Tertiary Care Center Research Articles

S1318 Crohn’s Disease Is Associated With a Lower 10-Year Atherosclerotic Cardiovascular Disease Risk Compared to Ulcerative Colitis: A Retrospective Study at a Tertiary Care Center

S1318 Crohn’s Disease Is Associated With a Lower 10-Year Atherosclerotic Cardiovascular Disease Risk Compared to Ulcerative Colitis: A Retrospective Study at a Tertiary Care Center

Chromosomal Alteration Patterns in PitNETs: Massive Losses in Aggressive Tumors.

The molecular biology of pituitary neuroendocrine tumors (PitNETs) revealed few recurrent mutations and extensive chromosomal alterations, with the latter being the driving force in a subset of these lesions. Addressing the need for an easily applicable diagnostic tool, we conducted a retrospective study of 61 PitNETs operated at a tertiary care center. All cases were subtyped according to the 2022 WHO classification of endocrine tumors. A genome wide NGS panel targeting 1500 single-nucleotide polymorphisms (SNP) was used to classify chromosomal imbalances, loss of heterozygosity and copy number variations in DNA from formalin fixed paraffin embedded tissues. We identified four distinct chromosomal patterns, with varying distribution among different tumor lineages. Forty-two of 61 (69%) PitNETs showed chromosomal alterations. Gonadotroph PitNETs showed mostly quiet genomes. The majority of lactotroph PitNETs (19/20, 95%) were altered, exhibiting a gained genome and a remarkably low recurrence rate. Nine of ten (90%) corticotroph PitNETs harbored chromosomal alterations, of which two aggressive corticotroph tumors and one metastatic corticotroph PitNET showed massive chromosomal losses leading to near haploid/near homozygous genomes. The comparison of the molecular profile of primary and recurrent PitNETs of five patients showed no significant accumulation of alterations over time. A simple genome wide 1500 SNP test can be used in the identification of outspoken aggressive subsets of PitNET by the occurrence of a near haploid/near homozygous genome. Furthermore, the presence of neoplastic tissue in resected material can be potentially confirmed for non-gonadotroph PitNETs in suboptimal histological assessment conditions.

Editorial Comment on “Comparative Analysis of Dorsal Onlay Buccal Mucosal Graft and Vaginal Wall Graft Urethroplasty for Female Urethral Stricture at a Tertiary Care Centre”

Editorial Comment on “Comparative Analysis of Dorsal Onlay Buccal Mucosal Graft and Vaginal Wall Graft Urethroplasty for Female Urethral Stricture at a Tertiary Care Centre”

Radiological Comparison And Evaluation Of Faciomaxillary Tumour Or Tumor Like Lesions: A Case Series

Background: Faciomaxillary tumors and tumor like lesions can occur at all age groups irrespective of the gender. The lesions also do not demonstrate a specific location as most of them can occur in both mandible and maxillary region with involvement of tooth. These lesions cannot be distinguished based on the radiological appearance as most of the lesions have overlapping features and hence the patient has to undergo invasive procedure to get a definitive diagnosis. (10) Materials and Methods: Study design: Retrospective observational case series in tertiary care center. Study area is Bagalkote district, in the northern part of the Indian state of Karnataka. Study population: All patients reporting to the department of Radiodiagnosis from Oral Medicine department with OPG suggesting a lytic lesion in SNMC and HSK, Bagalkot. Study Time: Study done for a period of 26months were taken into consideration from March 2021 to April 2024 Results: Over 70 percent of the lesions were found in the mandible while the rest 30 percent was in the maxillary region. Computed tomography showed that around 90% of the case were unilocular solid cystic lesions while the rest were multilocular lesions.Out of 20 cases 11 were found to have features of odontogenic keratocyst. Among these 11 cases, 5 were given a differential diagnosis of ameloblastoma out of which 3 were proven to be ameloblastoma on HPR;3 were given a differential of dentigerous cyst with 2 being histologically proven and 2 of the cases had overlapping features of periapical cysts.6 cases were given differential diagnosis of periapical cyst or dentigerous cyst. One case was found to be ameloblastoma histologically whereas rest were found to be dentigerous cysts. Conclusion: Faciomaxillary lesions cannot be distinguished based on the OPG and computed tomography appearance as most of the lesions have overlapping features and hence the patient has to undergo invasive procedure to get a definitive diagnosis

