Tertiary Care Center Research Articles

A STUDY OF EPIDEMOLOGY AND OUTCOME OF SNAKE ENVENOMATION ADMITTED AT A TERTIARY CARE CENTRE, NORTH KERALA

Aims and Objectives:Snake envenomation is a medical emergency of significant public health concernfaced by rural populations mainly in tropical and subtropical countries with heavy rainfall and humid climate.Although India ia s single large contributor of snake bites,reporting is very poor. Very few studies describe epidemiology and outcome of snake bite from Kerala. Hence, this study was planned to collect information on various aspects of snake bite in a tertiary care hospital.. This tertiary care centre caters to all six districts of Kerala including Kozhikode,Kannur,Malappuram ,Kasargod,Palakkad and Wayanad . Study Setting and Design:This is a descriptive ,observational and crossectional study carried out at Govt Medical College ,Kozhikode Materials and Methods: Sampling Procedure:This was a descriptive cross-sectional study of all patients admitted with snake envenomation at Snake Bite unit, Govt Medical College,Kozhikode.Study period was from July 2017 –June 2018.Patients are included if they had a definite history of poisonous snake bite and developed features of envenomation and are evaluated based on a proforma with detailed history and clinical examination. Data are collected regarding age, sex, occupation, time of bite, symptoms, investigations, mode of treatment given and complications.Sample size is 110. Study Analysis: Data are analysed using computer software, Statitical Package for Social Sciences(SPSS) version 18.Data are expressed in its frequency and percentage .To elucidate the associations and comparisons between different parameters ,qualitative variables are analysed using Chi –square test and quantitative variables by t –test.The Institutional Ethics Committee of Govt. Medical College ,Kozhikode approved the research project. Written informed consent is obtained from all patients who had participated in this study in their vernacular language . Results:Detailed history with special reference to the type of snake, circumstances leading to the bite and clinical consequences are studied and final outcome is noted. Males (n=71) are bitten more often than females (n=31) .46 cases are in the age range of 40-60 years. 57(55%) cases are during the monsoon. Most (n=67) are encountered in the lower limbs. Viper is the most common poisonous snake encountered (73%)(n=75). 49 (48%) cases are from rural area. Among the viper bite Russells viper constitutes 26(25.4%) and Pit viper of 50(49%).Coagulation time is prolonged in 36 cases(35.3%). Hemotoxic symptoms present in 40(39.2%) victims ,neurotoxic features present in 32(31.3%) victims ,both hemotoxic and neurotoxic features are present in 12(11.7%) victims.Polyvalent anti snake venoum (ASV) is given to 66 cases. Hypersensitivity to ASV is noted in 13 cases out of 66 cases.Bite to needle time is >6hrs in all the victims who expired.The mortality rate among snake bite victims is 6.8%.The morbidity and mortality can be reduced substantially by early medical care and providing health education. Conclusion: On the basis of study findings ,Pit viper bites were predominant in our area which was less fatal.Eventhough the antisnake venom doesnot cover Pitviper,it was given empirically if coagulation failure occurs. Death was more in neurotoxic bites .Duration of hospital stay was more in Viper bites .Victims with bite to needle time <4 hrs were recovered earlier without complications. Morbidity and mortality due to this can be reduced by early administration of antisnake venom and management of complications.So prompt referral of victims with poisonous snake bite to centres where facilities in managing snake bite is crucial in preventing mortality.

"Is oral antioxidant (Vit C & E) helpful in minimizing shock wave induced renal damage? A study from a tertiary care Center from eastern India" A prospective study.

