Tertiary Care Center Research Articles

Estimation of fetal weight at term by clinical and sonographic assessment and its correlation with the birth weight – A prospective cohort study in a tertiary care hospital

Estimation of fetal weight is necessary to decide on the time and route of delivery. Different clinical and ultrasound methods for estimating fetal weight are followed by different institutions. Antenatal assessment of fetal weight is necessary to achieve better feto-maternal outcomes. The objectives of this study were: (a) fetal weight estimation by ultrasound (Hadlock’s formula) and clinical methods (Johnson’s formula and Dare’s formula) and (b) to compare them with the actual weight of the baby after birth. A prospective cohort study was conducted in a tertiary care centre at Puducherry, India including all singleton, term pregnant women with vertex presentation, normal AFI and BMI <35 kg/m who delivered within the next 48 hours of assessment. The agreement between the different methods of fetal weight estimation and actual birth weight were calculated using intraclass correlation coefficient. Bland and Altman plot was done to identify the intervals of agreements. A total of 400 term antenatal women with age range of 17 to 44 years participated in the study. Intraclass correlation coefficient for Johnson’s formula was 0.816, Dare’s formula was 0.672 and Hadlock’s formula was 0.912. All the three methods had statistically significant correlation with the actual birth weight. Ultrasound estimation of fetal weight is the best out of the three methods and it correlated well with the actual birth weight. Johnson’s formula also gave results close to actual birth weight. With a correlation coefficient comparable to that of ultrasound estimation, Johnson’s formula can be used in low resource settings where ultrasound facilities are not available.

The effectiveness of the abdominal sacrocolpopexy / sacrohysteropexy with synthetic mesh for repair of apical prolapse

: Pelvic organ prolapse is a common condition among parous women, badly affecting their life. They need a safe and consistent procedure that does anatomical correction and also improves their overall quality of life. Abdominal sacrocolpopexy and sacrohysteropexy are promising procedures for apical prolapse repair. Aim was to determine the effectiveness of the abdominal sacrocolpopexy /sacrohysteropexy with synthetic mesh for repair of vault and nulliparous prolapse respectively. The objectives were to describe the outcomes in the form of anatomical correction, symptomatic improvement and the complications in peri-operative and in follow up periods. This prospective observational study was carried out in the department of Obstetric and Gynaecology, at a tertiary care center. The present study included 22 women with vault prolapse (n=18) and nulliparous prolapse (n=4), underwent abdominal sacrocolpopexy /sacrohysteropexy respectively for 2 years from 1st February 2021 to 31st January 2023 and follow up for 12 months. : Most of the women had preoperative apical prolapse in stages-3 (59%), mean age in abdominal sacrocolpopexy/ sacrohysteropexy group was 53.6 years and 26.5 years respectively. Perioperative complications were bladder injury (n=1), paralytic ileus (n=1), wound dehiscence (n=1) and UTI (n=1). In post-operative reassessment of pelvic organ prolapse, vault/uterus was well supported (100%), 100% symptomatic relief. During follow up dyspareunia (n=1), lower backache (n=1) were present, no mesh erosion and no recurrence of Pelvic organ prolapse observed. : Abdominal sacrocolpopexy/ sacrohysteropexy with synthetic mesh are safe and durable procedures for vault and nulliparous prolapse repair respectively.

Comparison of Bishop’s score with transvaginal sonographic cerviComparison of Bishop’s score with transvaginal sonographic cervical assessment to predict success of induction of labor