Personal and Psychological Predictors of Glycemic Control among Patients with Type 2 Diabetes at a Tertiary Care Center in Ghana

Abstract Background: As diabetes is a chronic disease, patients must make adjustments to their lifestyle and self-care practices to live optimally with the disease and reduce associated morbidity. Their ability to make these adjustments is partly dependent on their coping capacity and resilience, which may enhance glycemic control. Materials and Methods: A cross-sectional study involving 156 consented and randomly selected type 2 diabetes patients was conducted at Korle-Bu Teaching Hospital, a national health facility in Accra, Ghana. Structured questionnaires were used to extract information on sociodemographic characteristics and clinical parameters (including glycemic control), while the Africultural Coping Systems Inventory and the Adult Resilience Measure were administered to assess cultural variables and resilience. Stata version 16.1 was used to analyze the data, and the significance level was set at P ≤ 0.05. Results: Ethnicity, age, and working status were significantly associated with glycemic control. Adjusted binary logistic regression revealed that the odds of good glycemic control among nonhypertensive patients was 2.8 times greater compared with hypertensive patients (adjusted odds ratio [aOR]: 2.80, 95% confidence interval [CI]: 1.02–7.69); while the odds of good glycemic control increase by 17% with every 1-point increase in the resilience caregiver arm score (aOR: 1.17, 95% CI: 1.01–1.37). Conclusions: Efforts should be made toward implementing proactive measures aimed at enhancing income levels, coping strategies, and resilience among patients diagnosed with diabetes mellitus. Such initiatives are crucial for assisting individuals in adapting to the chronic nature of the condition and its associated treatment regimen, ultimately leading to improved glycemic control and treatment outcomes.

Impact of Humidification Modality on Incidence of Endotracheal Tube Occlusion in COVID-19 Patients.

Background: Endotracheal tube (ETT) occlusion is reported at a higher frequency among coronavirus disease-2019 (COVID-19) patients. Prior to the COVID-19 pandemic, literature examining patient and ventilator characteristics, including humidification, as etiologies of ETT occlusion yielded mixed results. Our study examines the relationship of humidification modality with ETT occlusion in COVID-19 patients undergoing invasive mechanical ventilation (IMV). Methods: We conducted a retrospective chart review of COVID-19 patients requiring IMV at a tertiary care center in New York from April 2020 to April 2021. Teleflex Neptune heated wire heated humidification (HH) and hygroscopic Intersurgical FiltaTherm and Sunmed Ballard 1500 heat and moisture exchangers (HME) were used. Episodes of ETT occlusion were recorded. Univariate and multivariable logistic regression models were used to investigate the relationship between humidification modality and the occurrence of ETT occlusion. Findings: A total of 201 eligible patients were identified. Teleflex HH was utilized in 50.2% of the population and the others Intersurgical and Sunmed HME devices. Median age was 62 years and 78.6% of patients had at least one medical comorbidity. Precisely, 24% of patients experienced an ETT occlusion after a median of 12 days. The HME group was younger (58.5 vs 64 years), predominantly male (75% vs 59.4%), and experienced more total ventilator days than the HH group (24 vs 12). Those using the studied HME devices had significantly higher odds of ETT occlusion (OR 4.4, 95% CI 1.8-10.6, P = .0011). Three patients (6.1%) experienced cardiac arrest as a consequence of their occlusion. There were no deaths directly attributed to ETT occlusion. Conclusions: The studied HME devices were significantly associated with higher odds of ETT occlusion in COVID-19 patients requiring invasive mechanical ventilation. These events are not without significant clinical consequences. Prolonged use of under-performing HME devices remains suspect in the occurrence of ETT occlusions.

