Tertiary Care Centre In Kerala Research Articles

Clinical and functional profile of 6-12-year-old children with attention deficit hyperactivity disorder referred to a tertiary care center in South India

Objective: To describe the clinical, socio-demographic, and functional profile of children with Attention Deficit Hyperactivity Disorder (ADHD) referred to a tertiary care center in Kerala, India. Methods: A retrospective descriptive study was conducted from records of developmental evaluation clinic over a period of one year. All-consecutive cases the first time diagnosed as ADHD were enrolled. Autism Spectrum Disorder, genetic disorders, and children with sensory impairments were excluded. Clinical profile was based on presenting symptoms, gender, and socio-demographic characteristics; functional status assessed by Conner’s 3 Parent Scale and cognitive status by Intelligence Quotient. Results: ADHD prevalence in a clinically referred sample was 12.7%. Boy to girl ratio was 6:1. The mean age of presentation was 8.2 years (SD 6.09). The most common presenting symptom was hyperactivity and behavioral problems followed by poor scholastic performance and poor memory. The functional status assessment showed major concerns in all six domains - Inattention, Hyperactivity, Learning Problem, Executive Functioning, Aggression, and Peer relation, in the majority of children. Children presenting with ADHD symptoms at a later age (9-12 years) had lower IQ scores than those diagnosed at a younger age. Conclusion: Course of childhood ADHD shows a consistent clinical and functional pattern. Early diagnosis and quantification of difficulties at the outset is suggested, which can help in providing early intervention and is likely to improve long-term outcome in these children.

A study on seroprevalence of Rubella IgG antibodies among antenatal women in a tertiary care centre in Kerala

A study on seroprevalence of Rubella IgG antibodies among antenatal women in a tertiary care centre in Kerala

Change in trends in incidence and histopathology of lung carcinoma in a tertiary care centre in Kerala

Change in trends in incidence and histopathology of lung carcinoma in a tertiary care centre in Kerala

P140 Validation of EULAR/ACR 2019 classification criteria for SLE in a south Indian juvenile SLE cohort

Abstract Background To date there is no specific classification criteria for juvenile systemic lupus erythematosus (jSLE). Our aim is to compare the real world performance of EULAR/ACR 2019 criteria when applied to a known cohort of jSLE cases in Kerala, India. Methods We retrospectively reviewed the electronic medical record of all patients (n = 735), admitted under the Pediatric Rheumatology Department, Amrita Institute of Medical Sciences, Kochi, a tertiary care center in Kerala, India, during the period January 2012 to June 2019. 107 patients were diagnosed with jSLE by a qualified experienced pediatric rheumatologist and were independently assessed by an adult rheumatologist. Every sixth patient of the remaining 628 patients were selected as the control (n = 105). Patients were excluded if the diagnosis was uncertain or, if there was an overlap with jSLE. Each patient was evaluated to see if he or she satisfied the ACR-1997, SLICC-2012, or EULAR/ACR- 2019 criteria. Results Female: male ratio in cases and controls was 4.1:1 and 2.4 :1 respectively. Mean age for cases and controls was 12.6 +/-2.9 and 11.8 +/-3.5 respectively. The comparison of performance of each criterion is shown in table 1. Table 1: Validation of the EULAR/ACR 2019 SLE classification criteria using clinically diagnosed 107 jSLE cases. ACR- American College of Rheumatology; EULAR- European League Against Rheumatism; SLICC-Systemic Lupus International Collaborating Clinics; PPV- positive predictive value; NPV- negative predictive value Conclusion The new EULAR/ACR 2019 criteria achieved sensitivity, specificity, PPV, NPV and accuracy greater than SLICC 2012 criteria. It also achieved sensitivity, NPV and accuracy greater than 1997 ACR criteria. Disclosures H. Bhaskaran Nair None. S. Balan None.

Histopathological profile of ovarian tumors in a tertiary care centre in Kerala: a retrospective two year study

Histopathological profile of ovarian tumors in a tertiary care centre in Kerala: a retrospective two year study

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Self-perception on oral health and related behaviours among antenatal mothers attending a public antenatal clinic - Kerala.

