Tertiary Care Centre In Delhi Research Articles

Foreign Body Ingestion in Children: An Experience of 99 Cases in a Tertiary Care Center in Delhi

ABSTRACT Background: Accidental ingestion of foreign bodies in children is critical, as the inability to effectively communicate can potentially lead to devastating consequences. We aimed to determine the epidemiology of foreign body ingestion and variability according to age, gender, type, and location of foreign body, and describe its management. Aim and Objective: The aim was to study the various types of foreign body ingestions in children admitted to pediatric surgery and their management. Materials and Methods: A retrospective study was conducted from January 2020 to June 2022 on children under the age of 12 years with a confirmed diagnosis of foreign body ingestion. Patients were clinically and radiologically assessed, after which standard protocols were followed wherein patients were followed by either observation or emergent management. Emergent management included removal of the foreign body by either endoscopy or surgery. Comparisons among multiple age groups, gender, type of foreign body, location of foreign body, and their management were analyzed. Results: Out of 99 subjects in our study, there were 76 boys and 23 girls. The median age of presentation was 5 years. Most children were asymptomatic at presentation. The most frequently ingested foreign body was a coin in all age groups. The majority of the foreign bodies were suspected to be in the small bowel. The foreign bodies that had crossed the duodenojejunal flexure (n = 74, 74.7%) were managed conservatively with the observation of a variable period of a minimum of 24 h and a maximum of 48 h. 21 cases were managed by endoscopic removal, while three cases required surgical intervention. Conclusions: Overall, the most common gastrointestinal foreign body was a coin in all age groups. Button battery is the most worrisome foreign body; however, depending on its position, it can be managed conservatively. Upper GI foreign bodies can be safely removed endoscopically. Parental counseling is very important for the prevention of ingestion of foreign bodies.

Stroke survival at 1 year: A retrospective study of 400 patients in tertiary care centre in Delhi, India

Stroke survival at 1 year: A retrospective study of 400 patients in tertiary care centre in Delhi, India

INCIDENCE AND PREDICTORS OF SURGICAL SITE INFECTION IN MAJOR ABDOMINAL SURGERIES AT A TERTIARY CARE CENTER IN DELHI

Objective: Surgical site infections (SSIs) are the third commonly stated nosocomial infections, with the prevalence rate of 14–16%. In India, the prevalence of SSIs in elective surgeries ranged from 3.83% to 39% and in cases of emergency surgeries, the prevalence ranged from 12.41% to 26.4%. This study was aimed to measure the occurrence of SSIs amid subjects experiencing major abdominal surgeries at tertiary care center in Delhi and to assess the predictors related to occurrence of SSIs in these subjects. Methods: In this cross-sectional study, data were collected over a period of 1 year at the Department of Surgery, Super Specialty Hospital in New Delhi. The, from January 2017 to January 2018. All major gastrointestinal surgeries were considered. Sociodemographic details, clinical history, and surgical details were taken. Results: Out of total 626 patients, 42 (6.7%) developed SSIs. The positive predictors of SSIs in our study were male gender, American Society of Anesthesiology grade of 2 and above, wound class of two and above, longer duration of surgery, emergency surgery, open surgery, laparoscopic converted to open surgery, presence of comorbidities, presence of hypoalbuminemia, and hypoproteinemia. Conclusion: SSIs seems to be a common source of perioperative morbidity and mortality, leading to increased hospital stay and cost of treatment. Proper planning and accordingly managing such case by case scenarios can lead to decreased incidence of SSIs and help reducing burden to the health system.

A Quality Improvement Study to Improve Oxygen Prescription in the PICU of a Tertiary Care Centre in Delhi, India.