Thyrotoxic periodic paralysis-A retrospective study from southern India.

Thyrotoxic periodic paralysis is a rare manifestation of thyrotoxicosis. Here, we describe the clinical and biochemical features and treatment outcomes of this disorder. This retrospective study was conducted at a tertiary care centre in southern India. The clinical and biochemical features, treatment received, and therapeutic outcomes of all patients with thyrotoxicosis and acute flaccid paralysis without any other identifiable causes (cases for the study) were compared with an equal number of consecutively selected patients who presented with thyrotoxicosis but without features paralysis (controls for the study) during the same period. A total of 41 cases and controls were included in this study. The proportion of males was 92.6 % and 43.9 % among the cases and controls, respectively. The mean age was 32.8 (±7.6) years [cases] and 39.7 (±11.3) years [controls]. Among cases, 20 % of patients presented without clinical thyrotoxic features. Graves' disease was the most common aetiology of thyrotoxicosis in both groups (92.6% of cases and 87.8% of controls). The prevalence of goitre was significantly higher among controls (90.2 %) than among cases (53.7 %). The mean serum potassium, free T4 and Total T3 levels were significantly lower in the cases, than in the controls. Among these cases, two patients had an additional aetiology for persistent hypokalaemia, likely Gitelman's syndrome. This is one of the largest series of thyrotoxic periodic paralysis cases in India. Among subjects with thyrotoxicosis, serum potassium, free T4, and total T3 levels were significantly lower in those with periodic paralysis than in those without.

Open and Endovascular Treatment of the Common Femoral Artery in a Tertiary Care Center

ObjectivesEndovascular treatment of peripheral arterial disease (PAD) involving the common femoral artery (CFA) remains controversial. This study compares the perioperative and long-term outcomes of open and endovascular lower extremity revascularization (LER) involving the CFA. MethodsA retrospective analysis of all patients undergoing LER for PAD in a tertiary-care center was performed. Patients were divided into the open or endovascular group based on the first LER that involved the CFA. Patient characteristics were compared, and outcomes analysis focused on the ipsilateral CFA reintervention rate. Multivariable regression was used to determine the association between the CFA revascularization strategy and CFA reintervention. Analysis was stratified based on indication. ResultsA total of 1,954 patients underwent 4,879 LER (including all reinterventions) between 2013-2020. The CFA was treated in 22.9% of patients (N=447/1954) and 15.0% of LER procedures involved the CFA (N=734/4,879). Patients treated for CLTI were more likely to undergo open CFA treatment compared to patients with claudication (60.6% vs 42.7%, p<0.001). Patients treated for CLTI with endovascular therapy were more likely to be male compared to patients treated with open surgery (66.7% vs 51.2%, p=0.025). On the other hand, patients treated for claudication with endovascular therapy were more likely to have CAD (64.9% vs 50.5%, p=0.027) and diabetes (49.3% vs 33.0%, p=0.013) compared to open surgery. There was no difference in perioperative amputation or mortality but patients undergoing CFA endarterectomy were more likely to have post-operative bleeding in the claudication group as well as wound infections and longer hospital length of stay in both indication groups. On follow up, patients receiving endovascular LERs were more likely to require an ipsilateral CFA reintervention for both claudication (35.1% vs 21.0%, p=0.019) and CLTI (33.3% vs 20.9%, p=0.043) with no difference in major amputation or survival between the groups. Among claudicants, CFA endarterectomy was significantly more likely in patients initially treated with endovascular therapy (conversion to open endarterectomy) compared to patients initially treated with open surgery (redo endarterectomy) (14.9% vs 5.0%, p=0.015). Multivariable logistic regression revealed an independent association between endovascular therapy and CFA reintervention for claudication (OR= 2.29 [1.16-4.66]) and CLTI (OR=2.38 [1.18-4.90]). Kaplan-Meier analysis showed no difference in MALE-free survival. ConclusionEndovascular treatment of the CFA is associated with higher reintervention of the CFA regardless of indication. CFA endarterectomy is associated with higher perioperative complications and longer hospital stay. Understanding the severity of CFA disease could improve patient selection for optimal therapy.