Induction of labor for medical or obstetric indications is a common practice in modern obstetrics. Evaluation of the cervix by Bishop’s score is universally used to predict the success of induction of labor. But it is a subjective method and many studies have shown that it is not a good indicator of success of induction. To compare Bishop’s scoring system and trans-vaginal sonographic assessment of cervix in predicting the successful outcome of induction of labor.This was an observational study conducted in a tertiary care center. 120 patients who met the selection criteria were included. Prior to the induction of labor the Bishop’s score and the sonographic scoring was assigned. Successful induction was defined as the patient entering the active phase of labor. 84% of participating women entered the active phase of labor. While 72.6% women had a normal vaginal delivery, 67.8% women delivered vaginally within 24 hours of induction. The TVS score (MGPICSS) of ≥2 predicted the successful induction with a specificity of 100% and sensitivity of 39.3% and AUC 0.74. In comparison, the Bishop score of ≥4 had a specificity of 75% and sensitivity of 44% and AUC 0.56. The prediction of delivery within 24 hours at the MGPICSS of ≥2 had a specificity of 100% and sensitivity of 42.9% and AUC 0.76. For the same, the Bishop’s score of ≥4 had specificity of 83.3% and sensitivity of 45.5% and AUC 0.71. TVS assessment of cervix is a better predictor of successful labor induction in comparison to Bishop’s score.

Understanding the burden of teenage pregnancy: A five-year analysis at a tertiary care center of northern Karnataka in India

: The present study was planned to comprehensively investigate the epidemiological aspects and clinical feto-maternal outcomes associated with teenage pregnancy, to provide a holistic understanding of teenage pregnancy and the possible solutions. : This is retrospective record-based research conducted over a five-year period, spanning from January 2018 to December 2022, in the department of Obstetrics and Gynaecology of a tertiary care centre in northern part of Karnataka, India. The teenage pregnancy was considered as all pregnancies that occurred in women aged between 13 to 19 years who visited the institute for delivery during the study period. A comprehensive analysis was conducted, encompassing various facets of their antenatal experiences, delivery methods, postpartum complications, as well as the well-being of the new-borns. : A total of deliveries 52,715 deliveries had been recorded in our institute during the study period. Among these deliveries, 1,754 were among teenagers, resulting in a prevalence rate of 3.33%. Nearly one-fifth (19.16%) of teenage mothers were short stature whereas only 7.02% of adult mothers were short stature. The relatively higher proportion of teenage mothers were underweight. Maternal and fetal complication were comparatively higher among teenage mothers whereas caesarean sections were relatively more among adult mothers. : The present study emphasizes the importance of targeted healthcare interventions, including improved prenatal care, nutritional support, and education for teenage mothers, to mitigate these risks and improve the overall health and well-being of both mothers and their infants.

Post abortion contraception: A follow up study in women undergoing first and second trimester abortion at a tertiary care centre

: Worldwide 75 million women need post abortion care (PAC) services each year following safe or unsafe induced abortions and miscarriages. Majority of them do not wish to conceive in near future and are receptive towards using contraception. Contraceptive counselling and basket of choices should be made available to all women undergoing abortion and her right to decline or postpone this care should be respected while recognizing that each woman has a unique unmet need of contraception.: To compare the acceptance and continuation of various contraceptive choices offered after first and second trimester abortion. : A retrospective study was conducted at a tertiary care hospital in which women who underwent first and second trimester abortion over a period of one year were interviewed regarding their acceptance and continuation of the contraceptive method till six months post abortion.: A total of 378 women underwent first and second trimester abortions over one year, of which 61.3% had resulted from failure of contraception. Women were grouped into Group A for those undergoing first trimester and Group B for women undergoing second trimester abortion for study purpose. Average age of women in group A was 28.9 years and in group B was 26.5 years. Mean period of gestation of pregnancy in group A was 7.5weeks and in group B was 19.5 weeks. In group A 96% parous women had conceived as a result of failure of contraception of which 90% were using natural method (Coitus Interruptus). Group B majority (76.3%) women were nulliparous and early parous (P1, P2) and indication for termination of pregnancy in them were gross congenital anamolies (GCA) in fetus while in rest of multiparous were due to failure of contraception. With group A 53.1% nulliparous women did not opt for any contraception whereas 48.6% primiparous and second parous opted for long acting reversible contraception(LARC) –Intrauterine contraceptive device(IUCD) in contrast to 66% multiparous opting for permanent sterilization at the time of abortion. In group B 45.3% nulliparous and early parous opted for depot medroxy progesterone acetate (DMPA) and 64.2% multigravidas underwent permanent sterilization. : Post abortion care must include counselling and choice of contraceptive basket. Women with future reproductive plans preferred LARC after first trimester abortion whereas DMPA was most acceptable method of contraception after second trimester abortion. Women were most satisfied with LARC and permanent methods compared to methods that required daily intake of pills. There is need of effective contraceptive choices according to the reproductive plans of the women to reduce the burden, morbidity and mortality associated with abortions.