Introduction Oxygen has been gravely misused since its inception as a therapeutic agent. There is a deficit of audits and baseline data for the Indianpopulation, especially in the pediatric age group, which doesn't allow for standardization of protocols and guidelines. Objective Our study aimed at increasing valid prescription rates to 90% by implementation of quality improvement interventions, and assessing knowledge and perception of healthcare workers towards oxygen therapy. Methodology It followed a before-and-after prospective observational study model where baseline audit data was compared with data observed after the implementation of quality improvement strategies. The data was collected through an audit of the medical records of all pediatric patients receiving oxygen therapy in the PICU. Knowledge and perception of healthcare workers about oxygen therapy were assessed via a self-designed questionnaire. The study was undertaken in three phases, including Quality Improvement (QI) team formation and data collection, root cause analysis, and implementation of Plan-Do-Study-Act (PDSA) cycles. Observations and results In the baseline audit, 1.4% of the prescriptions were complete and valid. Subsequently, over the course of four PDSA cycles, valid prescription rates increased; 62.07% in the first, 79.51% in the second, 81.81% in the third, and 91.42% in the fourth cycle respectively. After applying the chi-square test to compare PDSA4 and baseline data, the p-values for written prescriptions and target saturation were found to be statistically significant. In the healthcare worker survey, we found that 100% of them were aware of indications of oxygen prescription, FiO2, and side effects of excessive usage of oxygen therapy, 95% were aware of conditions affecting pulse-oximetry in the pediatric age group, and 75% knew about target saturation and its significance and the procedure to change alarm settings on the monitor. Conclusion Currently, there exists a lack of effective oxygen prescription audits, especially in India, which can be attributed to a lack of awareness and partly, a lack of initiative. Quality improvement initiatives are effective in improving the valid oxygen prescription rate. However, sustained goals can be achieved through regular audits only.

Clinical profile of hospitalised moderate category COVID-19 patients: Short study from a Tertiary Care Centre in Delhi.

The clinical profile of hospitalized moderate-category COVID-19 patients has been understudied globally and in India. The present study was conducted to study the clinical profile and assess the proportions of patients who progressed to severe disease and its predictors among moderate COVID-19 patients. In this single-center observational study, 100 moderate-category COVID-19 patients as per Ministry of Health and Family Welfare (MoHFW) criteria of age ≥18 years of either sex, excluding pregnant females from February to November 2021, were studied by analyzing their clinical profiles and assessing Quick Sequential Organ Failure Assessment (qSOFA), National Early Warning Score 2 (NEWS-2), and chest computed-tomography severity score (CTSS) to predict progression to severe disease. Severe disease was defined as per MoHFW criteria. Out of 100 moderate-category COVID-19 patients, progression to severe disease was seen in 11 patients (11%), among which eight patients had expired, three patients were discharged, and the rest of the 89 patients (89%) who did not progress to severe disease were discharged. A higher age (62.2± 19.5 vs 54.8 ± 14.6 years), along with multivariate analysis revealing male sex (1.25 times), chronic kidney disease (2.86 times), leukocytosis (6.10 times), thrombocytopenia (1.04 times), anemia (9.3 times), a higher qSOFA score (3.6 times), and a higher NEWS-2 score on admission (1.56 times) had higher odds of progression to severe disease. A significant correlation (P < .05) of qSOFA score with serum LDH, ferritin, and hs-CRP levels; CT severity score with the serum ferritin, IL-6, and LDH levels; and NEWS-2 with serum LDH, hs-CRP, and ferritin levels were found. Moreover, the NEWS-2 score was found slightly better than qSOFA on receiver operating characteristic (ROC) curve analysis, with an area under the curve of 85.8% and 83.2%, respectively, predicting progression to severe disease. Our study revealed male gender, chronic kidney disease, leukocytosis, anemia, thrombocytopenia, a higher qSOFA and NEWS-2 score on admission, and further, NEWS-2 score better than qSOFA on ROC curve analysis, with an area under the curve of 85.8% and 83.2%, respectively, in predicting severe disease among hospitalized moderate COVID-19 patients.

Retrospective study of Mortality analysis in different Waves during COVID-19 in tertiary care centre of Delhi

COVID 19 is a communicable disease which has spread all over the world due to human-to-human transmission. The initial symptoms are non specific, and it presents with fever and cough, which can then resolve spontaneously or progress to acute respiratory distress syndrome (ARDS), multiple organ failure, and death. This is a retrospective study conducted in a tertiary care center in Delhi to find out association of factors like age, gender and various co morbidities on COVID-19 mortality. Male patients with older age and having co morbidities were found to have higher mortality and results were statistically significant.

Impact of sepsis in patients admitted with covid-19 infection in a tertiary care center in Delhi. A retrospective cross-sectional study.