Extracorporeal shock wave lithotripsy (ESWL) causes trauma to the renal parenchyma. Due to the kidney injury, free radicals are generated, and an inflammatory process develops. Inflammatory markers like interleukin's (IL), C-reactive protein (CRP), and procalcitonin (PCT) are released into the circulation. Antioxidants have the potential to mitigate the effects of the inflammatory process. Our objectives were the measurement of the effect of supplementation with Vit C and Vit E (antioxidants) and their effect on the reduction of CRP and procalcitonin and further kidney damage. There were two groups with 100 patients each. Group A, receiving oral Vitamin E (400 mg twice a day) and oral Vitamin C (500 mg twice a day) beginning 3 days before the lithotripsy and continuing for up to 7 days after the lithotripsy (total of 10 days). Group B served as the control group. Serum levels of CRP and procalcitonin were measured on the day of lithotripsy, day 2, and day 10 post ESWL. In Group B, CRP and PCT values are statistically significantly elevated as compared to Group A. In Group A, pre-ESWL, day 2 and day 10 CRP values are 1.23, 3.58, and 1.61. In Group B pre-ESWL, day 2 and day 10 CRP values are 1.38, 6.70, and 3.09 (p value < 0.001 in day 2 and 10). In Group A, pre-ESWL, day 2 and day 10 PCT values are 0.41, 1.42, and 0.44. In Group B pre-ESWL, day 2 and day 10 PCT values are 0.36, 3.03, and 1.10 (p value < 0.001 in day 2 and 10). The serum levels of the inflammatory marker for acute renal injury are decreased when vitamins C and E are taken orally, which can help to minimize kidney damage after lithotripsy for renal stone disease.

Perinatal Mental Health Disorders and Resilience in Patients with Fetal Anomalies.

Pregnant women face heightened vulnerability to mental health disorders (MHDs). There remains a lack of data during the antenatal period, particularly for high-risk subpopulations such as those with fetal anomalies. Understanding the psychological impact of women receiving a fetal anomaly diagnosis is crucial, as it can lead to MHDs. Additionally, maternal stress due to such diagnoses can have adverse effects on short- and long-term health outcomes for both the mother and the child. This study aimed to address the gap in knowledge regarding prenatal MHDs in women with fetal anomalies by characterizing maternal peripartum psychological health and identifying factors related to MHDs. Women diagnosed with fetal anomalies (N = 110) were recruited from a tertiary fetal care center and completed surveys assessing resilience, anxiety, depression, and posttraumatic stress symptoms (PTSs). Demographic characteristics were also collected and analyzed. Multiple regression analyses were conducted to explore associations between demographic variables and mental health outcomes. Participants endorsed elevated depressive symptoms (45%), anxiety (43%), and PTSs (39%). Private insurance and relationship status were positively associated, and resilience was negatively associated, with depression and anxiety levels. Maternal perception of diagnostic severity correlated with increased depressive symptoms and PTSs, whereas physician ratings of diagnostic severity did not. The findings underscore the prevalence of MHD among pregnant women with fetal anomalies and emphasize the importance of assessing maternal perception of severity in predicting mental health outcomes. Identifying risk factors like insurance status and relationship status suggests avenues for targeted screening and intervention. Multidisciplinary collaboration is essential for implementing effective strategies to address peripartum psychopathology related to fetal anomalies and improve overall maternal and fetal health. · Pregnant women with fetal anomalies face poor mental health.. · Resilience is negatively related to poor mental health.. · Perception of severity impacts mental health symptoms..

Relationship between multiple morbidities and performance on the Timed Up and Go test in elderly patients: a cross-sectional study

ObjectiveTo investigate how various morbidities affect older patients’ performance on the Timed Up and Go (TUG) test.DesignCross-sectional study.SettingThe seven government hospitals of Lahore, Pakistan, included are major tertiary care centres,...

Volumetric response after closure of a spinal CSF leak in patients with spontaneous intracranial hypotension: a multicompartmental longitudinal study

BackgroundCerebrospinal fluid (CSF) loss in spontaneous intracranial hypotension (SIH) is accompanied by volume shifts between the intracranial compartments. This study investigated tricompartimental and longitudinal volume shifts after closure of a...