Background and Aims:Antenatal oral care has been given least priority on a global scale. The study assesses self-perception of oral health knowledge and related behaviors among antenatal mothers.Method:A cross-sectional study was done among 400 pregnant women attending antenatal care clinic of a tertiary care center in Kerala, India. Details regarding knowledge, attitude, and practice were obtained, after getting an informed consent. The dental caries experience and gingival status were measured. To test the significance (p ≤ 0.05) between variables, Chi-square test was used.Results:Poor oral health knowledge was observed among 75.5% of the pregnant mothers. Oral health problems were reported by 63.2% of them. Low priority for oral health (59.4%) and fear for fetal safety (17.5%) were the reasons for delaying dental services. Oral examination showed that more than half of the study subjects had a high prevalence of dental caries (67.5%) and low gingival bleeding status (26.2%). The study highlights that more than half of the study population (60.8%) were influenced by the elderly in the family to avoid certain food items. A better oral health knowledge was observed among the upper middle class (OR - 2.8) who had visited dentists within the last six months (OR - 3.6) and child bearing mothers (OR- 0.46) (p ≤ 0.05).

First episode depression in women- a study of clinical characteristics through the female reproductive stages in a rural tertiary care center in Kerala

Background: The lifetime prevalence of major depressive disorders is 10-25% for women and 5-12% for men. Women are more prone to develop depressive episode from the period of menarche to the perimenopausal period. Relatively little research has been done on this. Materials and methods: Female patients between the ages of 12 years to 55 years presenting in the outpatient department with first episode depressive symptoms are selected (ICD 10) and the number of patients presenting in different stages of the reproductive cycle – perimenarche, pregnancy, post-partum, post abortion and perimenopausal are noted. Age at onset, severity of the illness, positive family history, presence of somatic and hypochondriac symptoms, and suicidal intent (Beck suicidal intent scale, Hamilton rating scale for depression) were noted. Results and discussion: Out of the total 120 patients, 53 were in the perimenopause state, 23 in the perimenarche, 5 in pregnancy, 14 in the post-partum, and 7 as post abortion. The mean age of onset of depressive disorders is 36.7 years (SD- 13.67). The severity of the depressive episode is significantly higher towards the younger age group (<30years) and number of patients presenting with somatic symptoms are much higher towards the older age group (41-55years). There is no significant difference in presence of positive family history, hypochondriasis and suicidal intent among various age groups. Conclusion: Perimenopausal and perimenarche periods show higher prevalence of depressive disorders during female reproductive cycle. Biological changes in reproductive cycle can cause increase prevalence of depression in women.

Incidence of Metabolic Syndrome in patients treated with Clozapine in a tertiary care center in central Kerala

Background: Clozapine is widely used for the treatment of resistant Schizophrenia (Sz). Metabolic syndrome (MetS) is its recognized side effect. Reports on the side effects of Clozapine are scanty from Kerala. Hence a prospective observational study was conducted. Aim: The aim of the present study was to find the incidence of Metabolic syndrome in patients with psychosis, after 12 weeks of treatment with clozapine in a tertiary care centre in Kerala. Methods: Patients diagnosed as Schizophrenia or Delusional disorder based on International Classification of Diseases (ICD)-10 and not meeting the threshold criteria for MetS according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), and on Clozapine treatment were recruited and followed up for at least 12 weeks. Augmentation, when needed, was limited to Amisulpride, Aripiprazole, and/or Modified Electroconvulsive Therapy (MECT). Bodyweight, waist circumference, blood pressure, fasting blood sugar, and triglycerides levels were measured at the enrolment and after 12 weeks. Seventy-five patients completing follow up for 12 weeks were considered as study subjects. Patients who fulfilled NCEP ATP III criteria at 12 weeks were diagnosed as having MetS. Results: Study sample of 75 had not met the threshold criteria of NCEP ATP III based MetS diagnosis at the study entry. But among them, 23 met no criteria, 23 met one criterion and 29 met two criteria. Out of 75 patients, 32 (42.7%) developed Metabolic Syndrome at three months. Among 23 who met no criteria at intake, 3 (13%) developed MetS, while it was 9 (39%) in 23 who met 1 criterion and 20 (69%) in 29 who met 2 criteria. The mean Clozapine dose at discharge was 514±148 mg in those who developed MetS while it was 428±164 mg in those who did not. This difference was statistically significant (p<0.05). Conclusion: Incidence of MetS is high in Clozapine receiving Psychotic patients. The present study showed that in the study population, risk factors have a cumulative effect on the development of this side effect, and the risk is high when the dose of clozapine is higher.