Complications of placenta previa: A retrospective observational study at tertiary care hospital

: Placenta previa (PP) is condition where the placenta is inserted completely or partially into the lower uterine segment, at or after 28 weeks of gestation. Maternal and fetal risks are antepartum haemorrhage (APH), postpartum haemorrhage (PPH), abnormal adherence of placenta, low birth weight (LBW), intra uterine growth restriction (IUGR), preterm births and congenital malformations. The purpose of this study was to determine the proportion of placenta previa, the demographics of patients, types- severity, complications and the feto-maternal outcome in patients of placenta previa.: After due permission of Institutional Review Board, this retrospective observational study was carried out at tertiary care teaching hospital from July 2020 to November 2022.Proportion of pregnancies with placenta previa was 0.3%. Majority 44(91.7%) patients were registered, 38(79.2%) of patients were in age group of 21-30 years, 38(79.1%) patients were multigravida, 41 (85.4%) had major degree of placenta previa, 29(60.4%) patients admitted after 37 weeks of gestation and 47(97.9%) of patients were delivered by caesarean section. Majority of patients, 20 (41.7%) had mild anemia. Major complications were bleeding episodes during antenatal period/APH in 23 (47.9%) and PPH in 22 (45.8%) patients. Maternal mortality occurred in 1 (2.1%) patient. All babies were live at time of birth and 44(91.7%) babies were alive at the time of discharge and neonatal death occurred in 4 (8.3%) preterm babies (28-33 week gestation). Majority of patients were multigravida. No patient was severely anaemic. Majority of patients were delivered by CS. APH and PPH were major complications. About two third of patients required blood transfusion in ante/intra/post-natal period. Obstetric hysterectomy was required in about one tenth of patients. Majority of babies were alive at the time of discharge due to higher number of registered patients who took regular antenatal care, hospital delivery and good NICU facilities. Once diagnosed, placenta previa and morbidly adherent placenta should be managed at tertiary care centre with multidisciplinary approach so as to lessen the feto-maternal morbidity and mortality. Prevention is better than cure. Multiparity increases the risk of placenta previa. Hence, family planning with an aim to reduce unwanted pregnancies and abortions will help to reduce the chances placenta previa. CS increases the risk of development of placenta previa. Efforts should be made to reduce the primary caesarean section rate as it poses more risk of placenta previa, morbidly adherent placenta and its related complications in subsequent gestations.

A comparative study on knowledge, awareness and perception of contraception among rural and urban population in Punjab

In developing countries like India, a lack of awareness about contraceptive methods often leads to misconceptions, limited choices, and improper family planning. This knowledge gap not only disrupts maternal and child health complications but also disrupts the economy of society and the nation. Therefore, the purpose of this study was to investigate the knowledge, awareness and perception of contraception among the rural and urban population in Punjab.This observational study conducted in the Department of Obstetrics and Gynecology at a tertiary health care centre, in Punjab, India. A total of 500 women were evaluated with the help of a pre-designed questionnaire to address knowledge, awareness, and perception of contraception among the rural and urban population in Punjab. The statistical analysis was performed by using SPSS Windows, version 28. In the present study, a total of 492 participants were included, of whom 387 were from rural areas and 105 were from urban areas. This study revealed, 100% of participants were aware of contraception. In terms of the source of information, social circles were identified as the primary channel (46.34%), followed by the media (33.94%), health workers (16.87%), and educational institutes (2.85%).This study highlights contraceptive methods, including condoms, oral contraceptives, and intrauterine devices (IUDs), as primary choices. Therefore, it's important to bridge the gap between awareness and action. Hence, this study, advocate the awareness program on interventions to ensure everyone can access effective family planning resources without barriers.