Psychosocial factors in children presenting with poisoning in a tertiary care centre

Background: Poisonings in children pose a significant challenge for paediatricians in India due to the diversity of substances and their clinical manifestations. This study investigates the psychosocial factors contributing to acute poisoning among children, aiming to identify key risk factors. Methods: A prospective, observational study was conducted on 50 children under 18 years admitted for poisoning at Kamineni Academy of Medical Science and Research Centre, Hyderabad, over 24 months (September 2022–September 2024). Data on age, sex, socio-demographic details, poison type, route of exposure, time to hospital arrival, storage practices, and psychosocial factors were analyzed. Results: Findings reveal that most poisoning cases occurred in children under five years, with 94% being accidental. Hydrocarbons accounted for 36% of cases, with three-fourths of incidents involving children aged 1–6 years. Rural areas contributed to 56% of cases, and poisoning incidents peaked during the summer (54%). A majority (58%) of cases were from lower socioeconomic backgrounds. All cases involved ingestion, and survival rates were 100%. Psychosocial analysis indicated significant risks associated with family dynamics: lack of emotional support, parental psychological illness, and substance abuse were observed in cases of suicidal poisoning. Conclusions: Childhood poisoning is a critical medical emergency with substantial morbidity. Beyond accidental incidents, it highlights underlying behavioral and family maladaptations, emphasizing the need for early psychosocial interventions to mitigate long-term consequences.

Radiological, cytological and histopathological correlation in patients undergoing thyroid surgery at a tertiary care hospital in western Gujarat: a cross-sectional study

Introduction: Thyroid gland is affected by various pathologies ranging from diffuse enlargement (goiter) to nodular lesions, thyroiditis, and malignancies. Fine needle aspiration cytology (FNAC) is a simple &amp; most cost-effective method to diagnose neck mass located superficially. Ultrasonography (USG) is the initial imaging modality in the evaluation of the neck swellings. The objective of the study being to correlate cytology, radiology and histopathology of patients undergoing thyroid surgery in our tertiary care center. Methods: All patients who were operated for thyroid gland surgery at our tertiary care hospital of western Gujarat at Ear, Nose, and Throat Department between October 2022 to March 2024 were analysed using statistical software. This study included 54 patients. Results: Out of the fifty-four (54) individuals who showed signs of thyroid enlargement, forty-five (45) were women and 9 were men. The average age of the participants in this research was 43.25±15.50 years. In our research, 79.67% of patients were classified as benign, 12.96% as malignant, and 7.4% were considered suspicious for malignancy. Only 10% were moderately suspicious of cancer (category IV). No patient was identified as highly suspicious of cancer (category V). FNAC specificity for benign was 95.24% and for malignant 93.02%. For TIRADS specificity was 93.33% for benign and 95.45% malignant. Conclusions: Most of the times it is easy to diagnose a thyroid swelling by clinical, radiological, cytological and histo-pathological examinations. Our study analyses FNAC with Bethesda, USG with TIRADS as a most important aspect for early diagnosis carcinoma of thyroid.

Intestinal atresia: a retrospective study of 36 neonates and risk factors to mortality in Tertiary care center, Tripura

Background: Intestinal atresia among neonates is still a condition which has huge morbidity and mortality, particularly in the developing world. We share a case series of intestinal atresia in context of their presentation, management and outcome. Methods: This study was conducted at Tripura Medical College and DR BRAM Teaching hospital, Tripura, over 1 year. We included all patients presenting with jejunoileal atresia, duodenal atresia and their demographic details, presentation, investigations, treatment strategies and the outcome were noted at a pre-designed proforma. All data were analysed using SPSS version 26. Results: A total of 36 neonates with intestinal atresia were included. Most of them (77.78%) presented after 48 h of life and the mean age at presentation was 5.68±4.75 days. There were 22 male patients (61.11%) and 30 (83.33%) were full-term. The most common presenting complaint was not being able to pass meconium (88.89%). Type III atresia was the most common subtype (41.67%). Most of them underwent resection without tapering. The mean hospital stay was 12.81±6.53 and it was significantly longer among those who underwent re-exploration (P=0.034). 13 patients (36.11%) expired within 6 months of follow-up. The only significant factor for mortality was the presence of short bowel syndrome (P=0.036). All other demographic and management factors did not alter the mortality rate. Conclusions: Management of surgical neonates is a difficult job in developing countries with limited resources. There is a high mortality rate of neonates following intestinal atresia surgeries and surgeons in these countries must fight on many fronts to improve the outcome.