Analysing maternal determinants and characteristics of obstetric referrals at a tertiary care centre in Kerala, India

Background: Timely and prompt referral of high risk pregnancies is an integral part of emergency obstetric care and is one of the effective strategies to avoid adverse pregnancy outcomes. This study aims to assess the maternal determinants and characteristics of obstetric referrals to Travancore Medical College and Hospital.Methods: This observational study reviewed 124 obstetric referrals over 3 years. Maternal risk factors and sources of referral were looked into. Distance travelled, referral-arrival interval, mode of transport, gestational age at referral, medical co-morbidities necessitating emergency/elective transfers to this tertiary centre have been analysed.Results: Referral rate was 7.03%. Mean age was 26. Primipara and multipara went hand in hand. 95% were graduates. Materno-fetal (58%) contributed the bulk of obstetric referrals. 83.1% were from private hospitals and 64 were in-labour referrals. 71.6% had referral arrival distance of &lt;15 kms. Mode of transport used by the referred patients was by ambulances (73.9%). Around 48% of our population had GA of 33-36.6 weeks. 73% had emergency decision among which caesarean was 83%. Anaemia (34%), HDP (30.5%), GDM (14.2%) and hypothyroidism (17.7%) were medical co-morbidities necessitating referrals. There was 1 maternal death and 4 near miss mortality cases. Mean hospital stay in private sector referrals was 10.17 days and it was 7.62 days in government referrals.Conclusions: Timely referrals with detailed referral slips imparting information regarding treatment received at the referring hospital has helped in early and optimal intervention in the study.

Role of basic haematological investigations in the evaluation of pancytopenia

Introduction: Pancytopenia is a caused by single or different co-existing pathology. As the management and prognosis depends on underlying pathology, identification of correct aetiology is crucial. Aims: The current study intends to study the etiological profile of Pancytopenia and to identify the CBC, peripheral smear findings which are helpful in planning the additional investigations to arrive at a specific diagnosis. Materials and Methods: It is a retrospective descriptive study conducted in a tertiary care centre in Kerala.132 Cases of Bone marrow aspirates with the indication of pancytopenia, received from January 2011 to June 2012 were analyzed. The etiological profile was studied. The clinical features, Hemoglobin, Total Leukocyte count, Platelet count and Peripheral smear findings were evaluated in detail. Results: The most common cause of Pancytopenia in the present study is Sub leukemic leukemia (23.5%) followed by Hypersplenism (17.4%) and Megaloblastic Anemia (14.3%). Age range was from 12 to 88 years and Males and Females were almost equal in distribution. Hepatomegaly, Splenomegaly were seen in 19% and 28% cases respectively. Lowest median Hemoglobin value was observed in Megaloblastic Anemia whereas Leucopenia and Thrombocytopenia were most severe in Hypoplastic Anemia. Anisopoikilocytosis, Polychromasia, circulating normoblasts and Hypersegmented neutrophils were predominant in Megaloblastic Anemia. Relative Lymphocytosis was predominant in Hypoplastic anemia whereas Immature WBCs were seen commonly in acute leukemia. Conclusion: This study highlights the importance of the primary haematological investigations, which are helpful in narrowing down the differential diagnosis and to plan the further investigations to arrive at a definite diagnosis. Keywords: Complete blood count, Peripheral smear, Bone marrow, Sub- acute leukaemia, Megaloblastic anaemia.

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Clinical profile of 315 Dengue patients in a tertiary care centre in Kerala (India)

Clinical profile of 315 Dengue patients in a tertiary care centre in Kerala (India)

Histopathological correlation of resected appendicectomy specimens - a five year study in a tertiary care centre in Kerala

Background: Acute Appendicitis is one of the commoncause of acute abdomen leading to appendectomy which is one of the most frequently performed operations all over the world. Being a common surgery, appendicectomy specimens contribute a major part of routine specimens in any pathology laboratory. a large number of medical and surgical diseases can closely mimic appendicitis leading to negative appendicectomy. Objectives: To find out the age, sex related incidence anddifferent histopathological lesions seen in resected appendicectomy specimens in a tertiary care centre in south India. We also tried to find out negative appendicectomy rate. Materials and Method: This is a retrospective study conducted in the department of pathology, Sree Narayana Institute of Medical Sciences, Kerala. We analyzed the histopathology reports of thosepatients who had undergone appendicectomy in our hospitalduring last five year period (January 2014- December 2018). Result: During the study period of five years, 597 appendectomies were done. The mean age of the patients undergoing appendicectomy was found to be 25-35 years. Most of the patients were adults between 21-30 years and number of male patients (386) was more compared to females. Acute appendicectomy specimens showed the presence of fecoliths, gangrene, serositis, worms, lymphoidhyperplasia etc. The negative appendectomy rate was 5.6%. Conclusions: Detailed histopathological examination is always recommended in appendicectomy specimensnot only toconfirm thediagnosis,but also to rule outincidental pathologies their by leading tobetter patient outcome.

