Tertiary Care Centre In Kerala Research Articles

A Study on the Clinical Profile of Cholinergic Insecticide Poisoning in a Tertiary Care Centre in Kerala

Introduction In India, insecticides pose a significant risk of poisoning, particularly in rural households where they are readily accessible and frequently employed for deliberate self-harm. Acute organophosphate (OP) poisoning represents a critical medical emergency and stands as a significant contributor to both mortality and morbidity rates. Among the various insecticides, OP poisoning stands out as the most commonly encountered. Patients afflicted with OP poisoning may experience respiratory failure due to several factors, including the aspiration of gastric contents, excessive secretions, pneumonia, and septicemia, which can further escalate into acute respiratory distress syndrome1 . Objectives To determine the clinical profile of cholinergic insecticide poisoning at the Government Medical College, Alappuzha, in both medical wards and the ICU.

Comparison of pain relief among patients with chronic plantar fasciitis treated with intralesional platelet-rich plasma injection versus corticosteroid injection in a tertiary care centre in Kerala - a prospective study

Background: Aim of the study was to compare pain relief and functional outcome and between intralesional autologous platelet rich plasma injection (PRP) versus corticosteroid injection in the treatment of plantar, and fasciitis by using visual analogue score and American Orthopaedic Foot and Ankle Society (AOFAS) score. Methods: The sample size for the study was 30 patients attending Dr. Somervell Memorial CSI Medical College. Patients were divided into two groups (PRP versus steroid) of 15 each. The study follows a prospective observational design with follow up at 2 weeks, 2 months and 3 months post procedure. The functional outcome of patients in each group was assessed using the visual analog scale and AOFAS score. Results: Post-procedure, a significant decrease in VAS score was seen in patients treated with PRP injection (8.73 to 2.27) than those treated with Steroid injection (8.8 to 3.53). Also, there was a significant improvement in the AOFAS score from 72.73 to 88.67 while for those patients treated with steroid injection, the AOFAS score was comparatively low (65.87 to 82.2). Conclusions: Plantar fasciitis is a prevalent condition in our community, and many treatment options typically offer only temporary relief from symptoms. Intralesional PRP injection emerges as a dependable treatment method that fosters the healing process of the affected fascia, resulting in improved functional outcomes. Our study indicates that a singular administration of platelet-rich plasma injection for plantar fasciitis yields substantial pain relief compared to the local steroid injection.

Health-related quality of life among patients undergoing hemodialysis in a tertiary center in South Kerala

IntroductionHealth-related quality of life is essential for evaluating treatment quality in chronic diseases, providing valuable patient perspectives for medical decisions. Chronic kidney disease and end-stage renal disease significantly affect Health-related quality of life. The study aimed to assess the Health-related quality of life and the factors affecting it in end-stage renal disease patients on maintenance hemodialysis. MethodsA cross-sectional study was conducted in a tertiary care center in Kerala from November 2021 to December 2022.A validated Kidney Disease Quality of Life in the local language Malayalam was used for data collection. Patients over the age of 18 who have end-stage renal disease and have been on maintenance dialysis for at least 3 months and agreed to participate were included in the study by consecutive sampling method. ResultsAmong the 124 patients studied, the physical component had the lowest mean score (38.11 ± 20.87), mental component displayed a higher score compared to the physical (47.33 ± 16.88), indicating moderate level of mental well-being. Kidney Disease Component Summary had the highest mean score (61.73 ± 9.42).Younger patients had better mental-health related quality of life, while age did not significantly affect physical or disease-specific health related quality of life. Gender differences appeared, with males reporting higher physical-health related quality of life. Discussion and conclusionThe study highlights the quality of life and its association with socio-personal variables. To enhance the well-being of end-stage renal disease patients in Kerala, public health initiatives should prioritize elderly females with limited education, tailoring interventions to address their specific issues.

Impact of conducting hand hygiene audits during the COVID-19 pandemic in an intensive care unit at a tertiary care centre in Kerala, India.

