Tertiary Care Center In South India Research Articles

The Role of Angiotensin II Type 1 Receptor A1166C Polymorphism in Autosomal Dominant Polycystic Kidney Disease.

Introduction Autosomal dominant polycystic kidney disease (ADPKD) is the most common monogenic disorder that affects the kidney, which affects all ethnical groups worldwide, with varied clinical presentations and severity. The studies done in various parts of the world on the association between angiotensin II type 1 receptor (AT1R) A1166C gene polymorphism and ADPKD patientshave revealed inconsistent results. This study was done to assess the role of AT1R A1166C gene polymorphism in ADPKDin the South Indian population, which is the first of its kind. Methodology This is a case-control study, conducted at a tertiary care centerin South India. This study was concerned with the frequency of exposure (genotype) in ADPKD patients. Peripheral blood samples from 85 unrelated ADPKD patients and 94 controls without diabetes, hypertension, or any kidney-related disease were collected. The AT1R A1166C polymorphism was compared between (i) the cases and controls, (ii) early and late stages of chronic kidney disease(CKD) (ADPKD) subjects, and (iii) ADPKD subjects with and without hypertension. Results Among the ADPKD patients, 45 (52.9%) subjects showed early stage (CKD stages 1-3), and 40 (47%) subjects showed late stage CKD (CKD stages 4 and 5). The genotype distribution of the studied 85 ADPKD patients was almost similar. No significant association was found between the genotype distribution of AT1R A1166C polymorphism in AA vs. AC (OR = 1.11; 95% CI = 0.37-3.32; p < 0.844) and A vs. C (OR = 1.11; 95% CI = 0.38-3.32; p < 0.847) between cases and controls. The genotype distributions in genetic model AA vs. AC (OR = 3.07; 95% CI = 0.56-16.8; p < 0.177) and allelic model A vs. C (OR = 2.13; 95% CI = 0.40-11.3; p < 0.364) between the early and late CKD stages of ADPKD were also not significant. No significant association of gene polymorphism was found between the non-hypertensive and hypertensive groups of ADPKD. Conclusion The results of our study suggest there is no significant association between AT1R A1166C polymorphisms and ADPKD in the South Indian population. Further, the gene polymorphism is not related to the progression of ADPKD or the presence of hypertension in ADPKD cases in South India.

Incidence and Characterization of Post-COVID-19 Symptoms in Hospitalized COVID-19 Survivors to Recognize Syndemic Connotations in India: Single-Center Prospective Observational Cohort Study.

Long COVID, or post-COVID-19 syndrome, is the persistence of signs and symptoms that develop during or after COVID-19 infection for more than 12 weeks and are not explained by an alternative diagnosis. In spite of health care recouping to prepandemic states, the post-COVID-19 state tends to be less recognized from low- and middle-income country settings and holistic therapeutic protocols do not exist. Owing to the syndemic nature of COVID-19, it is important to characterize post-COVID-19 syndrome. We aimed to determine the incidence of post-COVID-19 symptoms in a cohort of inpatients who recovered from COVID-19 from February to July 2021 at a tertiary-care center in South India. In addition, we aimed at comparing the prevalence of post-COVID-19 manifestations in intensive care unit (ICU) and non-ICU patients, assessing the persistence, severity, and characteristics of post-COVID-19 manifestations, and elucidating the risk factors associated with the presence of post-COVID-19 manifestations. A total of 120 adult patients admitted with COVID-19 in the specified time frame were recruited into the study after providing informed written consent. The cohort included 50 patients requiring intensive care and 70 patients without intensive care. The follow-up was conducted on the second and sixth weeks after discharge with a structured questionnaire. The questionnaire was filled in by the patient/family member of the patient during their visit to the hospital for follow-up at 2 weeks and through telephone follow-up at 6 weeks. The mean age of the cohort was 55 years and 55% were men. Only 5% of the cohort had taken the first dose of COVID-19 vaccination. Among the 120 patients, 58.3% had mild COVID-19 and 41.7% had moderate to severe COVID-19 infection. In addition, 60.8% (n=73) of patients had at least one persistent symptom at the sixth week of discharge and 50 (41.7%) patients required intensive care during their inpatient stay. The presence of persistent symptoms at 6 weeks was not associated with severity of illness, age, or requirement for intensive care. Fatigue was the most common reported persistent symptom with a prevalence of 55.8%, followed by dyspnea (20%) and weight loss (16.7%). Female sex (odds ratio [OR] 2.4, 95% CI 1.03-5.58; P=.04) and steroid administration during hospital stay (OR 4.43, 95% CI 1.9-10.28; P=.001) were found to be significant risk factors for the presence of post-COVID-19 symptoms at 6 weeks as revealed by logistic regression analysis. Overall, 60.8% of inpatients treated for COVID-19 had post-COVID-19 symptoms at 6 weeks postdischarge from the hospital. The incidence of post-COVID-19 syndrome in the cohort did not significantly differ across the mild, moderate, and severe COVID-19 severity categories. Female sex and steroid administration during the hospital stay were identified as predictors of the persistence of post-COVID-19 symptoms at 6 weeks.