Pattern of disease disclosure to patients in pediatric HIV clinic in a tertiary care center in Kerala

Background: The pattern and rates of disclosure of HIV status to infected children may differ within a country, and among the states, based on the socioeconomic, cultural, and even health status. Understanding this pattern is important in the formulating guidelines of disclosure on their HIV diagnosis to children infected by HIV, and to design strategies for improvement of adherence. This study was proposed to study the pattern of disclosure of HIV status in children aged 6 to 17 years.Methods: This cross sectional study was conducted for a year (2016-2017) at a Pediatric HIV clinic in Thrissur, Kerala. Participants for this study were 58 HIV-infected children in the age group of 6-17 years who were on ART, and their parents/caregivers.Results: Among the 58 participants, only 25 (43.1%) were aware of their HIV status, either fully (17; 68%) or partially (8; 32%). Healthcare providers were more likely to disclose the status to the affected child. Majority of the participants (84%) had better compliance to therapy after disclosure and most of the children in the non-institutional group were more supportive towards their parents (50%) after disclosure. The factors that were associated with disclosure in the non-institutional group were age of the child and duration of therapy.Conclusions: Children infected with HIV showed better adherence after complete disclosure. Rate of disclosure can be improved by reviewing the disclosure hurdles in our state so that intervention programs can be planned for improving the rate of disclosure.

Cardiac Manifestations in Dengue Patients in a Rural Tertiary Care Centre in Coastal Kerala

Background: Dengue epidemic is a major health problem in India. Kerala has reported the highest number of dengue related deaths in the country in 2017 as per the reports of the directorate of National Vector Borne Disease Control Programme (NVBDCP). The aim of the present study is to find out the cardiac manifestations of patients admitted with dengue fever during the epidemic in 2017 in a rural tertiary care centre in coastal Kerala. Method: 341 patients who were admitted in the medicine department of a rural tertiary care Centre in Kerala with Dengue were included in the study. W.H.O case definitions were used for the diagnosis. Complete blood counts, RBS, serum creatinine and liver function tests and E.C.G were carried out in all patients. Echocardiogram and cardiac biomarkers were done when indicated. Results: Males predominated. 317 were diagnosed as dengue fever, 12 as dengue hemorrhagic fever and 12 had dengue shock syndrome. Only four patients succumbed to death. Head ache and myalgia were the common symptoms at the time of presentation. 72 patients had abnormal ECG, but all had normal ECG at the time of discharge, indicating a transient change during the episode. Conclusion: This retrospective observational study included 341 patients admitted in a rural tertiary care Centre in Kerala. Patients were diagnosed as per W.H.O. case definition for dengue. 317 were diagnosed as dengue fever, 12 as dengue hemorrhagic fever and 12 had dengue shock syndrome. Study population was predominantly males. 72 patients had abnormal ECG, but all had normal ECG at the time of discharge, indicating a transient change during the episode.

Second hand smoke exposure in pregnancy and the risk of still birth – a case control study in a tertiary care centre in Kerala

Second hand smoke exposure in pregnancy and the risk of still birth – a case control study in a tertiary care centre in Kerala

A Cross sectional Study on Maternal and Foetal Outcomes in Multifoetal Pregnancies in a Tertiary Care Centre in Kerala

A Cross sectional Study on Maternal and Foetal Outcomes in Multifoetal Pregnancies in a Tertiary Care Centre in Kerala

Effect of Yoga as an Adjunctive Therapy on the Respiratory Function of COPD Patients with mild to Severe Grades of Severity in a Tertiary Care Centre in Kerala

Effect of Yoga as an Adjunctive Therapy on the Respiratory Function of COPD Patients with mild to Severe Grades of Severity in a Tertiary Care Centre in Kerala