The COVID-19 pandemic era had witnessed an upsurge of healthcare-associated infections (HAI) in COVID intensive care units (ICUs), which can be reduced by following proper hand hygiene (HH) practice. Performing HH auditing in COVID ICUs and providing timely feedback to the stake holders is crucial to reduce HAIs. From July 2021 to December 2021, HH auditing was conducted in COVID ICUs. Hand hygiene (HH) complete adherence rate (HHCAR), HH partial adherence rate (HHPAR) and HH total adherence rate (HHTAR) were analysed. Profession-specific HHTAR and moment-specific HHTAR (for each WHO moment) were also calculated. HHCAR, HHPAR and HHTAR were found to be 47%, 19% and 66%, respectively. There was a significant increase in the monthly HHTAR from 62.2% to 72.2% (p<.001). The profession-specific hand-hygiene adherence rate (HHAR) was found to be highest among nurses (67%), and the moment-specific HHAR of WHO-moments 2 (90%) and 3 (94.8%) had the highest HH adherence. Auditing HH and providing timely feedback significantly improved HH adherence. The greatest need now is to regularly conduct HH auditing in COVID locations of all healthcare facilities to reduce the HAI rate among the COVID-19 infected patients in ICUs.

Diagnostic Validity of Urinalysis in Comparison with Urine Culture Prior to Micturating Cystourethrogram in Children: A Retrospective Observational Study at a Tertiary Care Centre in Kerala, India

Introduction: Micturating Cystourethrogram (MCUG)-triggered Urinary Tract Infections (UTIs) are well-known, but the risk factors that trigger infections are not well studied. Even though MCUG being invasive, there is no general consensus regarding the use of peri-procedural antibiotic coverage and screening for sub-clinical UTIs just before MCUG. Aim: To determine the diagnostic validity of Urinalysis (UA) when compared with the gold standard, Urine Culture and Sensitivity (UCS), to exclude pre-procedure infections. Materials and Methods: This retrospective observational study involved paediatric patients who underwent MCUG from January 2021 to December 2022, at Kozhikode Government Medical College (Kerala) to exclude urological anomalies. All children were tested with UA and UCS before MCUG, which was done under antibiotic coverage. A positive UCS was defined as a significant growth of a single organism (&gt;100,000 for mid-stream urine or &gt;50,000 for catheterised sample), while a positive UA was defined as pus cells &gt;5/high power field on microscopy. After exclusions, the authors analysed 300 patients. The diagnostic validity of UA was assessed using the Pearson Chi-square test, by Statistical Package for Social Sciences (SPSS) version 16.0. and a p-value less than 0.05 was considered significant. Results: The median age was nine months (IQR 13 months) with 68% being male. The most common indication for MCUG was evaluation for recurrent/febrile UTIs (n=171, 56.6%). Both Pre-MCUG, UA and UCS were documented as positive in eight patients (2.6%), and pre-MCUG, UCS alone was positive in two patients. The diagnostic validity of UA when compared with UCS showed high specificity and positive predictive values at 100% (p&lt;0.05). Conclusion: A simple UA, when compared with UCS (the gold standard investigation for UTIs), has high specificity and positive predictive value in excluding sub-clinical UTIs prior to MCUGs. It may be preferable as it yields quick and reliable results.

Study on Risk Factors Associated with Severity of Diabetic Retinopathy in Type-2 Diabetic Patients, Attending a Tertiary Care Centre in Kerala

Introduction: Diabetic retinopathy (DR) is a significant public health concern affecting individuals with diabetes mellitus (DM). Despite treatment advances, a substantial proportion of patients do not respond adequately. This study investigates risk factors associated with the progression of non-proliferative diabetic retinopathy (NPDR) to proliferative diabetic retinopathy (PDR) in type-2 diabetes patients. Methods: A retrospective case-control study was conducted on diabetic patients older than 40 years with at least 5 years of Type-2 Diabetes Mellitus history, attending ophthalmology clinic in Government Medical College, Thrissur, a tertiary care hospital. Data from patients with retinal examination showing diabetic retinopathy were analyzed. Records with missing data were excluded. Patients with Proliferative Diabetic Retinopathy (n=153) were compared with those having Non- Proliferative Diabetic Retinopathy (n=230). Various risk factors were assessed using statistical analysis. Results: Among the studied variables, sex, duration of diabetes, serum urea, serum creatinine, serum triglycerides, and chronic kidney disease were significantly different between Proliferative Diabetic Retinopathy and Non-Proliferative Diabetic Retinopathy patients. Binary logistic regression revealed that duration of diabetes (OR = 1.8, 95% CI = 1.1 - 2.39) and serum creatinine (OR =1.8, 95% CI = 1.1 - 2.39) independently influenced Proliferative Diabetic Retinopathy development. Conclusion: This study highlights that longer diabetes duration and elevated serum creatinine levels independently increase the risk of Non- Proliferative Diabetic Retinopathy progressing to Proliferative Diabetic Retinopathy in type-2 diabetic patients. Other factors such as age, gender, hyperlipidemia, systemic hypertension, type of diabetic treatment, and history of ischemic heart disease did not show significant associations with disease progression. These findings emphasize the importance of close monitoring, early detection, and intervention in patients with Non- Proliferative Diabetic Retinopathy, particularly those with a longer diabetic history, to prevent Proliferative Diabetic Retinopathy development. Further research should explore the causal relationship between serum creatinine and diabetic retinopathy progression and evaluate the impact of renal disease management on disease outcomes. Keywords: Diabetic Retinopathy, diabetes mellitus (DM), Type-2 Diabetes Mellitus (T2DM).