COVID-19 pandemic has emerged as one of the worst humanitarian crises in human history. Viral sepsis is implicated as a major source of morbidity and mortality in COVID-19 infection. The study provides an insight into impact of COVID -19 associated sepsis on the patient's clinical course and mortality. The study was conducted on 112 participants admitted with symptomatic COVID -19 infection in a COVID -19 designated center in New Delhi, India between July and October 2020. 41.1% (n=46) of the participants had critical disease which includes sepsis. Out of 46 Critical patients 19 (41.3%) had sepsis, 21(45.7%) had septic shock and 6 (18.8%) had Sepsis with ARDS. Sepsis and septic shock at time of presentation was associated with higher mortality. Severe and critical illness was marked by advance age, comorbidities like Diabetes mellitus, high total leucocyte count and deranged renal and hepatic function in the study. Thus COVID-19 induced sepsis is an important determinant of disease severity precipitating multiorgan dysfunction and adverse outcome in patients.

Comparison of Feto-maternal Outcomes Among Various BMI Groups As Per Asia Pacific Standards: An Observational Retrospective Comparative Study in a Private Tertiary Care Center in Delhi.

To compare the feto-maternal outcomes among various BMI groups as per Asia Pacific Standards. This is a retrospective non-interventional observational study on 1396 antenatal women with singleton pregnancy. Their BMI based on pre-pregnancy weight was calculated and the women were divided into various groups as per Asia Pacific standards for BMI classification. Details of associated morbidities and delivery outcomes were noted in a pre-structured proforma and a comparison was made among the various groups using Chi square test. A p value of < 0.05 was taken as significant. Among the 1396 women under study, 10.6% were underweight, 36% had normal weight, 21% were overweight while 32% were obese or very obese. There was a significant association of low BMI with preterm labor (p value 0.03) and fetal growth restriction (p value < 0.01). Overweight and obese women were found to be more prone to hypertensive disorders of pregnancy (p value- 0.002), gestational diabetes (p value- 0.003) and overweight women were more prone to cholestasis of pregnancy (p value 0.03). The women with higher BMI had a significantly higher requirement of induction of labor (p value-0.0002). There was significant increased number of babies more than 90th percentile in overweight and obese women (p value 0.003). However, there was no change in Neonatal ICU admissions (p value 0.85) or neonatal mortality. Asia Pacific references should be used for studies related to all studies on BMI and pregnancy. All women having BMI outside the normal BMI spectrum are at increased risk of antenatal and postnatal complications. Early identification of such women will enable careful evaluation and counseling to improve the reproductive outcome and feto-maternal health.

Estimation of Serum Calcium Level among Hospitalised Infants with Acute Bronchiolitis: A Cross-sectional Study

Introduction: Acute bronchiolitis is a common viral respiratory illness with clinical features ranging from mild to severe forms, requiring intensive care management. Calcium, a micronutrient, plays a significant role in numerous intracellular and extracellular events. Vitamin D deficiency is known to be associated with respiratory infections, and vitamin D metabolism regulates serum calcium and Alkaline Phosphatase (ALP) levels. Thus, calcium levels may be the actual causative factor at the molecular level to determine the severity of respiratory infections. Aim: To estimate and compare serum calcium levels in infants with acute bronchiolitis and controls. Additionally, it aimed to investigate the effect of sunlight exposure on calcium levels in infants presenting at a tertiary care centre. Materials and Methods: A cross-sectional study was conducted from October 2004 to April 2006, over two consecutive years, among 446 infants in the paediatric unit of a tertiary care centre in Delhi, North India. A total of 223 infants (&lt;1 year of age) hospitalised with a diagnosis of acute bronchiolitis, presenting with the first episode of wheeze based on American Academy of Paediatrics (AAP) criteria (including coryza, fever, tachypnoea, tachycardia, paroxysmal wheezy cough, and irritability), were considered as cases. An equal number of age-matched controls (n=223), admitted for non respiratory illnesses, were included. Blood samples were collected for total serum calcium, phosphorus, and ALP, along with other relevant investigations related to their diagnosis. Statistical analysis was performed using Student’s t-test, Kruskal-Wallis’s test, and Chi-square test. Results: The study included 223 patients in both the case and control groups. In the control group, there were 76.58% males and 23.42% females, while in the cases, there were 81.53% males and 18.47% females. The mean age of cases was 5.78±3.45 months, and controls were 4.77±2.83 months, with a mean difference of 1.01 (95% CI, 0.42-1.59). The mean calcium levels were 9.00±1.43 mg/dL and 8.71±1.51 mg/dL in controls and cases, respectively, with a mean difference of 0.29 (95% CI0.02 to 0.56), which was statistically significant (p-value=0.037). There was no significant difference in phosphorus and ALP levels between the two groups. Conclusion: This study found an association between calcium levels and acute bronchiolitis. The findings suggest that low serum calcium levels might serve as a risk factor for acute bronchiolitis.