Clinical profile of neonates with polycythemia at a tertiary care hospital in North East, India

Background: Neonatal polycythemia (NPC) is associated with hyper viscosity of blood causing impairment of tissue oxygenation, perfusion and formation of microthrombi. Polycythemia is defined as a venous hematocrit (Hct) of≥65% or a haemoglobin (Hb)&gt;22g/dl. It presents with a nonspecific clinical features like plethora, poor feeding, lethargy, hypoglycaemia, jaundice. The aim of this study was to assess the clinical profile in neonates with polycythemia admitted in the paediatrics ward of a tertiary care centre in North East, India. Methods: A hospital based cross sectional study was carried out from January 2021 to October 2022 and 149 participants were recruited after fulfilling the inclusion and exclusion criteria with approval from ethical board. Statistical analysis was done using SPSS statistics version 21.0 WINDOWS (IBM Corp. Armonk, NY, USA). Results: Among the 149 cases, 89 (59.7%) neonates were symptomatic and 60 (40%) neonates were asymptomatic. The most common presentation were poor feeding and plethora in 89 neonates each (59.7% each), followed by lethargy (39.6%), hypogycemia (30.2%), jaundice (29.5%), necrotizing enterocolitis (21.5%), cyanosis (10%) and oliguria (10%). Partial exchange therapy was done in 30 neonates (20%), 59 neonates (39.6%) required intravenous fluid and 60 neonates (40.3%) were treated conservatively. All neonates were successfully discharged and no deaths were noted in our study. Conclusions: Anticipation, early recognition and intervention can prevent acute short-term complications and long-term sequelae of this easy to treat disorder.

Evaluating the Effect of Body Mass Index on Procalcitonin Level in Patients with Pneumonia: A Retrospective Cross-Sectional Study

Procalcitonin (PCT) is commonly used to evaluate the etiology and severity of pneumonia. PCT has been shown to be elevated at baseline in patients with obesity. The aim of this study is to determine if body mass index (BMI) has an influence on admission PCT level in patients admitted to the hospital with a diagnosis of pneumonia. We conducted a retrospective cohort study that encompassed patient visits to a tertiary care center from 2014 until September 2023. A total of 18,652 patients presented to the emergency department with a diagnosis of pneumonia. A total of 3659 were admitted to the floor, and 2246 were admitted to the MICU. Patients were grouped based on admission BMI into five categories. The Kruskal–Wallis test performed on patients admitted to the floor revealed a statistically significant difference in PCT levels among groups of different BMIs (H = 34.97, df = 4, p &lt; 0.001). In patients admitted to the MICU, the Kruskal–Wallis test revealed a significant difference in PCT levels among groups of different BMIs (H = 32.92, df = 4, p &lt; 0.001). BMI has a statistically significant effect on PCT in patients admitted to the hospital with pneumonia. Patients with higher BMI may exhibit less robust PCT levels, which may impact management decisions.

Pulmonary Function Test Abnormalities in Children with Sickle Cell Anemia: A Cross-Sectional Study from a Tertiary Care Centre in Odisha, India

Pulmonary Function Test Abnormalities in Children with Sickle Cell Anemia: A Cross-Sectional Study from a Tertiary Care Centre in Odisha, India

Distress and coping mechanisms among people with diabetes: cross-sectional assessment from an NCD screening clinic of a tertiary care hospital in North India

BackgroundOf the numerous complications encountered by people with diabetes (PWD), the effect on mental health is concerning. Within mental health, diabetes distress (DD) occurs when a patient has unfavourable emotional stress while managing their condition, which can be managed by coping strategies but are less studied together in Indian settings. So, the present study aimed to determine the proportion of DD and associated factors and coping skills among the PWD.MethodsCross-sectional study was conducted among 596 clinically stable, ambulatory PWD visiting the NCD clinic of a tertiary care centre in North India between June 2023 and January 2024 and recruited using a systematic random sampling technique. DD was the primary dependent variable assessed using the Hindi version of the Diabetes Distress Scale (DDS). Coping was assessed using a GlucoCoper scale. Independent variables included socio-demographic and clinic history variables. Bivariate analysis described the sample characteristics. Multivariable binary logistic regression analysis explored the factors affecting the DD. The study was ethically approved, and written informed consent was obtained from the patients.ResultsOf the 596 study participants, 17.4% depicted uncontrolled diabetes, while 18.1% PWD experienced moderate to severe DD, with emotional distress depicting the highest prevalence (23.8%). Significantly increased odds of living with DD in professionals compared to Clerical, shop-owners, farmers with less monthly average income (vs. the group with unstable income), tobacco users, and those with uncontrolled disease. Overall, scores for negative coping were higher than positive coping, with significant differences between the two types among the participants with DD.ConclusionsThe study underscores the complex interplay between diabetes control, distress, and coping mechanisms in patients attending an NCD screening clinic. The findings highlight the need for a holistic approach to diabetes management that addresses not only the physical aspects but also patients’ emotional and psychological well-being.