A Study on the Clinical Profile and Outcome of Cerbera Odollam Poisoning in a Tertiary Care Centre in Kerala

Background: Cerebera Odollam is a small plant/shrub which grows wild over many parts of Kerala. It is the most common plant suicidal agent in the coastal areas of southern Kerala. This is an attempt to study the clinical profile and outcome of C.odollam poisoning in my institution. Objectives: To study the clinical profile with respect to age, sex, methods of self-administration, circumstances of poisoning, dosage, clinical features, ECG changes, treatment and various determinants of outcome of Cerebera Odollam poisoning in a tertiary care centre in Kerala.

A predictive score for severity in patients with confirmed dengue fever in a tertiary care hospital in Kerala, India.

The study aimed to identify predictors of severe dengue during the 2017 epidemic and to develop and validate a simple predictive score for severity. A retrospective analytical study was conducted using clinical and laboratory data from adult dengue patients with a confirmed microbiological diagnosis. The study included patients who presented to a tertiary care centre in Kerala, India, during the febrile phase (≤4d) between June 2017 and February 2019. Using appropriate statistical tests, we derived predictors of severe disease and computed a risk score model. Of the 153 patients (mean age 50±17y; 64% males), 31 (20%) had severe dengue and 4 (3%) died. Petechial lesions, hypoalbuminemia (<3.5 g/dl), elevated alanine aminotransferase (>40IU/l) and urea >40IU/l were significant predictors. Our scoring system (cut-off: 2) showed excellent performance, with an area under the receiver operating characteristics curve of 0.9741, sensitivity of 100%, specificity of 96% and accuracy of 98%. The risk score was secondarily validated on 48 patients hospitalized from March 2019 to June 2019. Our scoring system is easy to implement and will help primary healthcare practitioners in promptly identifying severe dengue cases upon hospital presentation.

Delays in Lung Cancer Diagnosis: Observations from a Tertiary Care Centre in Kerala, India.

Merin YohannanIntroduction Timely diagnosis of lung cancer is critical because treatment outcomes correspond to the stage of disease. This study identified patient and physician determined reasons for diagnostic delays. Materials and Method s This was an observational cross-sectional study, conducted at a tertiary care institution in South India, for 12 months. From 207 consecutively selected patients, with a presumptive lung cancer diagnosis, 150 were enrolled utilizing a prefixed questionnaire. The time intervals from appreciation of initial respiratory symptoms to a final tissue diagnosis were defined sequentially as approach interval, referral interval, and diagnostic interval and factors causing delay in each interval were identified. Results In a state with 100% literacy, the mean time to approach a doctor was 8 weeks (range: 0-336 days; SD: 7.95) with a delay seen in 52% of the study group. Referring a suspect lung cancer diagnosis to a specialist, took an average of 4.98 weeks (range: 1-26 weeks; SD: 5.64) with referral delays in 47.3% of patients. The mean diagnostic interval was 9.21 days (range: 3-41 days; SD: 7.18) and 16.7% of cases had diagnostic delays in spite of a definite procedure. Conclusion In a tuberculosis endemic location, empirical treatment with anti-tuberculosis therapy and prolonged antibiotic courses without serially monitoring the course of disease are responsible for referral delays. Also, 88.2% of the total females studied, presented late due to family and work pressures, fear of being stigmatized and being on prolonged home remedies. A wider dissemination and awareness on lung cancer are needed especially among females. A low threshold to reinvestigate and an early referral to a pulmonary or lung cancer specialist, when expected clinicoradiological improvement is lacking, in microbiologically negative tuberculosis should be highlighted.