A comparative interventional study on fixed-dose versus titrated- dose oral misoprostol solution for induction of labour at term gestation in a tertiary care centre of Eastern Uttar Pradesh

Induction of labor entails the deliberate initiation of uterine contractions before the spontaneous onset of labor, irrespective of whether the amniotic membranes have ruptured or not. The Modified Bishop’s score of six or higher indicates that the cervix is ripe, or “favorable” – when there is a high likelihood of spontaneous labor or responsiveness to interventions designed to induce labor. Misoprostol being cost-effective, easily available and stable at room temperature makes itself a promising agent in future for induction of labour if the feto-maternal safety concerns are proved with evidence. The aim of our study was to compare the efficacy of titrated versus fixed dose oral misoprostol solution regimen as inducing agents and the effects on fetomaternal outcome.A comparative interventional study was conducted for one year and study population consisted of term pregnant women admitted to the labour room of the hospital. A total sample size of 150 was deemed necessary, with 75 participants required per group. Following allocation into groups, induction of labor was carried out using either oral titrated-dose misoprostol solution or fixeddose misoprostol solution.Successful induction of labour was higher in fixed -dose group (Group F) (80%) as compared to 65.53% in titrated-dose group (Group T), the difference was statistically significant (p=0.0439). The need for augmentation was lower in group F (30.67%) than in group T (56%). Statistically, this difference was significant (p = 0.0017). Uterine hyper stimulation and atonic post-partum haemorrhage were noted more in group T but this difference was not significant (p = 0.1461; p = 0.3108). Requirement of newborn resuscitation was observed higher in group T [34 (45.34%)] than group F [16(21.33%)]. Statistically, this difference was significant [p=0.0081]. NICU admissions were more in group T (21.34%) than group F (13.33%), but difference was not significant (p = 0.0574).This study concludes that both fixed- dose and titrated-dose oral misoprostol solution regimens are effective in induction of labour but fixed-dose regimen has an advantage of less mean total dose of misoprostol administered, reduced induction to delivery interval, less uterine hyperstimulation, atonic postpartum hemorrhage and better fetomaternal and neonatal safety profile.

Plasma biomarkers increase diagnostic confidence in patients with Alzheimer’s disease or frontotemporal lobar degeneration

BackgroundThe recent development of techniques to assess plasma biomarkers has changed the way the research community envisions the future of diagnosis and management of Alzheimer’s disease (AD) and other neurodegenerative disorders. This work aims to provide real world evidence on the clinical impact of plasma biomarkers in an academic tertiary care center.MethodsAnonymized clinical reports of patients diagnosed with AD or Frontotemporal Lobar Degeneration with available plasma biomarkers (Aβ42, Aβ42/Aβ40, p-tau181, p-tau231, NfL, GFAP) were independently assessed by two neurologists who expressed diagnosis and diagnostic confidence three times: (T0) at baseline based on the information collected during the first visit, (T1) after plasma biomarkers, and (T2) after traditional biomarkers (when available). Finally, we assessed whether clinicians’ interpretation of plasma biomarkers and the consequent clinical impact are consistent with the final diagnosis, determined after the conclusion of the diagnostic clinical and instrumental work-up by the actual managing physicians who had complete access to all available information.ResultsClinicians assessed 122 reports, and their concordance ranged from 81 to 91% at the three time points. At T1, the presentation of plasma biomarkers resulted in a change of diagnosis in 2% (2/122, p = 1.00) of cases, and in increased diagnostic confidence in 76% (91/120, p < 0.001) of cases with confirmed diagnosis. The change in diagnosis and the increase in diagnostic confidence after plasma biomarkers were consistent with the final diagnosis in 100% (2/2) and 81% (74/91) of cases, respectively. At T2, the presentation of traditional biomarkers resulted in a further change of diagnosis in 13% (12/94, p = 0.149) of cases, and in increased diagnostic confidence in 88% (72/82, p < 0.001) of cases with confirmed diagnosis.ConclusionsIn an academic tertiary care center, plasma biomarkers supported clinicians by increasing their diagnostic confidence in most cases, despite a negligible impact on diagnosis. Future prospective studies are needed to assess the full potential of plasma biomarkers on clinical grounds.