The Association Between Microalbuminuria and QTc Prolongation in Patients With Type 2 Diabetes Mellitus: A Single-Centre Study From South India.

One of the most significant complications of type 2 diabetes mellitus (T2DM)is diabetic nephropathy, the leading cause of end-stage renal disease. Another important clinical marker in patients with type 2 diabetes is QTc interval prolongation.We aimed to study the association between QTc interval prolongation and microalbuminuria in patients with T2DM. The primary objective of this study was to examine the association between QTc interval prolongation and microalbuminuria in patients with T2DM. The secondary objective was to correlate the prolongation of the QTc interval with the duration of T2DM. This study was conducted as a single-centre, prospective, observational study in a tertiary-care centre in South India, Amrita Institute of Medical Sciences and Research Center. The study was conducted over two years, between April 2020 and April 2022.Patients aged more than 18 with T2DM with and without microalbuminuria were recruited into the study and control groups, and various parameters, including QTC intervals, were recorded. A total of 120 patients were enrolled in the study, with 60 patients with microalbuminuria forming the study group and 60 patients without microalbuminuria forming the control group. There was a statistically significant association between microalbuminuria with a prolonged QTc interval, hypertension, a longer duration of T2DM, higher haemoglobin AIc (HbA1c) levels, and higher serum creatinine values.

Platelet Indices as Indicator of Diabetic Nephropathy among Patients Attending a Tertiary Care Centre in South-India

Introduction: Diabetes mellitus, a chronic metabolic disease affects various organs of the body on a long-term basis. Studies have been conducted on different aspects of the disease, to understand its complications and to detect them earlier to avoid irreversible damage like nephropathy.&#x0D; Aim: The study aims at comparing platelet indices like Plateletcrit (PCT), Platelet Distribution Width (PDW) and Mean Platelet Volume (MPV), with serum creatinine among diabetes, prediabetes patients and non-diabetes controls, to understand the association of the platelet indices and creatinine, an indicator of renal damage.&#x0D; Materials and Methods: The cross-sectional study conducted over a period of three months involved 30 non-diabetic controls with normal HbA1c, 30 diabetics and 30 prediabetic subjects, of age group 18-35 years. The groups were classified based on their HbA1c concentration. The blood samples were analyzed for parameters PCT, PDW, MPV, creatinine and HbA1c by their respective methods. The study will guide in understanding the role of platelets in pathogenesis of diabetic nephropathy.&#x0D; Results: Platelet indices like Plateletcrit (PCT), Platelet Distribution Width (PDW) and Mean Platelet Volume (MPV) were found to be increased in diabetics and 30 prediabetic subjects than the non-diabetics. The Platelet indices were also correlating with the serum creatinine levels of the three study groups.&#x0D; Conclusion: There is a positive association between the Platelet indices and creatinine, in patients with pre-diabetes and diabetes who have the risk of progression to diabetic nephropathy. Hence, the Platelet indices shall be included as early and cost-effective biomarkers of diabetic nephropathy.

Presence of hemophagocytes in bonemarrow- A study in a tertiary care center inSouth India