A Brief Report on Telerehabilitation During COVID-19 Outbreak at a Tertiary Care Center in Kerala, India

The unanticipated lockdown following the COVID-19 outbreak significantly impacted the field of rehabilitation, compelling the professionals to switch to tele-mode to continue providing their service without interruption. This article aims to highlight the steps taken to overcome the various challenges that were encountered in this period and to strengthen the opportunities in telerehabilitation services at a tertiary care center in Kerala, India. An average of 1000 clients were served monthly through telerehabilitation in various units at the selected institute during the COVID-19 pandemic. The telerehabilitation services included assessments, intervention, and counseling for clients of all ages with various types of disabilities. A high literacy rate and better access to technology among the general population in Kerala, India were identified as advantages for the rapid implementation of telerehabilitation as a viable form of service delivery.

Patient-reported Outcome of Mild Coronavirus Disease 2019 Infection in Patients diagnosed from a Tertiary Care Center in Kerala: A 1-year Follow-up Study.

The coronavirus disease 2019 (COVID-19) infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus had a huge burden on asymptomatic or mildly symptomatic persons who may have only briefly been associated with healthcare delivery systems during their illness. The knowledge about patient perception of disease outcomes is important in deciding future programs for dealing with pandemics in the community. The objectives of the study were to determine patient-reported outcomes (PROs) 30 days and 1 year after the initial diagnosis of mild COVID-19 infection and to determine any factors associated with PROs. Patients who attended the fever screening clinic and were diagnosed with mild COVID-19 infection were contacted telephonically as they completed 30 days after their initial diagnosis, and their responses to the EuroQoL five-dimensions 5-level (EQ-5D-5L) questionnaire were recorded. The patients were again contacted 1 year after the initial diagnosis and the same process was repeated. A total of 237 patients were contacted telephonically and 167 patients responded to the call. The domain most affected at 30 days was usual activities, and at 1 year, it was anxiety and depression. The mean utility score at 30 days was 0.9347 and at 1 year was 0.9801. The factors associated with worse utility scores were age &gt;45 years and comorbidities. There is a significant proportion of patients who had restrictions in performing their usual activities 30 days after a mild COVID-19 infection, whereas the domain which showed the least improvement after 1 year was anxiety or depression. Even mild COVID-19 infection had an impact on the health-related quality of life (HRQOL) of people with the elderly and those with comorbidities affected more.

CLINICO-PATHOLOGICAL PROFILE OF BLADDER CANCER PATIENTS IN A TERTIARY CARE CENTRE.

Introduction: Bladder cancer (BC) is one of the most common urological malignancies.With Industrialisation, increasing exposure to occupational hazards and ever increasing use of tobacco in various forms, more and more of these BCs are being diagnosed nowadays. Objectives of the study: To study the clinical and histo-pathological prole of bladder cancer patients attending a tertiary care centre in Kerala in southern part of india. Materials and methods: A prospective observational study of 90 patients with bladder cancer was conducted in department of Urology at a tertiary care centre over a period of 1 year from Feb 2020 to Feb 2021. Patients presenting to department of urology, undergoing surgery for BC were studied by demographic parameters (age,gender) detailed history, clinical examination, cystoscopy ndings and cytopathology results and results analyzed. Results: A total of 90 patients were evaluated in the study. Highest number was found in patients of 60-80 years age group, with males &gt; females. Most patients presented with haematuria (88.89%), some with pain (18.89%) and irritative voiding complaints (12.22%) and 5.56% were incidental detection. Of all patients, 70% had history of smoking. Transitional Cell Carcinoma (TCC) was most common histology found in 92.22% of study population followed by Adenocarcinoma (4.44%), Squamous cell carcinoma (2.22) and leiomyosarcoma(1.11%). Among TCC, 54.22% had low grade, 33.73% were high grade and rest of them were PUNLUMP. Most of the lesions were unifocal polypoidal growths. High grade cancers were found predominantly in patients with age&gt;60 and history of tobacco smoking. Conclusion: Bladder cancer is predominantly a disease of older men. High index of clinical suspicion, as well as thorough exploration of all possible epidemiological factors will help clinician diagnose bladder malignancies. Awareness among the public should also be emphasized to make them understand the deleterious consequences of exposure to risk factors like smoking.

