insights into the patterns and outcomes of spinal injuries over five years of time. The mortality rate and cases of patients leaving against medical advice highlight areas for improvement in patient care and follow-up.

Bird beak-related ocular injuries in southern India: Factors and visual implications

PurposeTo evaluate the visual outcomes and identify prognostic factors in patients with ocular bird beak injuries treated at a tertiary eye care center in South India. MethodsWe conducted a comprehensive analysis of patients with bird beak injuries, considering factors such as age, gender, mode of injury, and size of laceration. The affected eyes underwent detailed examinations using slit-lamp biomicroscopy, and B-scan ultrasonography was performed to assess the status of the posterior segment. Postoperatively, the best-corrected visual acuity (BCVA) was measured at the last follow-up visit. ResultsOur findings demonstrated significant improvements in visual outcomes, including BCVA and uncorrected visual acuity (UCVA), over a follow-up period ranging from 1 week to 3 years (p < 0.05). No significant changes were observed in endophthalmitis, intraocular pressure (IOP), lens status, or retinal abnormalities during the study duration. ConclusionThis retrospective study highlight the potential for favorable long-term visual improvement in patients with ocular injuries caused by bird beaks and emphasize the importance of timely intervention. Delayed surgical treatment and the requirement for multiple surgeries within the first week were found to negatively impact visual acuity. Hence, it is crucial to raise public awareness, particularly in rural areas, to prevent these potentially devastating injuries and ensure early intervention for optimal visual recovery.

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

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

A 3-arm randomized control trial to compare the efficacy of re-circulant hyperthermic intravesical chemotherapy versus conventional intravesical mitomycin C and BCG therapy for intermediate-risk non-muscle invasive bladder cancer.

To evaluate the efficacy and side effects of re-circulant hyperthermic intravesical chemotherapy versus conventional treatments for intermediate risk non-muscle invasive bladder cancer (NMIBC). A randomized 3-arm, parallel group trial was conducted at a single tertiary care centre. 135 patients with low-grade intermediate-risk cancer, having undergone complete resection of bladder tumor were included. Patients were assigned 1:1:1, to receive intra-vesical chemo-hyperthermia (C-HT), mitomycin-C (MMC) or BCG therapy. There was no treatment crossover. Patients were followed up with check cystoscopy every 3 months for histopathological recurrence. The three arms were comparable in terms of age, gender, tumor size, number of tumors and clinical stage or grade of tumors. Mean tumor size was 2.58 (± 0.88) cm and the mean number of tumors resected was 2.04 (± 1.02) (Range 1-5). There was no significant difference between the various groups for tumor recurrence (χ2 = 1.96, p = 0.375) or time to recurrence (13.6 vs. 10.8 vs. 9.8 months, p = 0.844)though incidence of non-healing necrotic area was higher with C-HT (22.2% vs. 11.1% and 4.8%, χ2 = 6.093, p = 0.048). Median (IQR) follow up period was 26 (12-52) months. Treatment discontinuation or drug intolerance was significantly higher in BCG arm (p = 0.03). Intravesical C-HT with MMC, conventional MMC and BCG are equally effective and comparable alternatives for intravesical therapy in low-grade intermediate-risk NMIBC. Higher incidence of non-healing resection site with C-HT and higher local symptoms with BCG are a concern.

Efficacy of Otago versus Bosu ball exercise protocol on core stabilization, static and dynamic balance in non-specific chronic low back pain: a randomized parallel arm clinical trial

Abstract Chronic non-specific low back pain (NSLBP) is a pain and stiffness in the lower back region for which specific cause of the pain is unknown. Otago exercises and Bosu ball exercises aim to improve balance and reduce pain and disability. There is a lack of literature where these approaches are not compared and hence the need arises to evaluate their efficacy in the management of NSLBP. A randomized parallel arm clinical trial was conducted in physiotherapy outpatient department at tertiary care center located in Belagavi city, India. 36 individuals with NSLBP, where 18 individuals were randomly allocated into two groups, i.e. Group A (Otago exercise) and Group B (both sides utilized (Bosu) ball exercise). Both the groups received conventional therapy (hot moist pack and interferential current therapy) 3 times/ week for 4 weeks. Outcome measures like plank holding test, star excursion balance test (SEBT), single-leg stance test (SLST), visual analogue scale (VAS) and Oswestry disability index (ODI) were assessed at baseline and on day 12 post-treatment. A within-group analysis using the Wilcoxon matched-pairs test and the dependent t-test showed statistically significant improvements in all outcome measures (). Between group analysis has shown both interventions to be equally effective in ODI () in individuals with NSLBP. In conclusion both Otago and Bosu ball exercises were effective, Bosu ball exercise demonstrated greater efficacy in enhancing core stability, static and dynamic balance, as well as reducing disability and pain in individuals with chronic NSLBP. Clinical trial registry of India: registration number CTRI/2023/11/059489

Histopathological patterns of gastrointestinal lesions: Insights from a Tertiary Care Centre

Gastrointestinal (GI) lesions are a common clinical concern with significant implications for patient health, particularly in cases involving malignancies. Understanding the histopathological spectrum of these lesions is crucial for improving diagnosis and treatment strategies. This study aimed to investigate the histopathological spectrum of gastrointestinal lesions at a tertiary care center, focusing on the prevalence of different types of lesions and their distribution according to clinicopathological parameters. Methods: This cross-sectional study was conducted over a one-year period, from November 2022, to October 2023, at the Department of Pathology, Rohilkhand Medical College and Hospital, Bareilly, UP. A total of 100 patients with clinically suspected GI lesions were included. Biopsy specimens were collected and analyzed using standard histopathological techniques. The data were analyzed to determine the frequency of different types of GI lesions and their correlation with clinical features. Results: The study found that inflammatory lesions were the most prevalent, accounting for 57% of the cases. Malignant lesions were identified in 35% of the patients, with adenocarcinoma being the most common malignancy, especially in the colon, representing 57.14% of malignant cases. The small intestine was the most frequently affected anatomical site, involved in 33% of the cases, followed by the appendix at 22%. The majority of patients were middle-aged males, with a significant correlation between the type of lesion and gender. Conclusion: This study highlights the significant burden of gastrointestinal lesions, particularly inflammatory and malignant lesions, in the studied population. The findings underscore the importance of early detection and intervention to prevent the progression of these lesions, particularly in high-risk groups such as older males. Enhanced clinical management strategies are needed to address the substantial impact of GI pathologies on patient health.