Surgical Approach to Urethral Diverticulum and Urethrovaginal Fistula With Mesh Erosion.

This video illustrates a rare surgical case involving a urethral diverticulum, urethrovaginal fistula, and mesh erosion. We present a 58-year-old patient attending a tertiary care center with a suspected urethrovaginal fistula. Her concerns included stress urinary incontinence (SUI), recurrent urinary tract infection, and vaginal pain. The surgical history was notable for the placement of two different mesh slings during the same procedure to treat SUI. Preoperative evaluation and findings are illustrated in detail. The video uses a high-definition surgical camera to emphasize the initial intraoperative evaluation with localization of the fistula and diverticulum. We then demonstrate the approach to the dissection with the goal of ensuring complete resection of the diverticulum, fistula, and mesh, while preserving healthy tissue for subsequent closure. The utilization of unique and specialized tools for each portion of the procedure is also illustrated. A layered vaginal closure, including a Martius flap, is created to prevent recurrence. The surgery was accomplished without complications. To our knowledge, concomitant findings of a urethral diverticulum, urethrovaginal fistula, and mesh erosion are unique in the literature. We postulate that this triad could have resulted from the mesh burden in this particular patient.

Laparoscopic modified e-tep repair of concomitant inguinal and ventral hernias.

Laparoscopic hernia repair in recent times has gained the most acceptance among both the surgical community and the patient groups, as it has proven benefits of lesser postoperative hospital stay and less pain scores. The incidence of both inguinal and ventral hernias has increased significantly in the present days. Various methods have been postulated by different surgical groups for repairing the same but no there is no standard consensus on managing concomitant inguinal and ventral hernias. The conventional e-TEP requires an extensive dissection with increased operative time. We present our experience in managing cases with both inguinal and primary M2/M3 and W1 ventral hernias with or without divarication of recti using a modified up to down approach for inguinal hernia followed by down to up approach for the ventral hernia, from a tertiary care center in South India. We managed 16 cases with simultaneous incidence of inguinal and primary M2/M3 and W1 ventral hernias with or without divarication of recti between January 2022 and November 2023. Institute ethical committee clearance and informed consent was obtained from all the 16 patients. They were all subjected to an extra peritoneal repair of both the hernias. All the demographic data, intraoperative data, postoperative complications and follow up were digitally stored. All patients were followed up for six months after surgery. Out of 16 patients, 15 were males and 1 was female. The mean age was 48years and the mean BMI of all the patients was 29.2kg/m2. The postoperative recovery was smooth in all patients and being discharged within 24h after surgery. The pain scores of all patients were significantly lower than patients who underwent intraperitoneal repair. e-TEP hernia repair is gaining popularity and has amused the hernia surgical community. Our method of e-TEP RS repair in cases with concomitant inguinal and primary M2/M3 W1 ventral hernias with or without divarication helps in addressing both the hernias in the extra-peritoneal space. Our technique reduces the area of dissection needed for mesh placement and preserves the integrity of abdominal musculature in the upper abdomen when compared with the conventional technique. It further allows extension of the e-TEP inguinal space into the Rectro rectus space without much alteration in the port arrangement allowing simultaneous repair of groin and umbilical hernias. Good knowledge of anatomy and laparoscopic skills are pertinent for safe and effective hernia repair by this technique.