Outcome of Concurrent Chemoradiation after Induction Chemotherapy in Locally Advanced Head and Neck Squamous Cell Carcinoma - A Prospective Study among Patients Attending a Tertiary Care Center in Kerala, India

BACKGROUND&#x0D; Concurrent chemoradiation (CCRT) is the standard of care for locally advanced head and neck squamous cell carcinoma (LAHNSCC). In settings with considerable waiting period for radiation, institutional protocols advocate induction chemotherapy before CCRT. This study aimed to assess the outcome of concurrent chemoradiation after induction of chemotherapy among patients with LAHNSCC attending a tertiary care radiotherapy center in Kerala, India.&#x0D; METHODS&#x0D; Patients with non-metastatic LAHNSCC (stage 111 and 1V) with good performance score of 0-1 who received induction chemotherapy (with docetaxel 75mg/m2and cisplatin 75 mg/m2, day 1 and 5-fluorouracil 750 mg/m2, day 1 and 2 as infusion every 3 weeks for 3 cycles) followed by CCRT (with concurrent cisplatin 40 mg/m2 weekly) were selected for the study. CCRT was administered only to those patients who showed more than 30 % response to induction chemotherapy. They were followed up for 24 months. The primary end point was the clinical response assessed by ENT evaluation 8 weeks after the completion of CCRT.&#x0D; RESULTS&#x0D; 117 patients with LAHNSCC were enrolled. Four patients (3.4 %) dropped out after induction therapy. Out of 113 patients who initiated concurrent chemo radiation, two patients (1.7 %) dropped out while on CCRT, two patients (1.7 %) were intolerant to CCRT and two patients (1.7 %) left soon after CCRT. 107 patients were available for follow up after treatment completion. Acute toxicities were noticed in 9 (7.7 %) while on induction treatment. Mucositis occurred in 1 (0.9 %), haematological toxicities in 4 (3.4 %), gastrointestinal toxicities in 2 (1.7 %) and fatigue and malaise in 2 (1.7 %). In patients who underwent concurrent chemo radiation, 53 (49.03 %) had acute mucosal, skin, GIT and haematological toxicities. On treatment completion, 82 patients (70.1 %) had complete response, 24 (20.5 %) had partial response and one (0.9 %) had stable disease. During the follow up period of 24 months, locoregional failure (relapse) was noted in 15 patients (12.8 %) while 61 patients (52.1 %) remained disease free. Organ preservation rate was 53.4 % for laryngeal primaries. 4 patients (3.4 %) developed distant metastases during the follow up.&#x0D; CONCLUSIONS&#x0D; Induction chemotherapy with docetaxel containing regime followed by concurrent chemoradiation was associated with good clinical response and acceptable toxicity profile.

Association of serum magnesium with insulin resistance in patients with metabolic syndrome

Background: Metabolic syndrome (MS) consists of a constellation of metabolic abnormalities that confer an increased risk of cardiovascular disease. Low magnesium level is an important pathogenic factor in most of the disorders of MS and also contributes to increased cardiovascular risk. Aims and Objectives: The aim of the study was to find the association of serum magnesium with insulin resistance in patients with MS. Materials and Methods: A cross-sectional comparative study was conducted in a tertiary care center in Kerala after obtaining clearance from the Institutional Ethics Committee. Thirty subjects with MS who satisfied at least 3 features of national cholesterol education program adult treatment panel III criteria in the age group of 45–65 years were selected and 30 normal subjects after proper exclusion and obtaining written informed consent. Serum magnesium levels and fasting C-peptide levels were measured. Insulin resistance was calculated from fasting serum C-peptide and fasting plasma glucose value using homeostasis model assessment. Results: The mean values of magnesium levels were significantly lower, and insulin resistance was higher in patients with MS when compared to normal subjects. The correlation of serum magnesium levels with insulin resistance was negative and significant. Conclusion: The present study shows that hypomagnesemia can result in insulin resistance. Magnesium supplementation can reduce insulin resistance and improve glycemic controls and reduce cardiovascular risk.

