Tertiary Care Center Research Articles

Comprehensive assessment of male lower urinary tract symptoms at a tertiary care urology clinic: A prospective study

Introduction: Lower Urinary Tract Symptoms (LUTS) significantly impact men's quality of life, often due to benign prostatic occlusion. Therefore, the study aimed to assess the severity of LUTS associated with demographic and clinical factors. There is potential for tailored care and public health strategies to alleviate the burden of male LUTS (mLUTS).Methods: A one-year prospective cross-sectional study conducted at a urological clinic in a tertiary care centre, gathered data from male patients using self-reported questionnaires and investigator interviews on Lower Urinary Tract Symptoms and International Prostate Symptoms Score (IPSS). Statistical analysis, employing SPSS, utilized descriptive statistics and the Chi-square test, with significance set at P < 0.05.Results: The total of 181 male patients participated in this study with mean age 66.65 years. The majority (80.7%) were over 60 , showing a mean IPSS score of 21.06 ± 7.8. BMI analysis revealed 58.6% normal and 41.4% overweight/obese, with distinct IPSS scores. Occupation significantly linked to LUTS severity (p=0.002), distinguishing employed and retired individuals. diabetes (p=0.047) and alcohol consumption (p=0.034) were significantly associated with LUTS severity. 44.2% had equally dominant voiding and storage symptoms, and 52.5% underwent surgical interventions, TURP being the most common (30.9%). Moderate and severe LUTS were associated with poor Quality of Life (p=0.0001)Conclusions: mLUTS associated with rising age (more mLUTS in >60 years), obesity/ over weight, Diabetes and Alcohol consumption. Majority had moderated LUTS (IPSS) Study on individuals over 60 found occupation, diabetes, and alcohol consumption linked to severe Lower Urinary Tract Symptoms (LUTS). Coexistence of voiding and storage symptoms underscored complexity. High rates of medical interventions, notably Transurethral Resection of the Prostate, emphasized clinical impact and management challenges in this demographic.

Role of Radiation Therapy in the Management of Locally Advanced Vulvar Cancer—15 Years of Experience at a Tertiary Care Center in Southern India

Role of Radiation Therapy in the Management of Locally Advanced Vulvar Cancer—15 Years of Experience at a Tertiary Care Center in Southern India

Extra-digestive manifestations of celiac disease

Introduction. Celiac disease (CD) is a chronic autoimmune disorder triggered by gluten ingestion in genetically predisposed individuals, presenting with a diverse range of symptoms that extend beyond the gastrointestinal tract. The condition’s systemic nature is evidenced by its extra-digestive manifestations, which can affect various organs including the skin, joints, liver, and nervous system. Methods. This descriptive, retrospective study was conducted at a tertiary care center, focusing on adult patients diagnosed with CD who exhibited extra-digestive symptoms. Data were extracted from medical records of patients admitted between January 1, 2010 and June 30, 2024. Variables included demographic information, primary diagnosis, and associated extra-digestive manifestations. Descriptive statistical methods were employed for data analysis. Results. The sample included 108 patients with CD, the mean age was 43.21 years, with a predominance of females (76.85%). Iron deficiency anemia was the most common extra-digestive manifestation, affecting 20.37% of patients, followed by hypoproteinemia (18.52%) and Hashimoto’s thyroiditis (14.81%). Co-occurrence analysis revealed frequent combinations of conditions, such as anemia with cardiovascular diseases and depressive disorders. Notable associations with neurological conditions like gluten ataxia and peripheral neuropathy were also observed. Conclusion. This study highlights the extensive extra-digestive manifestations of celiac disease, underscoring its systemic impact. The high prevalence of autoimmune conditions such as Hashimoto’s thyroiditis and rheumatoid polyarthritis among CD patients reflects the need for holistic management strategies. Discrepancies between our findings and existing literature, particularly regarding skin and neurological conditions, emphasize the need for further research to better understand these associations and the long-term effects of a gluten-free diet.