Compliance of Surgical Care in Patients with Carcinoma Endometrium in a Tertiary Care Centre in South India, to European Society of Gynaecologic Oncology (ESGO) Quality Indicators

Compliance of Surgical Care in Patients with Carcinoma Endometrium in a Tertiary Care Centre in South India, to European Society of Gynaecologic Oncology (ESGO) Quality Indicators

Comparative Analysis of Clinicopathologic Characteristics and Outcomes of Urothelial Bladder Cancer Between Young and Older Adults—Experience from a Tertiary Care Center

Comparative Analysis of Clinicopathologic Characteristics and Outcomes of Urothelial Bladder Cancer Between Young and Older Adults—Experience from a Tertiary Care Center

Acute Coxiella burnetii Infection: A 10-Year Clinical Experience at a Tertiary Care Center in the United States

Abstract Background Identifying and treating patients with acute Q fever who are at an increased risk of progressing to persistent disease is crucial for preventing future complications. In this study, we share our decade-long clinical experience with acute Q fever, highlighting the challenges clinicians encounter from making an initial diagnosis and risk stratification to determining the appropriate prophylaxis regimen and duration. Methods We retrieved records of adult (≥ 18 years) Mayo Clinic patients with positive Coxiella burnetii serologies between January 1, 2012, and March 31, 2022. Patients with Q fever anti-phase II IgG ≥ 1:256 by indirect immunofluorescence were further analyzed. Results Thirty-one patients were included. Their median age was 58 years (IQR 50-64), and the majority were men (84%). Acute hepatitis (29%), flu-like illness (25.8%) and pneumonia (16%) were the most common presentations. Thirteen patients (42%) received antibiotic prophylaxis to prevent disease progression, with significant variation in the indications and duration across physicians. The combination of doxycycline and hydroxychloroquine was the preferred regimen. Prophylaxis was administered for a median of 333 days (IQR 168-414). Four patients (13%) progressed to Q fever native valve infective endocarditis with elevated anticardiolipin (aCL) IgG levels being the sole risk factor in two cases. The small sample size precluded drawing conclusions on the impact of prophylaxis in preventing disease progression. Conclusion Management of acute Q fever is complicated by the lack of comprehensive clinical guidelines leading to varied clinical practices. There is a critical need for randomized trials to establish robust, evidence-based protocols for management.

Determinants of Outcomes in Convulsive Status Epilepticus: An Observational Study at a Tertiary Care Center in North India

Determinants of Outcomes in Convulsive Status Epilepticus: An Observational Study at a Tertiary Care Center in North India

Breast lymphomas: Clinical and pathological insights from a tertiary cancer care center in India.

Breast lymphomas are a rare group of malignancies that are further subdivided into primary and secondary. AIMS: To study the pathological and clinical course of breast lymphomas. This is a retrospective analysis of patients treated at our institute over a period of 4.5 years from September 2018 to February 2023. The details of all the patients diagnosed with breast lymphoma were reviewed and analysed for the histomorphological, immunohistochemical, clinical, and treatment details. Appropriate statistical analysis including Kaplan-Meier methods was used. Out of 11 cases of breast lymphoma, five were primary and six were secondary. It was seen predominantly in females (82%) and the age range was 31 to 73 years. Diffuse large B cell lymphoma (DLBCL) was the predominant morphology (73%), along with single rare cases of ALK-negative anaplastic large cell lymphoma, Burkitt lymphoma, and small lymphocytic lymphoma. The treatment details were analyzed for 7 patients. The median follow-up was 28 months. Rituximab along with CHOP regimen or its variants was commonly used as first-line treatment with initial response rates of 71%. The median progression-free survival was 5 months. The median overall survival was 15 months. Lymphomas of the breast are rare but it is crucial to differentiate them from the commoner breast carcinomas as the treatment and prognosis vary vastly.

Cost Analysis of Bladder Catheterization After Pelvic Floor Surgery.