Correlation of Lymph Node Characteristics and Extranodal Extension in Oral Cavity Squamous Cell Carcinoma.

Identify correlations between lymph node characteristics and extranodal extension (ENE). Retrospective chart review. Tertiary care center. Patients who underwent neck dissection for oral cavity squamous cell carcinoma from 2004 to 2018 were included, with a starting sample of 496. The primary outcome was ENE in at least 1 lymph node. Additional variables included number of dissected nodes, positive nodes by level, positive lymph node ratio (LNR), and diameter of metastatic deposit and ENE focus. Univariate and multivariate binary logistic regression analyses were performed to determine correlations between included variables and ENE. Of the 496 patients, 233 had nodal metastasis (47.0%). 13,814 nodes were removed, with 714 (5.2%) containing metastasis. Of the positive nodes, 28.0% had ENE, 47.2% did not have ENE, and 24.8% were unknown. The mean ENE diameter was 5.1 mm (SD, 9.9). On univariate logistic regression analysis, ipsilateral neck LNR per 0.1 unit increase (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.02-1.32, P = .02), metastatic deposit size per 1 mm increase (OR 1.06, CI 1.04-1.08, P < .0001), and clinical T- (P = .02) and N-class (P = .0003) significantly correlated with ENE. On multivariate logistic regression analysis, size of metastatic deposit (OR 1.06, CI 1.03-1.08, P < .0001) remained significantly correlated with ENE. Controlling for confounding variables, size of metastatic deposit was an independent predictor of ENE, suggesting that as the metastatic deposit size increases, the odds of extension through the capsule also increases. This may be due to capsule thinning as the deposit grows or could represent the invasive nature of aggressive disease.

S1246 Decade-Long Analysis of Crohn's Disease and Ulcerative Colitis: Disease Burden, Phenotypic Differences, and Ethnographic Insights in a Tertiary Care Center

S1246 Decade-Long Analysis of Crohn's Disease and Ulcerative Colitis: Disease Burden, Phenotypic Differences, and Ethnographic Insights in a Tertiary Care Center

Validation of a 3D-Printed Silicone-Based Laryngeal Model for Resident Education.

We sought to validate a laryngeal simulation model and subsequently demonstrate its efficacy in improving surgical technique. Pre-post interventional study. Otolaryngology Program at a Tertiary Care Center. A low-cost, high-fidelity laryngeal model was created using a 3-dimensional-printed cast and multilayered silicone to mimic vocal fold lesions. Participants (attendings and trainees) were first given a series of tasks including mucosal vocal fold lesion resection and microflap excision of a submucosal lesion. Trainees were then provided with an instructional video from a laryngologist and asked to repeat the same tasks on the model. Performance data was then assessed using validated surveys and blinded expert reviewers. Eighteen participants completed the simulation. All subjects agreed that the "simulation experience was useful" and 93% agreed "the simulator helped improve my ability to do microsurgical tasks." In the postinstruction self-evaluation, trainees reported a significant decrease in mental demand (95% confidence interval [CI]: 0.37-0.91; P = .038) and significant increase in subjective performance (95% CI: 1.51-51.89; P = .016) compared to the preinstruction self-evaluation. On the postinstruction attempt, there was a significant improvement in all domains of the adapted objective structured assessment of technical skills as measured by 3 blinded, expert reviewers. This study demonstrates the usefulness of a silicone larynx model and the value of instructional video in developing laryngeal microsurgical skills. Participants positively reviewed the laryngeal model and trainees saw both a subjective and objective improvement indicating tangible operative benefits from the use of this laryngeal simulation.