Impact of COVID-19 pandemic on control of bronchial asthma in children attending the asthma clinic in a tertiary care centre in Kerala

Abstract BACKGROUND: COVID-19 pandemic led to widespread change in the life of people across the globe, including children, with far-reaching consequences. When control of disease is considered among children with asthma, a positive impact is to be expected. This study aimed to assess the impact of the COVID-19 pandemic on disease control among children with asthma. OBJECTIVES: The main objectives are (1) to compare the level of asthma control pre-COVID versus during the COVID pandemic in terms of exacerbations and short-acting beta agonist (SABA) usage and (2) to compare the use of inhaled corticosteroids (ICS) pre-COVID versus during the COVID pandemic. MATERIALS AND METHODS: Hospital-based study was conducted among children aged 5–15 years attending the asthma clinic of Government TD Medical College, Alappuzha, during the period May 2021–January 2022. Asthma control in terms of SABA usage, emergency visits, hospitalizations, and ICS usage was compared pre-COVID (before March 2020) to Complete lockdown (March 2020–May 2020), phased reopening (June 2020–May 2021) and after the lifting of major restrictions (June 2021–January 2022). Statistical analysis was done using IBM SPSS Statistics v.26. RESULTS: In total, 139 children were included in the study. A decrease was observed in the number of children requiring SABA as reliever therapy, with 18%, 25.9%, and 33.1% not requiring SABA during the complete lockdown, during phased reopening, and after the lifting of major restrictions, respectively, when compared to pre-COVID. A statistically significant decrease in hospitalizations and visits to the emergency department due to asthma exacerbations were also observed during various phases of the pandemic. ICS was stopped in 15.1%, 30.2%, and 35.3% of the study subjects during various phases of the pandemic without further exacerbations. CONCLUSION: There was a significant impact on asthma control during the pandemic, which was sustained during various phases of lifting restrictions.

Survival Analysis and Factors Affecting Treatment Outcome in Glioblastoma Multiforme: A Cohort Study

Introduction: High-grade gliomas, especially Glioblastoma Multiforme (GBM), are the most prevalent primary brain tumours in adults. Treating GBM is challenging due to resistant tumour cells, resulting in a dismal prognosis. While GBM often develops spontaneously, familial gliomas have also been identified in 1% of cases. Primary and secondary glioblastoma are the subtypes that affect patients of varying ages and develop via different paths. Aim: To estimate the two year survival and to assess factors affecting survival in patients diagnosed with GBM and to evaluate the “ability for self-care” following treatment. Materials and Methods: The cohort study investigated treatment outcomes in GBM using a sample of 65 patients from the Department of Radiation Oncology at Government Medical College Thrissur, a tertiary care centre in Kerala, India. The patients were diagnosed between January 2018 and December 2019. Survival and the factors determining survival were explored through case records and telephonic interviews with primary caregivers. Median survival and two year survival rates were calculated. The study examined possible associations of survival with patient-related, tumourrelated, and treatment-related factors. Patient-related factors assessed were age, gender, and Eastern Cooperative Oncology Group (ECOG) performance status at diagnosis. Tumour-related factors assessed included tumour location, laterality, and volume based on pretreatment Magnetic Resonance Imaging (MRI). Treatment-related factors such as extent of surgery, postoperative radiotherapy, and chemotherapy were also assessed. Data analysis was performed using the Statistical Package for Social Sciences (SPSS version 21.0). Qualitative variables were expressed in percentage and compared using the Chi-square test or Fisher’sexact test. Quantitative variables were expressed as mean and standard deviation and compared using unpaired t-tests. Telephonic interviews with primary caregivers were conducted to assess the “ability for self-care” following treatment. Results: The study included a total of 65 cases, with a mean patient age of 54 years. Out of the patients, 45 (68%) patients were male, while 20 (32%) patients were female. The median survival for GBM was found to be eight months. The one year and two year survival rates were 18.46% (12 patients) and 10.8% (7 patients), respectively. The survivors had a mean age of 48 years. There were no statistically significant differences in survival based on sex (p-value=0.527), tumour location (p-value=0.765), and laterality (p-value=0.596). Survival was found to be related to ECOG performance status at diagnosis (p-value=0.001) and tumour volume (p-value=0.002). Among the patients, 37 (58%) patients were able to perform self-care after treatment, while 28 (42%) patients were unable to do so. Conclusion: The survival of patients with GBM is related to ECOG performance status at diagnosis and the pretreatment volume of the tumour. The evidence was insufficient to establish a relationship between survival and the administration of postoperative radiotherapy and chemotherapy. Despite multimodality treatment protocols, the survival of patients with GBM remains dismal. A tailored treatment protocol that weighing morbidity of treatment and cost effectiveness on one side and survival on the other side is the need of the hour.