Approximately 15-45% of female patients develop transient postoperative urinary retention (POUR) following pelvic reconstructive surgery. Catheter options for bladder drainage include transurethral indwelling catheter (TIC), intermittent self-catheterization (ISC), and suprapubic tube (SPT). Each strategy has risks and benefits; none have been shown to be clinically superior, and to date, no comprehensive comparative economic analysis has been published. The objective of this study was to evaluate the cost of these different bladder catheterization strategies after transvaginal pelvic surgery. A Canadian universal single-payer (government funded) health system perspective was taken, and a decision tree model was constructed to evaluate the costs associated with each catheterization strategy over a 6-week horizon. Base-cases were set based on recently published clinical data of our institutions, 2 academic tertiary care centers, and based on systematic reviews and meta-analyses. Costs were established in consultation with process stakeholders, in addition to published values. The average cost calculated for management of transient POUR after outpatient pelvic reconstructive surgery was 150.69 CAD (median 154.86; interquartile range [IQR] 131.30-176.33) for TIC, 162.28 CAD (median 164.72; IQR 144.36-189.39) for ISC and 255.67 CAD (median 270.63; IQR 234.32-276.82) for SPT. In costing inpatient surgical data, the average cost calculated was 134.22 CAD (median 123.61; IQR 108.87-151.85) for TIC and 224.61 CAD (median 216.07; IQR 203.86-231.23) for SPT. TIC and ISC were found to be significantly less costly than SPT in managing transient POUR following transvaginal pelvic reconstructive surgery.

A Pilot Real-World Study of Ultrasonography Findings of Hidradenitis Suppurativa in Indian Patients and Its Diagnostic and Therapeutic Implications

Abstract Introduction Hidradenitis suppurativa (HS) is a multifactorial chronic inflammatory follicular disorder affecting apocrine gland-bearing areas of the body. We conducted an observational study to assess the ultrasonography (USG) findings in suspected HS patients at a tertiary care center in North India over 6 months. Aim The aim of this article was to study the USG findings in HS and correlate clinical and USG findings and scoring systems in HS with stage wise treatments. Materials and Methods All patients with a clinical suspicion of HS underwent an USG examination after clinical examination with a probe of 18 Hz frequency. Hurley's staging of patients was used to stage clinically, and the HS-SOS scoring and Doppler changes were assessed on USG. The treatment was revised in case of a change in the USG grading of severity. Results A total of 23 patients suspected of HS underwent USG evaluation, of which 12 (52%) were male and 9 (48%) were females, with the mean age being 25.3 years (range: 14–40 years). Based on the HS clinical grading, eleven patients (47.8%) were Hurley's stage I, six patients (26%) were stage II, and six patients (26%) were stage III. USG demonstrated that three patients had been misdiagnosed and had folliculitis (8.6%) and Crohn's disease (4.3%). Out of the remaining twenty patients with USG features of HS, based on HS SOS grading, three patients (15%) were grade I, seven (35%) were grade II, and ten (50%) were grade III. Of these, nineteen patients (95%) had axillary involvement, which was bilateral in 84% of cases. The other region affected was the groin in five patients (26.3%), while two had inframammary involvement (10.5%). On further characterization of the type of lesion, nodules (41; 40.6%) were the most common type of lesion by sinuses and thickened hair follicles in 31 (30.6%) patients. Based on USG findings, the management of 26% of patients was changed from medical to surgical intervention. Conclusion USG and Doppler are noninvasive bedside tools for the examination of HS, which helps to rule out differentials and delineate the extent and depth of the disease better by picking up subclinical lesions and help in determining disease activity by Doppler, which in turn helps in planning appropriate medical and surgical management of patients. It also identifies radiological parameters that help identify patients who could fail medical management.

Cardiogenic shock following ST-segment elevation myocardial infarction in women: complications and outcomes