Four year long simulation of carbonaceous aerosols in India: Seasonality, sources and associated health effects

India's air quality is in a dismal state, with many studies ascribing it to PM2.5. Most of these corroborate that carbonaceous aerosol (CA) constitute significant fraction of PM2.5. However, investigations on the effect of long-term meteorological or emission changes on PM2.5 and its components, and their associated health effects are rare. In this work, WRF-Chem simulations for three seasons over four years (2016–2019) were carried out to cogitate the spatial and temporal changes in PM2.5 and its components in India. Model predicted PM2.5 concentrations were in good agreement with the ground-based observations for 25 cities. PM2.5 was highest in winter and lowest in pre-monsoon. PM2.5 reduced by ∼8% in Indo-Gangetic Plain (IGP) but increased by ∼38% and ∼130% in south and northeast India, respectively, from 2016 to 2019. IGP witnessed three times higher average PM2.5 concentrations than south India. No significant interannual change in CA contributions was observed, however, it peaked in the winter season. Other inorganics (OIN) were the major component of PM2.5, contributing more than 40%. Primary organic aerosol (POA) fractions were higher in north India, while secondary inorganic aerosol (SIA) dominated south India. Transport and residential sectors were the chief contributors to CA across India. Biomass burning contributed up to ∼23% of PM2.5 in regions of IGP during post-monsoon, with CA fractions up to 50%. Associations between PM2.5 and its components with daily inpatient admissions from a tertiary care centre in Delhi showed that PM2.5 and OIN had lower associations with daily hospital admissions than CA. Every 10 μg/m3 increase in POA, black carbon (BC), and secondary organic aerosol (SOA) were associated with ∼1.09%, ∼3.07% and ∼4.93% increase in the risk of daily hospital admissions. This invigorates the need for more policies targeting CA rather than PM2.5 to mitigate associated health risks, in India.

A Study of Satisfaction among Patients visiting Outpatient Department at a Tertiary Care Centre in Delhi

Background: Healthcare facilities at any point comprises different stakeholders and various mechanisms which require constant monitoring and feedback for smooth functioning and improvement in services. Feedback from patients is an important aspect and qualitative feedback is often left out. Hence a study was carried out to find patient satisfaction at a tertiary care hospital. Method: A cross-sectional study was conducted with a pre-designed bilingual questionnaire with a validated scale for measuring patients’ satisfaction among consenting individuals and caretakers of minor patients visiting OPD of a tertiary care hospital during Jun-Jul 2021. Results: Study participants were predominantly females with a mean age of 43 ± 14.23 years. The majority of study participants were found to be satisfied with “all but one parameter” of the scale for the facilities available at the hospital. Only for the overall cleanliness of the toilets, majority of them were not found to be satisfied. Patients who were asked for follow-up were found to be significantly associated with being overall satisfied with the attending doctor (p &lt; 0.05). Conclusion: Patient satisfaction is an important aspect of healthcare, which is often not considered among other parameters. Healthcare facilities, especially tertiary care hospitals need to assess this component of patient care regularly to improve the quality of services being delivered.

Current Pattern and Clinico-Bacteriological Profile of Healthcare Associated Infections in an ICU Setting: A Study from a Tertiary Care Centre in Delhi

Background: Global prevalence of healthcare associated infections (HAIs) ranges anywhere between 7% and 12% as per WHO estimates. This study was undertaken to understand the pattern and types of HAI at a selected healthcare facility and to determine the common causative agents and their antibiotic susceptibility profile. Methods: One hundred consecutive patients diagnosed with HAI were enrolled and monitored; the causative organisms isolated on culture were recorded and their sensitivity profiles were generated.Results: There were a total of 110 HAIs with 10 patients having two infections each. 69 patients had ventilator associated pneumonia (VAP), 21 patients had catheter associated urinary tract infection (CAUTI) patients, 20 patients had central line associated bloodstream infection (CLABSI), and 10 patients had both VAP and CAUTI. All of the HAIs were device associated. 76 pathogens were isolated on culture. No organism was isolated in 40 HAI. Majority (94.7%) of the organisms were gram-negative and all were multidrug resistant. Seventy-seven of the enrolled patients expired while 23 patients were discharged from the hospital.Conclusions: This study demonstrated that HAIs occur in patients of all age groups; younger patients were not spared. Majority of the HAIs were caused by multidrug resistant gram-negative bacteria and were associated with high mortality. Acinetobacter species was the most common organism associated with HAI.