EP.14A.14 Clinical Insights and Survival Outcomes of Malignant Pleural Mesothelioma: An Experience from a Tertiary Care Centre in India

EP.14A.14 Clinical Insights and Survival Outcomes of Malignant Pleural Mesothelioma: An Experience from a Tertiary Care Centre in India

Impact of prosthodontic rehabilitation on psychological status and quality of life in maxillectomy patients of coronavirus disease 2019-associated mucormycosis at a tertiary care center: A prospective clinical study

Aims: The study was aimed to evaluate the effect of prosthodontic rehabilitation on psychological status (PS) and quality of life (QoL) in maxillectomy patients of coronavirus disease 2019-associated mucormycosis (CAM). Settings and Design: The study was designed as a prospective and clinical study. Materials and Methods: Twenty-four CAM patients undergoing maxillectomy and subsequent prosthetic rehabilitation were included. The treatment involved surgical, intermediate, and definitive obturator delivery at various phases of healing. PS was assessed using the Hospital Anxiety and Depression Scale (HADS), QOL using the European Organization for Research and Treatment of Cancer QoL Questionnaire-Head and Neck Module (EORTC QLQ-HandN35), and the functioning of obturator was assessed utilising the Obturator Functioning Scale (OFS) at various time points: before maxillectomy (T1), 2 weeks after maxillectomy (T2), 2 weeks upon usage of intermediate obturator (T3), just before delivery of definitive obturator (T4), and 12 weeks after the usage of definitive obturator (T5). Statistical Analysis Used: Data were analyzed using a social science statistical analysis program (Stata 14.0; StataCorp LLC, Texas, USA). The significance level was chosen &lt;0.05. Shapiro–Wilk test was used to assess the normality of quantitative data. Student’s t-test was employed (α =0.05) to evaluate if the patient’s PS, QOL, and obturator function had changed over time. The Spearman correlation coefficient (α =0.05) was utilized to evaluate the correlation coefficient between PS, QOL, and obturator function seen at T3 and T5. Results: Out of 24 enrolled patients, nine were dropped out. HADS-anxiety score was the highest at T1 (18.6 ± 1.2) and HADS-depression score was the highest at T2 (18.8 ± 1.6). HADS scores decreased significantly (P = 0.001) after prosthetic rehabilitation. EORTC QLQ-HandN35 score was the highest at T2 (105.8 ± 29.5), with statistical significance (P = 0.001) after rehabilitation. OFS was the highest at T3 (51.9 ± 3.9) and lowest at T5 (25.4 ± 2.8). Conclusion: CAM and maxillectomy deliberately affects the PS and QOL. Prosthetic rehabilitation, psychological motivation, and education create greater improvement in PS and QOL. The progress in parameters showed an upward trend with good obturator quality over a period of time.

Distribution of port wine birthmarks and glaucoma outcomes in Sturge-Weber Syndrome

PurposeTo identify which features of Sturge-Weber Syndrome (SWS) were most associated with glaucoma onset, severity, and treatment failure at a tertiary care center. DesignRetrospective cross-sectional study. SubjectsChildren who had SWS with and without glaucoma. MethodsElectronic health records were reviewed for all children with SWS presenting between 2014-2020. Examination and imaging findings from dermatology, neurology, and ophthalmology were collected. Logistic regression was used to identify factors associated with glaucoma-related outcomes. Main Outcome MeasuresPrimary outcomes included glaucoma development, progression to surgery, and treatment failure. Failure was defined as having a final intraocular pressure >21 mmHg, devastating complication, or ≤20/200 vision. ResultsTwenty-three of 44 SWS patients (52.3%) developed glaucoma, and 6 of 23 patients (26.1%) had both eyes affected. Sixteen of 29 eyes (55.2%) required surgery, and 29.6% overall met our failure criteria (mean follow-up: 5.1±4.3 years). Glaucoma diagnosis was associated with bilateral port wine birthmarks (PWB; OR 5.9; 95% CI 1.3-43.2), PWB with any lower eyelid involvement (OR 9.7, 95% CI 2.6-44.5), and choroidal hemangiomas (OR 3.8, 95% CI 1.1-13.8), but was not associated with upper eyelid or leptomeningeal angiomas, seizures, prior hemispherectomy or pulsed-dye laser. Eyes that progressed to surgery were more likely to have PWB affecting the lower eyelid (OR 33.7, 95% CI 4.5-728.0). No clinical or demographic factors were associated with treatment failure. In most cases, angle surgery failed (72.7%) but was a temporizing measure before subconjunctival filtering surgery. ConclusionsLower eyelid and choroidal angiomas were associated with glaucoma diagnosis, suggesting a spatial relationship with SWS findings. However, leptomeningeal angiomas were not associated possibly because these are further from the eye.