Study to Assess the Clinical and Sociodemographic Profile of Measles in Children Admitted to a Tertiary Care Center: A Retrospective Study

Study to Assess the Clinical and Sociodemographic Profile of Measles in Children Admitted to a Tertiary Care Center: A Retrospective Study

Efficacy and Surgical Outcomes of Posterior Apical Spinal Osteotomy in Severe Thoracic/Thoracolumbar/Lumbar Kyphoscoliosis in Dystrophic Curves of Neurofibromatosis Type 1

Objective: Kyphoscoliosis is the most common deformity seen in patients with neurofibromatosis type 1 (NF1), occurring in 10%–60% of cases. These dystrophic curves often exhibit severe deformities that require surgical intervention. Various procedures have been evaluated and studied; however, there is no consensus, and these are also associated with a higher rate of morbidity. Therefore, this study aimed to evaluate the clinical and radiological outcomes of apical spinal osteotomy (ASO) in NF1 patients with dystrophic curves who exhibited thoracic, thoracolumbar, or lumbar kyphoscoliosis.Methods: We conducted a retrospective analysis of prospectively collected data involving 21 children with dystrophic NF1 curves who underwent ASO at a single tertiary care center from November 2009 to June 2017. The efficacy of ASO for correcting coronal and sagittal deformities was assessed. Clinical outcomes (visual analogue scale [VAS], Oswestry Disability Index [ODI], and Frankel grade) and radiological outcomes (Cobb angle correction, fusion, and complications) were evaluated.Results: The study included 21 patients (11 males, 10 females) with a mean age at surgery of 9.33 years. The mean kyphotic Cobb angle improved significantly from 98.33° to 36.52°. The mean sagittal vertical axis also improved significantly from 7.40 cm to 4.21 cm, along with significant improvements in VAS and ODI scores.Conclusion: This study describes a technique using a posterior approach for single-level ASO in the treatment of severe dystrophic NF1 curves. The technique can be effective in children with mild to moderate curves, yielding good clinicoradiological outcomes and satisfactory correction rates.

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

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

Long term survival and prognostic factors for Thymoma and Thymic carcinoma. Results from a tertiary care center

Background: Thymomas and thymic carcinoma are rare tumors though thymoma is the most common anterior mediastinal neoplasm. We aimed to determine the long-term survival after thymectomy and also to identify the poor prognostic factors of survival. Methods: A retrospective analysis of tumors with the final diagnosis of thymoma or thymic carcinoma (n = 42) was done. Upfront surgery or a multimodality approach was used depending upon Masaoka-Koga stage. Statistical analysis was done using SPSS 26.0 Results: Median survival was 144, 97, 123, 45, 19 and 20 months in Masaoka-Koga stages 1, 2a, 2b, 3, 4a and 4b, respectively (p < 0.001). Median survival and five-year overall survival (OS) were 86 months and 60%, respectively. Median OS was 125, 25 and 24 months for R0, R1 and R2 resections, respectively (p < 0.001). Median OS was 123 months in no-tumor spillage group vs 24 months in tumor spillage group (p < 0.001). Conclusion: Masaoka-Koga stage, resection status and intraoperative tumor spillage are the most important predictors of long-term survival.

Can peripheral perfusion index predict disease mortality in COVID-19 patients in the emergency department

BackgroundCoronavirus disease 2019 (COVID-19) pneumonia remains a major public health concern. The prognostic efficacy of Peripheral Perfusion Index (PPI) has been researched in different pathologies such as trauma and sepsis. We hypothesized that PPI may serve as predictor of mortality in hospitalized patients with COVID-19 infection. This study aimed to describe the association between PPI at admission and COVID-19 mortality, a new mortality prediction tool. MethodsThis retrospective, observational study was conducted at a tertiary care center in Turkey. Adult patients diagnosed with COVID-19 infection were enrolled in this study between Februrary 15, 2022 to April 15, 2023. Patient demographic and clinical data including vital signs, laboratory parameters and PPI on admission were collected from an electronic database. PPI was measured using Philips G30E patient monitor system. The primary outcome was in-hospital mortality. ResultsIn total, 200 patients with COVID-19 infection were included and 42 (21 %) in-hospital deaths were identified. For all parameters of study, age, oxygen saturation, respiratory rate, PPI, urea, creatinine, White Blood Cell (WBC), and High-sensitive cardiac Troponin T (hs-cTnT) values were significantly different between survivors vs non-survivors. hs-cTnT >21,25 pg/mL[HR:2.823 (95 % CI:1.211–6583)], PPI <2,15 [HR:2485 (95 % CI:1.194–5.175)], Oxygen saturation <87 % [HR:2258 (95 % CI:1.191–4.282)], and WBC >9680 x103/ml [HR:2.124 (95 % CI:1.083–4.163)] were independent predictors of in-hospital mortality. ConclusionsThis study identified the factors affecting in-hospital mortality among COVID-19 patients. Importantly, besides many parameter, PPI at admission was significantly associated with COVID-19 mortality and could be a feasible marker in emergency department to identify high risk patients.