A Cross Sectional Study of the Prevalence of Retinopathy in Patients with Chronic Kidney Disease on Hemodialysis in a Tertiary Care Centre in Chengalpattu District, South India

Context: Many studies have reported varying proportions of retinopathy among cases with chronic kidney disease (CKD). Cases with severe grades of CKD were more likely to develop ocular complications, especially diseases which occurs due to small vessel pathology. Aim: To estimate the prevalence of various types of retinopathies in patients with CKD undergoing hemodialysis in a tertiary care centre in South India. Settings and Design: The outpatient Department of Ophthalmology and Hemodialysis unit of Nephrology, Karpaga Vinayaga Institute of Medical Sciences from January 2022 to June 2023 A cross-sectional hospital-based observational study in a low resource setting. Methods and Material: The study consists of 28 patients who were known cases of CKD on hemodialysis. Patients underwent complete ocular evaluation and findings were noted. The pre hemodialysis values of blood urea and serum creatine, hemoglobin, liver function tests and vital parameters were also noted. Data analysis was done utilising version 20 of Statistical Packages for the Social Sciences (SPSS). Results: 56 eyes of 28 patients on hemodialysis were studied. The mean age was 53 years + 10.9 with a male preponderance. 31.6% had retinopathy of which 26.3% had hypertensive retinopathy and 5.3% had diabetic retinopathy. This is contrary to the previous studies that have reported a higher incidence of diabetic retinopathy in patients with end stage CKD. Hypertension resulted in CKD earlier than diabetes. Conclusion: The results emphasize the importance of frequent eye examination in patients with CKD to identify retinopathy earlier, thus potentially averting permanent vision impairment.

Histopathological Profile of Cholecystectomy Specimens at a Tertiary Care Center: A Retrospective Study

Abstract Introduction: Gallbladder is one of the most frequently received specimens in any histopathology laboratory. Its diseases may present with a varied spectrum ranging from congenital anomalies, cholelithiasis, and inflammatory or noninflammatory lesions to noninvasive and invasive neoplasms. Cholelithiasis (gallstones) is the most common lesion and accounts for more than 95% of gallbladder diseases and affects 10%–20% of the adult population. The incidence is 2–4 times higher in females than in males. Aims and Objectives: This study was designed to study the histopathological spectrum of gall bladder diseases in the population, study the most common gall bladder diseases in cholecystectomy specimens, and study the frequency of gall bladder carcinoma. Methodology: This retrospective observational study was done in the Pathology department at a tertiary care hospital and research center, from September 2016 to September 2023. Tissue was fixed in 10% buffered formalin and then processed by the routine paraffin embedding techniques. Sections were cut at 4–5 μ thickness and stained with hematoxylin and eosin stains. Special stains were done if required for confirmation. All the slides were analyzed and reported by a trained histopathologist. Results: Females were affected more as compared to males. The commonest age group affected was 41-50 years. Gallstones were observed in 33.58% of patients. Gallbladder neoplasm was rare and incidental findings. Conclusion: Gallbladder disease demonstrated a diverse spectrum of histopathological changes in the cholecystectomy specimens and showed female preponderance. Gallbladder carcinoma was observed as a rare occurrence and was an incidental finding mainly. Hence, a microscopic (histopathological) examination is required for every cholecystectomy specimen.

Surgical Strategy and Decision Making in Recurrent Atlanto-Axial Dislocations: The Role of Traction

ObjectiveTo analyse patients with recurrent atlantoaxial dislocation and give a criterion of an ideal patient who can benefit from redo surgery. MethodsThis retrospective study was conducted in a tertiary care centre, which included 20 patients who failed atlantoaxial surgery from January 2013 to June December 2021. They were evaluated using X-ray, CT, and MRI examinations, and their clinical data were accessed from the hospital's medical records department and the picture archiving and communication system. They were given a trial of traction to look for clinical and/or radiological improvement. Those showing clinical and/or radiological improvement underwent redo fixation. The operative steps involved removing joint capsules, denuding articular cartilage and joint preparation followed by reduction of basilar invagination by the combination of spacer and/or bone graft and putting screws in C1/Occiput and C2. A strut graft was placed between Occiput/ C1 and C2. ResultsThe mean change in mJOAS and Nurick grade following the first surgery was statistically significant (1.00 ± 0.73, p-value 0.002 and -0.15 ± 0.27, p-value 0.046, respectively). On similar paths, the mean change in mJOAS and Nurick grade following the second surgery was also statistically significant (4.25 ± 0.32, p-value <0.001 and -1.2 ± 0.11, p-value <0.001, respectively). Improper usage of constructs (31.57%), inadequate/no joint preparation (42.10%/57.90%) and poor choice of graft (100%) were the leading causes of failure of index surgery. ConclusionsThe best candidates who can benefit after re-do surgery are the ones who exhibit either clinical and/or radiological improvement on the trial of traction, as the pathological C1-C2 joints are either not fused or have undergone pseudoarthrosis. Those patients who do not exhibit significant clinical or radiological improvement post-trial of traction should not be offered subsequent surgical intervention.