Pregnancy Outcomes in Women with Low and Ultra-Low Ejection Fraction: A Retrospective Study in a Tertiary Care Center

The data about pregnancy while having a low ejection fraction are scarce, since pregnancy is not recommended for women with an ejection fraction of less than 30%. There is an increased risk of obstetrical complications and adverse maternal-fetal outcomes. Pregnancy is a rough journey for this group of patients. However, a successful pregnancy can be achieved when cardiac complications are managed during pregnancy. The early recognition of women at risk of cardiovascular events and early referral can optimize the maternal and neonatal outcomes with close collaboration between the maternal-fetal medicine specialist and the cardiologist. The study’s aim was to assess the experience of our tertiary center with regard to the adverse maternal outcome for women with an ejection fraction ≤ 30% compared to those with an EF &gt; 30% in our tertiary center. The fetal and obstetric outcome for pregnancies with an EF ≤ 30% was compared to that for pregnancies with an EF &gt; 30%. Methodology: After receiving the approval of the local Ethical Board Review, a retrospective study was conducted at King Faisal Specialist Hospital and Research Center (KFSHRC) in the city of Riyadh, Kingdom of Saudi Arabia. Our study population included women with cardiomyopathy (acquired or congenital) who were followed up or delivered in KFSHRC from the period of January 2004 till March 2020. Cases were identified by reviewing the database from the Cardiac Center Echocardiograph and maternal fetal medicine unit. The data on the maternal and fetal outcome were gathered from the hospital medical records. An adverse maternal outcome included: death, hospitalization due to decompensated heart failure, and worsening cardiovascular status during pregnancy. Adverse fetal outcomes included: miscarriages, termination of pregnancy, FGR, and placental insufficiency. Obstetrics complications included: complications related to the mode of delivery, antepartum hemorrhage, postpartum hemorrhage, or preeclampsia. Results: Our study included 44 subjects, examining the differences between those with an ejection fraction greater than 30 (n = 21 subjects) and those with an ejection fraction less than or equal to 30 (n = 23) with respect to demographics, co-morbidities, and outcomes (maternal, pregnancy, fetal, ultrasound, and baby). There was no evidence of any differences in the demographics. From among the co-morbidities, there was a statistically higher rate of dilated cardiomyopathy and lower rate of rheumatic heart disease in those with a lower ejection fraction. Also, women with a lower ejection fraction tended to deliver through a means other than simple vaginal delivery. There was a significant association (p = 0.0296) indicating that individuals with a lower ejection fraction tended to have a lower gestational age at delivery. The information on whether the pregnancy resulted in a live birth was available for all but one of the mothers. Across all the mothers, 32 (74%) resulted in a live birth and 11 did not. The percentage of pregnancies resulting in a live birth in the group for which the ejection fraction was greater than 30 was 90% and that in the group for which the ejection fraction was less than or equal to 30 was 59% (p = 0.0339). From among the ultrasound and baby outcomes, only the rate of the babies being discharged alive differed statistically between the two ejection fraction groups, with those mothers having a lower ejection fraction experiencing fewer babies being discharged alive (p = 0.0310). Conclusions: In conclusion, women with a low ejection fraction are at an increased risk of maternal-fetal complications. In our study, the lower the EF (≤30) the worse were the fetal and neonatal outcomes; however, in terms of the maternal outcomes, it was the same whether the EF was low or ultra-low. Yet, these groups of patients need to be counseled about the facts of poor obstetrical outcomes with an emphasis on preconceptual counseling.

Blunt Traumatic Aortic Injury Treated with Endovascular Aortic Repair: Does Age Influence the Outcome?