Study of the availability of home modifications in paraplegics

Background: Paraplegia is loss of motor strength, sensations and bowel bladder function below the level of injury due to spinal cord damage. Spinal cord injury is medically managed along with rehabilitation which includes muscle strengthening, and mobility in a wheelchair with proper training and home modification. The paraplegic population is the most demoted section of our society and is confronted with barriers to accessibility, health facilities, educational opportunities, and skill development. Accessibility is very important for the paraplegic population and lack of accessibility may affect their abilities in self-care and employment so our objective was to find out modifications done in the house of paraplegics, compartmentalize and standardize various modifications done. Methods: The study setting and design was done at tertiary care centre, community setting and observational study. The sample size was 40. Inclusion was of both genders, sub-acute to chronic phase spinal cord injury and wheelchair users was taken. Exclusion was quadriplegics and bedridden patient’s spinal cord injury individual. Results: The statistical analysis was done by using SPSS V 26 software. The mean and standard deviation were calculated. In this study, the mean average modification shows in the ascending order of the entrance and exits (69.5%), followed by the hall (64.30%), bedroom (60%) bathroom (60%) and the kitchen (37.5%). Conclusions: The study concluded that most of the spinal cord injury individuals modify their houses. Entrance, exits and followed by the hall were most modified and the kitchen was the least modified compartment in the house.

Prevalence of stricturing, penetrating complications and extraintestinal manifestations in inflammatory bowel disease detected on cross-sectional imaging in a tertiary care setting.

Stricturing, penetrating complications and extraintestinal manifestations (EIMs) are frequent in patients with inflammatory bowel disease (IBD). There is limited data on the prevalence of these complications in patients with IBD. Therefore, we aimed to assess the burden of these complications detected incidentally on cross-sectional imaging. A retrospective study conducted at two tertiary care centers in London, Ontario. Patients (≥18years) with a confirmed diagnosis of IBD who underwent CT enterography (CTE) or MR enterography (MRE) between 1 Jan 2010 and 31 Dec 2018 were included. Categorical variables were reported as proportions and the mean and standard deviations were reported for continuous variables. A total of 615 imaging tests (MRE: 67.3% [414/615]) were performed in 557 IBD patients (CD: 91.4% [509/557], UC: 8.6% [48/557]). 38.2% (213/557) of patients were male, with mean age of 45.6years (±15.8), and median disease duration of 11.0years (±12.5). Among patients with CD, 33.2% (169/509) had strictures, with 7.8% having two or more strictures and 66.3% considered inflammatory. A fistula was reported in 10.6% (54/509), the most common being perianal fistula (27.8% [15/54]), followed by enterocutaneous fistula (16.8% [9/54]), and enteroenteric fistula (16.8% [9/54]). Additionally, 7.4% (41/557) of patients with IBD were found to have an EIM on cross-sectional imaging, with the most prevalent EIM being cholelithiasis (63.4% [26/41]), followed by sacroiliitis (24.4% [10/41]), primary sclerosing cholangitis (4.8% [2/41]) and nephrolithiasis (4.8% [2/41]). Approximately 40% of patients with CD undergoing cross-sectional imaging had evidence of a stricture or fistulizing disease, with 7% of patients with IBD having a detectable EIM. These results highlight the burden of disease and the need for specific therapies for these disease phenotypes.