Seroprevalence of hepatitis B, hepatitis C, and human immunodeficiency virus in hemophilia A patients: A descriptive study

Background: Hemophilia A (Factor VIII deficiency) is a X-linked coagulopathy that affects approximately 1/10,000 male live births. In the past, the treatment of hemophilia A consisted of cryoprecipitated plasma and purified factor preparations. As a result, they experienced unusually high incidence of hepatitis and human immunodeficiency virus (HIV) seroconversion. Aims and Objectives: The aims of this study were to find out the seroprevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV infection, among hemophiliacs attending a tertiary care center in Kerala, southern India. Materials and Methods: A cross-sectional study was conducted on hemophilia A patients who attended the departments of medicine and pediatrics. Demographic details and treatment history were obtained by questionnaire. Enzyme-linked immunosorbent assay was used to detect HBV surface antigen, HCV antibodies, and HIV. The statistical data analysis was performed using SPSS software version. Results: Out of 90 hemophilia A patients who underwent testing for the seroprevalence of transfusion-transmitted viral infections, one (1.1%) patient tested positive for HIV, two (2.2%) for HCV, and one (1.1%) for HBV. Among patients with hemophilia A, the prevalence of transfusion-transmitted infection was 4.4%. Patients with HIV- and HCV-positive tests belonged to the severe hemophilia A group. Moreover, the HBV-positive patient belonged to moderate hemophilia A. Conclusion: The present paradigm of management of hemophilia A patients is with plasma-derived or recombinant Factor VIII concentrates, cryoprecipitates, and fresh frozen plasma. Due to the risk, however remote, of transfusion-transmitted viral infections, all hemophiliacs should receive the hepatitis B vaccine and undergo routine testing for HIV, HCV, and HBV viruses.

Thoracic radiological abnormalities in coir workers with respiratory symptoms in a tertiary care center in Kerala

Thoracic radiological abnormalities in coir workers with respiratory symptoms in a tertiary care center in Kerala

Clinical profile and outcome of children with diabetic ketoacidosis admitted in a tertiary care centre in kerala during the pre and post COVID period

Clinical profile and outcome of children with diabetic ketoacidosis admitted in a tertiary care centre in kerala during the pre and post COVID period

STAPLED VERSUS HANDSEWN INTESTINAL ANASTOMOSIS IN EMERGENCY SURGERY

Introduction The major problem following bowel anastomoses is the anastomotic failure leading to leakage peritonitis, fistula, abscess, sepsis, necrosis, stricture etc. adding to the morbidity and mortality. (e.g., 22% mortality in patients with a leak vs. 7.2% mortality in those without leak).The present study compares the complication rates of sutured and stapled anastomotic techniques in an emergency setting of a tertiary care institute in Kerala. Methodology The study evaluates the complications (leak /intra-abdominal abscess) of both stapled and hand-sewn techniques of intestinal anastomosis in emergency setting. The study is conducted in a tertiary care centre in Kerala and the data is collected from the medical records and emergency register. A total of 112 cases that meet the inclusion and exclusion criteria are included during the period from 2017 to 2021 Results Among the 61 patients who had undergone hand sewn anastomosis 7 (11.5%) had anastomotic leak and 54 (88.5%) patients had no leak. Among the 51 patients underwent stapled anastomosis, 6 (11.8%) had anastomotic leak and 45 (88.2%) patients developed no leak. This data is statistically analyzed using Chi Squared test and found that there is no significant difference between the occurrence of anastomotic leak between the two study groups irrespective of whether the anastomosis is hand sewn or stapled. The average time taken for surgery in the hand sewn group is about 192.1 minutes and in stapled group is 162.5 minutes. This difference in the average duration of surgery is analyzed statistically and it showed that the difference in of the duration of surgery is statistically significant. Conclusion There is no significant difference between the complication rates of both type of anastomosis is identified in the emergency setting. But there is a clear advantage of less operating time for stapled anastomosis.