Lost dwell time and cycler alarms in inpatient automated peritoneal dialysis at a tertiary care hospital

Background and aims Dwell time is a critical component of automated peritoneal dialysis (APD) prescription, the stage at which transmembrane mass and fluid transfer occur. Loss of prescribed dwell time (LDT) can negatively influence the efficiency of APD. We investigated the incidence of LDT and related causes using APD in the acute care setting at a tertiary care center. Methods Retrospective analysis was conducted of all inpatients receiving APD treatments from 1 December 2021 to 1 June 2023. Patient demographics, comorbidities, laboratory, and treatment data were extracted from electronic medical records and a propriety database. Results N = 235 cycler treatments completed by 32 patients were included for analysis. The total LDT per treatment exceeding 30 minutes and 60 minutes occurred in 27% and 20% of all treatments. LDT of more than 10 minutes per each cycle exchange occurred in 26%. Session disruptions were caused by slow out-flow (55%), inadequate drain volumes (32%), patient line occlusions (20%), and priming errors (23%). The slow flow alarm requiring user intervention was reported to occur in about one-third of all treatments (31%). Conclusion There was significant LDT and inadequate drain volume seen in about one-quarter and one-third of all inpatient APD treatments respectively. This can impact solute clearance and ultrafiltration. Slow flow alarms were the most prevalent and the leading cause of LDT followed by inadequate drain volume. Future studies are required to investigate measures to reduce slow drain and improve drain volume in the hospital setting.

Prospectively investigating the impact of AI on shared decision-making in post kidney transplant care (PRIMA-AI): protocol for a longitudinal qualitative study among patients, their support persons and treating physicians at a tertiary care centre

IntroductionAs healthcare is shifting from a paternalistic to a patient-centred approach, medical decision making becomes more collaborative involving patients, their support persons (SPs) and physicians. Implementing shared decision-making (SDM) into...

Avoidant Restrictive Food Intake Disorder: A Case Series

Abstract Avoidant restrictive food intake disorder (ARFID), a recently described eating disorder categorized under DSM-5, has varied clinical presentations. The primary eating disorders have well-established practice parameters for management. However, there is no evidence-based first line of management for ARFID. There is a significant gap in this evolving construct and clinical practice. We present a case series from a tertiary care center in India, focusing on clinical management. Four adolescents with 3 girls and 1 boy between 12 and 17 years of age were included in the study. Diagnosis and management were delayed in all. Mean body mass index was 15.36 (5.26) kg/m2 at the time of diagnosis. Key drivers were dread of choking, sensory characteristics, and avoidance of unpleasant upper and lower gastrointestinal symptoms. This series supports a culturally cognizant hypothesis, an evidence based, viable management model for ARFID in low- and middle-income countries (LMIC). A combination of family-based treatment (FBT) and cognitive behavior therapy is an effective treatment model for India and other LMICs.

Can maternal inflammatory and nutritional status, evaluated by the hemoglobin, albumin, lymphocyte, and platelet (HALP) score and the prognostic nutritional index (PNI) in the first trimester, predict late-onset fetal growth restriction?