Introduction and Aim:HaemophagocyticLymphohistiocytic Syndrome (HLH) is a fatal disease with characteristic proliferation of histiocytes in the organs including bone marrow, liver, spleen, kidney, csf, meninges, lymph nodes and subcutaneous tissue which phagocytes the blood cells. In all unexplained cases of cytopenias, organomegaly and pyrexia of unknown origin the HLH should be thought off. Though there are established criteria to diagnose, early diagnosis can reduce the mortality rate due to HLH. Documenting the haemophagocytes in the biopsy can sometimes be very helpful in arriving at the diagnosis.&#x0D; &#x0D; Materials and Methods:We identified patients who were diagnosed with or suspected to have HLH by bone marrow aspiration or biopsy admitted to Sri Ramachandra Medical College Hospital and Research Institution from January 2010 to June 2017.We retrospectively reviewed patients’ medical records that have haemophagocytes in bone marrow aspirations and collected complete clinical history and laboratory findings. Those history included fever, cytopenias, and organomegaly. Their triglyceride levels, ferritin, ESR or any other abnormal elevated lab values were also noted down. If they had any established diagnosis then that was also noted.&#x0D; &#x0D; Results:This is a descriptive study and the details of the data like clinical history, clinical features, laboratory investigations and abnormal values are represented using tabular column, Pie chart and bar diagrams.&#x0D; &#x0D; Conclusion:From pathological point of view, documenting each case presenting with Haemophagocytes and looking into the factors like age, significant laboratory values along with clinical features can be a valuable tool to come to a provisional diagnosis and might help the clinician to proceed with the treatment for alife-threatening disease without much delay.

A study of patients presenting with idiopathic VT to a tertiary-care centre in South India - Immediate and follow-up results

A study of patients presenting with idiopathic VT to a tertiary-care centre in South India - Immediate and follow-up results

Induced glare testing — an underutilized test in evaluating visual disability in patients presenting with symptomatic cataracts

Background: Cataract increases intraocular light scatter which affects the retinal image contrast and sensitivity. Symptomatic patients with cataract complain of a drop in the quality of vision or glare affecting daily routine even with preserved visual acuity. This study was aimed to quantify the drop in the glare induced visual acuity (VA) and contrast sensitivity (CS) in different morphological types of cataracts. Material and methods: This was an observational study on a prospective cohort, conducted at a tertiary-care centre in South-India. Patients admitted for cataract surgeries between March and September 2017 with BCVA ≥ 6/60 (Snellen) and ≥ 40 years were enrolled. LogMAR VA and CS were measured pre and post-operatively, with and without glare induction using brightness acuity tester. Patients were sub-categorised based on morphology and the presence of glare as a symptom. Paired-t test for the pre- and post-operative values and analysis with Bonferroni’s adjustment were the statistical methods used. Results: Data of 78 patients were sub-categorised and analysed. Glare induction with high glare was significant in all the studied groups. LogMAR VA was affected most in group 3 (0.20, 10 letters, p < 0.05) and the CS in group 2 (0.62, 4.1 step drop, p < 0.05). Patients who had glare as a symptom had an average greater drop in LogMAR VA (0.30, p = 0.01) and CS (–0.29, p = 0.03) when induced with a high glare. Conclusions: All morphological types of cataracts affect VA and CS to a greater extent in conditions of bright lighting. Glare induced VA and CS testing is a sensitive and an adjunct tool to traditional high contrast VA testing, in evaluating the visual dysfunction of patients presenting with symptomatic cataracts.

Lung cancer in smokers versus nonsmokers: a retrospective analysis over a 5-year period

Background and aim Lung cancer is well known in tobacco smokers. It affects nonsmokers as well. This research was undertaken to analyse whether primary lung cancer in nonsmokers is on an increasing trend and also study the differences in clinicopathological patterns and disease staging in smokers versus nonsmokers. Patients and methods A retrospective record-based study of 198 primary lung cancer patients from January 2012 to December 2017 in the Department of Pulmonary Medicine in a tertiary-care centre in South India was done. Symptomatology, histopathology, and stage of presentation of lung cancer were compared between smokers and nonsmokers. Statistical analysis Statistical analysis was done using SPSS, version 18.0. Frequencies were calculated. Associations were calculated using the χ2 test. Results Out of 198 patients, 153 patients were men and 45 were women. The mean age of patients was 51.78 years. Of these, 88 (44.4%) patients were smokers and 110 (55.6%) patients were nonsmokers. Cough, chest pain, and breathlessness were major symptoms in nonsmokers and fever, hemoptysis, and hoarseness of voice in smokers. Adenocarcinoma was the most common cancer affecting both smokers and nonsmokers (P=0.691). Majority of patients presented in stage IV, 71 (54.6%) and 59 (45.4%) in nonsmokers and smokers, respectively (P=0.787). Conclusion In our study, primary lung cancer patients comprised more nonsmokers than smokers with a predominance of nonsmoker men. Lung cancer histopathology was predominantly adenocarcinoma. Majority of patients presented with stage IV of lung cancer and 10% of patients were inappropriately treated with antitubercular therapy.