Preoperative COVID-19 Testing for Elective Ophthalmological Procedure in a Tertiary Health Care Centre: Our Experience During the Pandemic.

BackgroundTo study the prevalence of coronavirus infection among asymptomatic patients requiring eye surgery and the role of screening in prevention of spread of infection among the healthcare workers.DesignThe prospective observational study was conducted in the Ophthalmology department of a tertiary care center in Delhi from September 2020 to December 2020.SettingPatients requiring elective ophthalmological procedures in a tertiary care hospital were screened for coronavirus using the RT-PCR method. Testing methods and results were documented.ResultsAmong the 218 asymptomatic patients posted for elective surgery in that period, 16 (7.3%) were found to be positive for COVID-19. Those who tested positive were advised home isolation and surgery was postponed for the next 14 days. No complications were reported in these patients. One health-care worker also tested positive for COVID-19 during our study period.ConclusionIn our study, 1 out of 14 asymptomatic patients were found to be carriers for the novel virus. Asymptomatic COVID-infected patients may lead to transmission of the virus inside the hospital among the visiting patients and hospital staff while they have no adverse effect on the surgery and its outcome.

Catastrophic health expenditure in patients with Guillain Barre syndrome: Retrospective study.

Catastrophic health expenditure (CHE) is a reliable measure of the financial unpreparedness of the studied population to meet unexpected health issues. The alarming proportion of patients who incur CHE in the wake of an acute neurological illness like Guillain Barre Syndrome (GBS) is of serious concern in a country like India where a large majority of households are uninsured. Medical records of patients diagnosed with at a tertiary care centre in Delhi were analysed retrospectively to determine the rate of CHE. Clinical details and other contributory variables were also recorded. 53 patients with a median age of 29years (10.5-46.5) were included in the study. Tow- third of patients were less than 40years of age and 58.5% were male. 90.6% of patients incurred CHE with a median amount INR 273300spent out of pocket. The enormous magnitude of financial distress and crisis emerging out of an acute neurological illness needs to be addressed with urgency to prevent impoverishment of already weakened households.

A Cross-Sectional Study of Barriers in Prevention of Anemia in Pregnancy.

IntroductionAnemia in pregnancy is a significant health challenge in India and other developing countries. Various health programs aiming anemia prevention are existing in India for many decades. Despite that, anemia affects more than half of pregnant women. Our objective for performing this study was to evaluate the barriers in the prevention of anemia and to evaluate the perceptions and practices of anemic women towards their condition.MethodsA cross-sectional questionnaire-based study, including 210 anemic women, was conducted in a tertiary care center in Delhi, India. In-depth interviews were conducted with 50 participants.ResultsOur important observations were that anemia was more prevalent in multigravida, and 43.80% of anemic patients were not taking iron supplements at the time of diagnosis. Chronic diseases were associated with 28.2% (n=59) of anemic women. Only 19% (n=40) of women sought antenatal care in the first and second trimester; the rest all booked themselves in the third trimester only. Twenty-two percent (n=48) of women reached our hospital after 36 weeks. Ignorance to anemia symptoms and the importance of consistent intake of the oral iron supplements was seen in 35.2% (n=74). One hundred and sixty-five (74.8%) women accepted that healthcare provider had informed them about iron-rich and high protein diet, but only 47.1% (n=98) actually made dietary modifications. Only 9.5% (n=20) of women were consistent in iron intake. Side effects of iron were reported by 30% (n=64) of women, and 15% (n=32) were intolerant to oral iron. Non-availability, change of residence, and forgetfulness were the main reasons behind non-compliance to oral iron.ConclusionWe emphasize motivation for early registration, regular antenatal care, adequate iron supplement supply, and persistent counseling to ensure compliance to iron supplements by the antenatal care provider. Behavior-changing communication is needed at a societal level for antenatal mothers and their families aiming to prevent anemia in pregnancy instead of focussing on treatment.