Quality of life and performance status after whipples surgery: experience from Sheikh Russel National Gastroliver Institute and Hospital

Background: Whipple surgery, or pancreaticoduodenectomy, is a complex surgical procedure often performed to treat pancreatic and periampullary cancers. Quality of life (QOL) and performance status are critical metrics for assessing post-operative outcomes. This study aimed to evaluate the QOL and performance status of patients after Whipple surgery in a tertiary care centre in Bangladesh. Methods: This cross-sectional study was conducted among 64 patients who underwent Whipple surgery at the Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh between January 2021, and January 2023. The World Health Organization Quality of Life-BREF (WHOQOL-BREF) and Eastern Cooperative Oncology Group (ECOG) performance scales were used to assess QOL and performance status, respectively. Data were analyzed using descriptive and inferential statistics. Results: Most participants were aged between 43 and 53 years, with a mean age of 54.66 years, and were predominantly male (64.06%). Most participants rated their physical health (34.37%) and psychological state (37.50%) as "good." Most patients (57.81%) experienced uneventful post-operative recovery. About (34.37%) was "restricted in strenuous work." Chemotherapy negatively impacted physical health (r=-0.198, p=0.02). Conclusions: The findings indicate that most patients experienced favourable outcomes in both QOL and performance status following Whipple surgery. The results underscore the importance of holistic patient care and highlight potential areas for clinical improvement and future research.

Family Satisfaction of Polytrauma Patients in Intensive Care Unit at a Tertiary Care Center

Family Satisfaction of Polytrauma Patients in Intensive Care Unit at a Tertiary Care Center

Oncologic outcomes based on lymphovascular space invasion in node-negative FIGO 2009 stage I endometrioid endometrial adenocarcinoma: a multicenter retrospective cohort study

BackgroundThe 2023 International Federation of Gynecology and Obstetrics (FIGO) staging system includes lymphovascular invasion quantification as a staging criterion for endometrioid endometrial carcinomas; no lymphovascular invasion and focal invasion (≤4...

A Retrospective Analysis of the Association of Obesity with Anthracycline and Trastuzumab-Induced Cardiotoxicity in the Treatment of Breast Cancer and Lymphoma

IntroductionBackground: Trastuzumab and anthracyclines are mainstays of chemotherapy in breast cancer and lymphoma patients. We aimed to assess the relationship between obesity and the risk of developing chemotherapy-associated cardiotoxicity.Material and methodsA retrospective chart review was conducted of all patients who received trastuzumab or anthracyclines at our tertiary care center. Bivariate analyses were conducted to determine the association between demographic and clinical variables with cardiotoxicity status. Two multivariate logistic regression models were generated to assess whether BMI was independently associated with cardiotoxicity.ResultsOf the 368 patients receiving either trastuzumab or anthracyclines, 16 patients developed cardiotoxicity. Demographically, age, race, BMI, BSA, and weight did not differ between the patients who developed cardiotoxicity and those who did not. The mean dose of anthracycline and trastuzumab did not differ between the patients who developed cardiotoxicity and those who did not. Obesity was not found to increase the odds of developing cardiotoxicity and was slightly protective. A non-significant decrease in the odds of developing cardiotoxicity was found for every one-unit increase in BMI. In a multivariable model using BMI as a continuous predictor and controlling for BMI, age, hypertension, chemotherapy type and coronary artery disease, the only significant predictor of cardiotoxicity was a previous history of arrhythmia.ConclusionsObesity was not a significant risk factor for patients developing cardiotoxicity from trastuzumab or anthracycline based chemotherapy and may be a protective factor for cardiotoxicity. Additional studies with greater statistical power are needed to further evaluate this effect and independently evaluate obesity as a risk factor for cardiotoxicity.

Barriers and Opportunities to Improve Healthcare Access for Uninsured Patients at a Student-Run Free Clinic in New Haven, Connecticut.