Candida auris: Clinical profile, diagnostic challenge and susceptibility pattern: Experience from a tertiary-care centre in South India

ObjectivesCandida auris is an emerging, multidrug-resistant yeast transmitted in healthcare settings. Conventional methods of speciation are unable to identify C. auris to species level. Three methods, namely VITEK® MS v.3.0, VITEK®2 and target sequencing of the internal transcribed spacer (ITS) region and 28S rRNA gene, were evaluated. Antifungal susceptibility testing (AFST) was also performed, and risk factors for acquisition of C. auris candidaemia were studied. MethodsBetween November 2016 and November 2017, 203 Candida spp. were isolated from blood cultures, of which 11 isolates that were unidentifiable by conventional methods were further tested by VITEK® MS v.3.0 and VITEK®2 and were confirmed by sequencing. AFST was carried out on all 11 isolates by broth microdilution according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Clinical and epidemiological data of all patients retrieved from electronic patient records were reviewed. ResultsOf the 11 isolates identified as C. auris both by ITS and 28S rRNA sequencing, VITEK®2 identified only 5 as C. auris and VITEK® MS v.3.0 was not able to identify any of them as C. auris. Ten isolates (91%) were resistant to fluconazole, whereas all isolates were susceptible to amphotericin B and caspofungin. ConclusionCandida auris can be misidentified in routine microbiology laboratories. Sequencing remains the gold standard if commercial identification systems are not updated.

Management of hepatolithiasis in a tertiary care centre in South-India

Aim: This study is to analyse the clinicopathologic features, diagnosis and treatment for hepatolithiasis in a tertiary centre. Methods: This is a retrospective study of prospectively maintained database between June 2012 to October 2017. The demography, clinical presentation, surgical management were analyzed. Results: The age range was between 24 to 70 years. The study includes 20 patients (M - 4, F - 16). Hepatectomy was done in 12 patients. Left lateral segmentectomy (8), left hepatectomy(1), Segmental resections done in 3 patients. All these patient had access to the bile duct through Choledochoduodenostomy in 16 patients and Hepaticojejunostomy with Jejunoduodenostomy as access loop to the first part of duodenum (4 cases). Cholecystectomy was done in all patients without prior cholecystectomy. Conclusion: Hepatolithiasis is rare in South India. Surgical management depends on liver parenchymal status, cholangitis, diameter of CBD, biliary stricture and distribution of stones. The access to the biliary system was made either by choledocoduodenostomy or access loop to the first part of duodenum.

Comparison of sterile water irrigation versus intravesical mitomycin C in preventing recurrence of nonmuscle invasive bladder cancer after transurethral resection.

Introduction:Early recurrence of nonmuscle invasive bladder cancer (NMIBC) following transurethral resection (TUR) remains relatively high. An immediate single instillation of mitomycin C (MMC) reduces the recurrence rates in the first 2 years but has not shown benefits in tumor progression or overall survival. Distilled water irrigation has shown to delay tumor recurrence by osmolysis of tumor cells. There are only limited clinical studies comparing the efficacy of MMC with continuous sterile water irrigation (CSWI) in preventing the recurrence of NMIBC after TUR in clinical setting.Materials and Methods:A prospective, randomized, open-label, two-arm, single-center, pilot study was conducted between December 2013 and September 2015 at a tertiary-care center in South India. Patients were randomized into CSWI group (n = 19) or single dose intravesical MMC group (n = 17) following TUR for NMIBC and analyzed. All patients were followed up with flexible cystoscopy and urine cytology at 3 months interval for 1 year. Recurrence-free rate was estimated as the primary criterion for outcome analysis.Results:At the end of 12 months, recurrence-free rates for MMC and CSWI groups were 47.1% and 52.6%, respectively. The mean recurrence-free interval for MMC and CSWI groups were 10.9 months and 9.8 months, respectively. The difference in recurrence-free rate or recurrence-free interval between two groups was statistically nonsignificant. Further, the complications in MMC group were significantly higher than that in CSWI group (P = 0.047).Conclusions:Continuous bladder irrigation with sterile water after TUR may be comparable to immediate single dose intravesical MMC in preventing tumor recurrence in NMIBC.

Draft Genome Sequences of Three Hypervirulent Carbapenem-Resistant Klebsiella pneumoniae Isolates from Bacteremia.

Hypervirulent Klebsiella pneumoniae strains have been increasingly reported worldwide, and there is emergence of carbapenem resistance among them. Here, we report the genome sequences of three carbapenem-resistant hypervirulent K. pneumoniae isolates isolated from bacteremic patients at a tertiary-care center in South India.