Abstract Funding Acknowledgements None. Background Differences in women’s prognosis have been described for both ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock (CS). These might reflect asymmetries in clinical management, but also gender-specific comorbidities and pathologic mechanisms. Purpose We aimed to evaluate the risk of in-hospital complications and mid-term outcomes of women with CS following STEMI. Methods We retrospectively studied STEMI patients treated by primary percutaneous coronary intervention (PCI) from 2008 to 2017 in a tertiary care centre, presenting or evolving in Killip class IV (defined as cardiogenic shock or hypotension and organ hypoperfusion). Clinical and demographic characteristics, as well as complications and outcomes, were collected. Major adverse cardio-cerebrovascular events (MACCE) at 1-year follow-up was a composite of death, cerebrovascular accident, new myocardial infarction in any vessel, or target lesion revascularization. Results Among 1131 patients presenting with STEMI, our study included 117 (10.3%) patients in CS, of which 40 (34.2%) were women. Women were older [71.8(±13.4) vs 64.6(±11.72) years, p=0.002] and less frequently smokers (25.0% vs 50.7%, p=0.008). Prevalence of classic cardiovascular risk factors, namely diabetes (34,1% vs 39.2%, p=0.860), hypertension (71.5% vs 60.8%, p=0.212), and dyslipidaemia (47.5% vs 70.0%, p=0.799), was the same for both groups. Body mass index was also similar [26.6(±5.2) vs 26.1(±3.4) kg/m2, p=0.539]. Women had lower haemoglobin [12.4(±1.9) vs 13.8(±1.9) g/dl, p&amp;lt;0.001] and lower creatinine clearance at admission [52.4(±30.6) vs 67.3(±29.4) ml/min, p=0.017]. Door-to-balloon times [80(59-180) vs 68(48-105) min, p=0.302], total ischemic time [210(120-360) vs 203(120-476) min, p=0.302] and prevalence of anterior STEMI (35.0% vs 50.0%, p=0.123) were not significantly different between sexes. The prevalence of in-hospital complications was generally similar for both sexes (Table 1), except for the risk of advanced atrioventricular (AV) block that was higher in women (32.5% vs 10.7%, p=0.004). Also, haemoglobin nadir was lower in women [10.6(±2.1) vs 11.7(±2.1) g/dl, p=0.023]. In a 1-year follow-up, the occurrence of MACCE was similar for both sexes (60.0% vs 59.7%, log-rank P 0.734) (Figure 1). Conclusion Women with STEMI complicated by CS submitted to PCI had a similar prevalence of in-hospital complications as men. Also, mid-term outcomes, assessed by MACCE at 1 year, did not differ between groups.

Mitigation of Effect Modification by Psychological Status in Patients with Hearing Loss

Although patient-reported outcomes provide valuable insights, these subjective data may not align with objective test results. Hearing loss is a pervasive problem, such that concordance between subjective perceptions of hearing ability and objective audiogram assessments would be beneficial. To determine (1) whether psychological status is an effect modifier of the association between subjective patient reports of hearing ability and objective audiometry results, and (2) whether any effect modification observed in standard static questionnaires would be either mitigated or exacerbated by adaptive testing based on Item Response Theory analyses. This diagnostic study at a tertiary care center and community-based practice included consecutive adults who presented with queries related to hearing loss. Participants were recruited and enrolled and data analyses occurred from 2022 to 2024. Participants prospectively reported their hearing-specific abilities through either a standard static or adaptive version of the Inner Effectiveness of Auditory Rehabilitation (EAR) scale, alongside validated measures of their mental health and audiometry. Word recognition scores (WRS) and pure tone averages (PTA) were used to analyze audiometric testing. The association between subjective Inner EAR results and audiometry was evaluated. Stratified analyses were used to assess for effect modification by psychological status. The results of standard static and adaptive testing were compared. In this study of 395 patients (mean [range] age, 55.9 [18-89] years; 210 [53.2%] female), standard static Inner EAR mean scores were appropriately higher in patients with higher (better) WRS (50.7, 95% CI, 46.4-54.9), compared with patients with lower (worse) WRS (34.7, 95% CI, 24.3-45.1). However, among patients with worse mental health, there was no association between standard static Inner EAR scores and WRS. In contrast, adaptive Inner EAR mean scores were significantly higher for those with better WRS, regardless of mental health status. Thus, effect modification was observed in standard static assessments, whereas adaptive testing remained durably associated with audiometry, regardless of mental health. Psychological status was an effect modifier of the association between standard Inner EAR scale scores and audiometry, with a positive association observed only in those with better mental health. Adaptive testing scores, however, remained significantly associated with audiometry, even when mental status was worse. Adaptive testing may stabilize the association between subjective and objective hearing outcomes.