Uninsured patients have limited options to pay for necessary medical services. Most United States hospitals offer financial assistance programs (FAPs) to help patients pay for care, but the challenges of accessing these programs demonstrate a need for more solutions. This study was a retrospective review of 200 randomly sampled HAVEN Free Clinic patients from September 2022 to September 2023. Patients were eligible to be seen at HAVEN if 18-65 years old, without health insurance, and living in New Haven County, Connecticut. Application histories to Medicaid and hospital FAP at a non-profit tertiary care center in Connecticut were assessed. In the 200-patient sample, average age was 43.4 ± 11.2 years old, 61.0% were female, and 86.5% were Hispanic or Latino. 68% were employed with a median household yearly income of $18,200 [$7,293-$26,741]. 80% had applied for a hospital FAP-71.1% were currently approved for Free Care or Discounted Care. 6% were approved for Medicaid; 2.5% were approved for Emergency Medicaid. Of those who applied for a hospital FAP, 28.3% received ≥ 1 application denial. Most common hospital FAP denial reasons were missing, wrong, or outdated proof of income (93.9%), and incomplete application (6.1%). Hospital FAPs and Medicaid provide important access to care for uninsured patients, but are not without barriers and should not be viewed as the only solution. Improving hospital FAP access involves assessing eligibility at presentation, extending approval duration, and advocating for more funding. Addressing these barriers can advance equitable care for all.

Aptamer and Aptasensor Technology for Diagnosis of Infectious Diseases: A Mini Review

Aptamers are not so new a concept, however, it is scarcely discussed by medical fraternity. Aptamers are potent, new identification molecules set to rope in a new technique in the diagnostic arena. Aptamers have started almost a revolution in diagnostic assays since their discovery in the 90s. (Radu S. Current and previous disease outbreaks around the world, U.S. News & World Report. 2020 Mar 13 [cited 2024 Jun 17]. Available from: https://www.usnews.com/news/best-countries/slideshows/20-pandemic-and-epidemic-diseases-according-to-who) provides an overview of pandemics and epidemics as reported by the WHO. It is interesting to note that several endemic and epidemic diseases viz. Chikungunya, Cholera, Crimean-Congo haemorrhagic fever, Ebola virus disease, Hendra virus infection, Influenza, Lassa fever, Marburg virus disease, Meningitis, MERS-CoV (Middle East Respiratory Syndrome Corona Virus), Monkeypox, Nipah virus infection, Novel coronavirus, Plague, Rift Valley fever, SARS (Severe Acute Respiratory Syndrome), Smallpox, Tularaemia, Yellow fever, and Zika virus disease have been identified by the WHO and are being explored for applicability of aptamer technology in their identification. One of the most important necessities to control epidemic or pandemic diseases is early diagnosis. However, the majority of the diagnostic tests for these diseases are available only in tertiary care centres. The objective of this review is to discuss the potential of aptamer technology to provide undemanding, simple, specific, sensitive, and cost-effective diagnostic assays that are usable in remote and field conditions. Here, we discuss recent advances and approaches in aptamer and aptamer engineering useful in the diagnosis of infectious and non-infectious conditions. This review also discusses a few sensing discoveries which are a gift of advanced engineering and technology using optical and electrochemical aptasensors. It's still a long way to go, and we need to take into account the technological challenges being faced by aptamer-aptasensor technology.

Survival among patients with lung cancer managed at a tertiary care center in North India.

Though there has been advancement in the management of lung cancer, it is not well utilized due to its limited availability and high cost. This is a prospective observational study done at a tertiary care center from January 2014 to December 2022, involving patients with primary lung cancer. After tumor-node-metastasis staging and molecular testing, the patients received chemotherapy, radiotherapy, surgery, targeted therapy, and immunotherapy in various combinations as per the prevailing National Comprehensive Cancer Network Guidelines. 92 patients were enrolled in the study, with the mean age being 58.94±10.33 and 72 (78.26%) being males. 69 (75%) patients were either current or former smokers. 78 (84.78%) patients had an Eastern Cooperative Oncology Group (ECOG) score of 0-2 while the remaining had an ECOG of 3-4. 80 (86.95%) patients had non-small cell lung cancer (NSCLC) [44 (47.83%) adenocarcinoma, 25 (27.17%) squamous cell carcinoma, and 11 (11.95%) NSCLC: not otherwise specified], while 12 (13.04%) patients had small cell lung cancer. One (1.08%) patient each presented in stage I and stage II, 31 (33.69%) patients presented in stage III, and 59 (64.13%) patients presented in stage IV. 44 patients with adenocarcinoma were subjected to mutational analysis, and an epidermal growth factor receptor mutation was found in 13 (29.5%) patients. None of the patients had ALK mutation, ROS-1 rearrangement, or BRAF mutation. PD-L1 expression was evaluated in 9 patients with NSCLC, and it was found in 6 (66.66%) patients. The overall mean survival was 12.7 months. The mean survival for patients with stages I, II, III, and IV was 70, 96, 8.1, and 12.7 months, respectively. Survival in stage IV was better than in stage III, as the eligible patients received targeted therapy and immunotherapy. Targeted therapy and immunotherapy have improved survival. Molecular analysis should be done whenever indicated, and eligible patients must be administered targeted therapy and immunotherapy.