Real-world data of second-line immunotherapy in metastatic clear cell renal cell carcinoma: A retrospective study

Background: Targeted therapies have prolonged the survival of patients with metastatic renal cell carcinomas (RCC). However, the majority of patients with metastatic RCC develop treatment resistance and disease progression. The programmed cell death protein 1 inhibitors offer a new ray of hope for such patients. Objectives: The primary objective of this study was to evaluate the overall survival (OS) of patients with relapsed metastatic RCC treated with immunotherapy in the second-line setting. The secondary objectives were to assess the safety profile and objective response rate (ORR) for nivolumab. Materials and Methods: This retrospective study was conducted in the Department of Medical Oncology at the Max Institute of Cancer Care, a tertiary care center in Delhi, India. Patients with histologically proven stage IV RCC who had progressed on first-line tyrosine kinase inhibitors (TKIs) and treated with at least four cycles of nivolumab at our center between December 2015 and January 2019 were enrolled in the study. The OS, progression-free survival (PFS), immune-mediated adverse events (irAEs), and ORR were determined. Results: Out of 50 patients with metastatic RCC who progressed on first-line TKIs, 19 received immunotherapy with nivolumab. The median age of the patients was 62 years (range, 31–71 years); the male-to-female ratio was 2:1. The median follow-up time and duration of treatment were 11 months (range, 2–23) and 4.5 months (95% confidence interval [CI], 3.52–5.96), respectively, and 8 (42.1%) patients were alive at the time of analysis. The median OS was 13 months (95% CI, 10.4–15.5) from the start of nivolumab therapy, and the median PFS was 8 months (95% CI, not evaluable). The best response was progressive disease in 47.3%; the ORR was 26.3%. Grade 1/2 and grade 3/4 adverse events were observed in 68.4% and 10.5% of the patients, respectively. Adverse events of any grade were reported in 13 (68.6%) patients. Fatigue and hypothyroidism were the most frequently observed irAEs associated with nivolumab and occurred in 4 (21%) and 11 (57.8%) patients, respectively. Four (15.7%) patients developed grade 1 pruritus. No fatal toxicities were recorded. Conclusion: Nivolumab is efficacious and safe as a second-line treatment option for metastatic RCC in Indian patients.

Risk Factors of COVID-19 among Patients Attending a Tertiary Care Centre in Delhi: A Case Control Study

Introduction: COVID-19 is an infectious disease caused by a newly discovered coronavirus Severe Acute Respiratory Syndrome Corona Virus-2 (SARS CoV-2). Therefore, there is paucity of data on risk factors of COVID-19 in India which will help in designing preventive measures. Objective: To determine the risk factors of COVID-19 patients attending a tertiary care institution. Methods: The study was conducted at tertiary care hosipital in South Delhi, India among the patients admitted in Covid-19 wards or visiting the hospital for testing of SARS CoV-2 infection. Contact data of test results was collected from the medical record and detailed information was collected through telephone calls. 103 cases were selected who were found test positive by RT PCR and 103 negatives were selected as controls. Data was collected using pre-tested Questionnaire. The data were first captured in paper-based case record form and then entered in a Microsoft Excel and analyzed in SPSS Software version 21.0. Result: The mean age of all the participants was 37.63±15.32 years. On comparing cases and controls, it was found that symptoms like fever, general weakness, cough, sore throat, breathlessness and headache were significantly associated with cases, having an odds ratio of greater than 1 and p value&lt; 0.05. On analysing various underlying medical conditions amongst controls and cases, it was found that there was a significant difference among cases and controls who had Diabetes Mellitus (DM) and Hypertension (p-value: 0.001) with a high odds ratio of 6.130 and 5.964 respectively. Around half of the cases (54.4%) and 23.3% of controls reported to have faced discrimination or changed attitude of their neighbours after revealing their RT-PCR report and this difference was statistically significant (p-value 0.001). Conclusion: Study revealed that majority of symptoms were not predictors of COVID-19 and only occupations and history of contact remained significant risk factors of COVID-19 in multivariate analysis. A multicenter research study is required to learn more about risk factors.