ObjectiveThe aim of this study was to evaluate the potential of immunonutritional markers, specifically the hemoglobin, albumin, lymphocyte, and platelet (HALP) score and the prognostic nutritional index (PNI), in predicting late-onset fetal growth restriction (LO-FGR) during the first trimester.Materials and methodsThis retrospective study was conducted at a tertiary care center between October 2022 and August 2023. The study included a total of 213 singleton pregnancies, with 99 women in the LO-FGR group and 114 in the healthy control group, matched by maternal age and gestational age at delivery. All blood samples were collected between 11 and 14 weeks of gestation (during the first-trimester screening test). We analyzed first-trimester laboratory parameters, specifically focusing on hemoglobin levels, white blood cells (WBCs), lymphocytes, platelets, and albumin levels. Afterwards, we calculated the HALP score and PNI, and then compared the values of both groups.ResultsBoth HALP score (3.58 ± 1.31 vs. 4.19 ± 1.8, p = 0.012) and PNI (36.75 ± 2.9 vs. 39.37 ± 3.96, p < 0.001) were significantly lower in the FGR group than in the control group. The HALP score cut-off value of < 3.43 in predicting FGR had a sensitivity of 62.3% and specificity of 54.5% (AUC = 0.600, 95% CI: 0.528–0.672, p = 0.012). The PNI cut-off value of < 37.9 in predicting FGR had a sensitivity of 65.8% and specificity of 62.9% (AUC = 0.707, 95% CI: 0.632–0.778, p < 0.001). While the HALP score was not a significant predictor of composite adverse neonatal outcomes in the FGR group, PNI showed a cut-off value of < 37.7 with a sensitivity of 60.9% and specificity of 59.7% (AUC = 0.657, 95% CI: 0.581–0.733, p < 0.001).ConclusionThe HALP score and PNI are valuable prognostic tools for predicting the risk of FGR in the first trimester. Low PNI values are also associated with composite adverse neonatal outcomes in pregnancies complicated by FGR.

Bacterial profile of wound site infections and evaluation of risk factors for sepsis among road traffic accident patients from Apex Trauma Centre, Northern India.

Background. Among the most significant yet often ignored health issues worldwide are trauma and accidental injuries. India accounts for 11% of global deaths in road accidents, the highest in the world, according to the World Bank report. There are limited data about the bacterial contamination of road traffic accident (RTA) wounds and their antibiotic susceptibility patterns. Materials and Methods. This prospective study was conducted in a tertiary care centre in northern India from January 2023 to January 2024. Wound deep swabs or aspirates were collected from RTA patients with traumatic injuries at different time intervals. Gram stain and culture were performed, and positive aerobic culture was subjected to antibiotic susceptibility testing. Organism identification was done using MALDI-TOF MS and routine biochemical tests. Blood samples were also collected to rule out bloodstream infections during follow-up if the patient became febrile or showed symptoms of systemic infection. Sepsis was defined in those patients who had two or more scores in the systemic inflammatory response syndrome criteria with a positive microbiological culture. Risk factors were evaluated for sepsis on the basis of the patient's vitals, injury characteristics, procalcitonin, Glasgow Coma Scale (GCS) score, need for mechanical ventilation and complete blood count, which were obtained from the patient's admission file. Results. A total of 189 wound samples were collected, of which 99 (52.38%) samples showed the growth of microorganisms. The aerobic isolates included 69 (69.69%) Gram-negative bacilli, of which the majority were Klebsiella pneumoniae, 28 (28.28%) Gram-positive cocci, of which the majority were Staphylococcus aureus and 2 (2.02%) anaerobic isolates. Among the Gram-negative isolates, none of the isolates were resistant to colistin. All S. aureus isolates were susceptible to vancomycin, teicoplanin and levonadifloxacin. Sepsis developed in 50 (26.45 %) patients. Significant risk factors evaluated for sepsis were a raised procalcitonin level, a low GCS score, a higher injury severity score, the need for mechanical ventilation and a raised quick sequential organ failure assessment score. Conclusion. It is essential to ascertain the profile of microorganisms isolated from RTA wounds in order to reduce antibiotic resistance and deliver efficient treatment.

Postkidney Transplant Thrombotic Microangiopathy Effectively Treated with Eculizumab in a Tertiary Care Center

Postkidney Transplant Thrombotic Microangiopathy Effectively Treated with Eculizumab in a Tertiary Care Center