Impact of the Early COVID-19 Pandemic on the Quality of Obstetric Care in a Tertiary Care Center in Karachi, Pakistan

Impact of the Early COVID-19 Pandemic on the Quality of Obstetric Care in a Tertiary Care Center in Karachi, Pakistan

Exploring diaphragmatic response to high-flow nasal cannula in patients with COVID-19 pneumonia using ultrasound: a proof of concept study.

Recent studies have highlighted the recognition of diaphragmatic dysfunction as a significant factor contributing to respiratory disturbances in severely ill COVID-19 patients. In the field of noninvasive respiratory support, high-flow nasal cannula (HFNC) has shown effectiveness in relieving diaphragm dysfunction. This study aims to investigate the diaphragmatic response to HFNC in patients with COVID-19 pneumonia by utilizing ultrasound. This retrospective study was conducted in a medical-surgical intensive care unit (ICU) at a tertiary care center in Buenos Aires, Argentina (Sanatorio de Los Arcos) over a 16-month period (January 2021-June 2022). The study included patients admitted to the ICU with a diagnosis of COVID-19 pneumonia who were deemed suitable candidates for HFNC therapy by the attending physician. Diaphragm ultrasound was conducted, measuring diaphragmatic excursion (DE) both before and during the utilization of HFNC for these patients. A total of 10 patients were included in the study. A statistically significant decrease in respiratory rate was observed with the use of HFNC (p = 0.02), accompanied by a significant increase in DE (p = 0.04). HFNC leads to a reduction in respiratory rate and an increase in DE as observed by ultrasound in patients with COVID-19 pneumonia, indicating promising enhancements in respiratory mechanics. However, further research is required to validate these findings.

Imaging-Based Disease Assessment and Management Recommendations: Impact of Multidisciplinary Sarcoma Tumor Board

Multidisciplinary tumor boards (MTBs) facilitate decision-making among subspecialists in the care of oncology patients, but the mechanisms by which they enhance outcomes remain incompletely understood. Our aim was to measure the agreement between sarcoma MTBs and radiology reports’ disease assessment and management recommendations. This single-center IRB-approved retrospective study evaluated cases presented at a weekly sarcoma MTB from 1 August 2020 to 31 July 2021. Cases without clinical notes, imaging studies, or radiology reports were excluded. The data collected included the patient’s clinical status at the time of the MTB, the treatment response assessment by the MTB and radiologists (stable disease; partial response; complete response; progressive disease/recurrence), and the recommendations of the radiology reports and of the MTB. The agreement between the initial radiologist review and MTB on disease assessment and recommendations was analyzed using kappa statistics. In total, 283 cases met the inclusion criteria. Radiology reports provided recommendations in 34.3% of cases, which were adhered to by the ordering providers in 73.2% of cases. The agreement between MTBs and radiology reports was moderate in disease assessment (86.2% agreement; κ = 0.78; p &lt; 0.0001) and negligible in recommendations (36% agreement; κ = 0.18; p &lt; 0.0001). Radiologists were more likely to assign progressive disease/recurrence than MTBs (54.4% vs. 44.4%; p &lt; 0.001) and to recommend short-term imaging follow-up more commonly than MTBs (46.4% vs. 21.7%; p &lt; 0.001). At a tertiary care center, radiologists’ isolated interpretations of imaging findings and management recommendations frequently differ from the MTB’s consensus, reflecting the value of multidisciplinary discussions incorporating the patient’s clinical status and the available treatment options into the final radiographic assessment.