Cytomorphological evaluation of Cutaneous and Subcutaneous masses: A seven year study from a tertiary care centre in Delhi

Introduction: Skin, subcutaneous and soft tissue masses form a varied group of non-distinctive lesions showing a wide variety of differentiation and morphological features. Clinically these lesions are often misdiagnosed due to their wide array of types and variants. FNAC plays an important role in early timely diagnosis of these masses especially in distinguishing benign from malignant lesions. Our aim is to study the spectrum and cytomorphological features of skin, adnexal and soft tissue lesions by FNAC in patients presenting with lump, nodule or any induration. Material and Methods: Out of a total of 15,533 FNAC cases during the study period, 1162(7.5%) cases from skin, adnexa and soft tissue lesions were included in the study. FNAC smears were stained with Papanicolaou (PAP)/May Grunwald Giemsa (MGG) stain and classified on cytology into inflammatory, benign and malignant neoplastic conditions. The spectrum and cytomorphological features of skin, adnexal and soft tissue lesions was studied. Results: Out of a total of 1162 cases of cutaneous and subcutaneous lesions, non neoplastic lesions/ inflammatory comprised of 447 cases (38.4%), benign tumors comprised of 686 cases (59%) and malignant tumors comprised of 29 cases (2.5%). Maximum number of cases were seen in the age group of third and fourth decade. The most common lesion in non neoplastic was epidermal inclusion cyst, neoplastic benign was lipoma and malignant was squamous cell carcinoma. Conclusion: FNAC is an excellent diagnostic modality in early diagnosis of skin and soft tissue lesions. It helps in ruling out malignancy thus obviating the need for surgical procedures and facilitating initiation of appropriate therapy. Keywords: Soft tissue tumors, Skin lesions, Fine needle aspiration cytology.

Propofol versus Fentanyl for Sedation in Pediatric Bronchoscopy: A Randomized Controlled Trial

To compare propofol and fentanyl to induce conscious sedation in children undergoing flexible bronchoscopy. Randomized controlled trial. Pediatric Pulmonology division at a tertiary care center in Delhi, India. Children aged 3-15 years who underwent flexible bronchoscopy. Children received either intravenous propofol 1 mg/kg administered as a slow bolus over 1 minute followed by 2 mg/kg/hour infusion, or intravenous Fentanyl 2 µg/kg administered as a slow bolus over one minute. Primary outcome was time to achieve conscious sedation (Ramsay score 3). Secondary outcomes were need for adjuvant midazolam, physician satisfaction, level of cough, recovery features, and side-effects in the groups. 53 children (propofol 27, fentanyl 26) were enrolled in the study. The mean (SD) time taken to achieve Ramsay score 03 was lower in propofol than fentanyl [15.7 (4.4) s vs 206 (55) s, P<0.001]. Propofol arm had significantly higher physician satisfaction, less requirement of adjuvant midazolam, less coughing and faster regain of full consciousness. There was no difference in drug side-effects between the groups. Propofol has a shorter sedation induction time, less coughing during procedure, less recovery time, and better physician satisfaction compared to fentanyl for flexible bronchoscopy in children.

CLINICOLABORATORY PREDICTORS OF HOSPITALIZATION (&gt;7 DAYS) IN CHILDREN WITH SWINE FLU INFECTION: A RETROSPECTIVE STUDY FROM NORTH INDIA

Background: High morbidity and mortality of swine flu in children result in frequent hospitalization. Clinical and laboratory parameters predicting the duration of hospitalization are important but not studied in children till date. Aim: This study aims to evaluate the clinical and laboratory predictors of hospitalization (>7 days) and clinicodemographics in children with swine flu infection. Materials and Methods: This retrospective study was done in the department of pediatrics of a tertiary care center in Delhi. The records of children between the age group of 1 and 14 years of age in the previous 3 years and having clinical symptoms and real-time polymerase chain reaction positive for H1N1 infection were included in the study. Baseline characteristics, clinical details, laboratory profile, and treatment of these patients were recorded and analyzed. The outcome parameters were compared between Group A (children hospitalized for ?7 days) and Group B (hospitalized for >7 days) by appropriate statistical analysis. Results: Of 51 children analyzed, the mean age was 45.83 months and three-fourth of them were ?5 years (50% of infants). The mean duration of hospitalization in Group A and Group B was 5.09±1.82 and 11.2±4.51 days, respectively. Patients with longer duration of breathlessness (mean difference 1.75 days, p=0.026), hypoxemia, cyanosis, and neutrophil/lymphocyte (N/L) ratio 0.05). The most common presenting symptoms were fever (98%), cough (98%), rhinorrhea (88%), and breathing difficulty (88%) with asthma as the most common comorbid factor. Conclusion: The swine flu is a mild illness with highest hospitalization in children <5 years with non-specific clinical and laboratory features. Breathlessness of longer duration, hypoxemia, cyanosis, and N/L ratio <2 after 48 h of admission were risk factors for hospitalization of more 7 days.