Background: Blunt traumatic aortic injury (BTAI) is the second most common cause of death following blunt trauma, and it can affect people of all ages. The aim of this study was to evaluate age-related differences in outcomes among patients undergoing thoracic endovascular aortic repair (TEVAR) for BTAI. Methods: All patients treated with TEVAR for BTAI at a tertiary care center in Europe between 2005 and 2023 were included in this study. All clinical and imaging data were collected and analyzed retrospectively. Results: A total of 70 patients with a median age of 43 years were included, and 89% were male. Older patients had significantly higher American Society of Anesthesiologists (ASA) physical status classification scores (p &lt; 0.001) compared to younger patients. All age groups (&lt;18, 18–40, 41–65, and &gt;65) exhibited low to borderline low initial hemoglobin levels with a further decline over time (p = 0.063, p &lt; 0.001, p &lt; 0.001, and p = 0.018, respectively). Age groups were comparable regarding injury mechanism, Injury Severity Score (ISS), concomitant injuries and postoperative complications. The age-independent ISS showed a moderate to strong correlation to the length of intensive care unit stay (r = 0.594, p &lt; 0.001). Total in-hospital mortality was 6% and none was from aortic-related complications. There was a generally high rate of loss of follow-up (59%). Conclusions: Although older patients presented worse ASA scores in comparison to younger patients, no significant differences regarding postoperative morbidity/mortality were noted. These findings imply that patient age and preinjury physical status might not substantially influence outcomes when treating BTAI with TEVAR.

FAP-positive activated fibroblasts are detectable in the microenvironment of endometriosis and correlate with stroma composition and infiltrating CD8+ and CD68+ cells

Abstract STUDY QUESTION Do activated fibroblasts expressing fibroblast activation protein-α (FAP)—which is traceable in positron emission topography/computed topography (PET/CT)—play a role in the microenvironment of endometriosis? SUMMARY ANSWER Activated fibroblasts expressing FAP are detectable in endometriotic lesions and correlate with iron and collagen content and infiltrating CD8-positive cytotoxic T cells and CD68-positive macrophages in the microenvironment endometriotic lesions. WHAT IS KNOWN ALREADY FAP-positive activated fibroblasts are found in various fibrosis-related pathologies and in the desmoplastic stroma of solid tumors; they can be traced in PET/CT but have not been investigated in the context of endometriosis, a chronic disease involving hormone-mediated repetitive tissue remodelling and fibrosis. STUDY DESIGN, SIZE, DURATION We analysed a cohort of endometriosis patients (n = 159) who had undergone surgery with removal of endometriotic foci at our University Hospital (tertiary care center) between 2018-2024. All patients provided written informed consent. The median age of the patients was 34 years. In total, 245 samples from different locations were analysed retrospectively. PARTICIPANTS/MATERIALS, SETTING, METHODS We investigated the expression of FAP and its relation to stroma composition and the immune microenvironment of endometriosis in 245 specimens from peritoneal lesions, ovarian endometriomas, deep infiltrating endometriosis and extra-abdominal lesions using conventional histology and immunohistochemistry followed by digital image analysis. Tissue within a radius of 500 µm of ectopic endometrium-like epithelium was analysed. To measure FAP expression in the perilesional stroma, a histoscore (H-score) was calculated. Masson trichrome staining was used to determine collagen content. Prussian blue staining for iron was used for age-dating of lesions. The abundance of CD68-positive macrophages and CD8-positive cytotoxic T cells within the microenvironment of ectopic endometriotic glands was analysed. Extra-lesional tissue served as controls. MAIN RESULTS AND THE ROLE OF CHANCE Distinct FAP expression (H-score &amp;gt; 10) was observed in 84% of endometriotic lesions and in only 4% of extra-lesional controls. FAP expression was significantly higher in endometriotic lesions (mean H-score of 61.8) than in extra-lesional tissue (mean H-score 3.8, p &amp;lt; 0.0001). There was a significant (p &amp;lt; 0.05) association with collagen content when comparing samples with low (H-score &amp;lt; 100) and high (H-score ≥ 100) FAP expression, and a significant difference in FAP expression correlating with the tissue iron content when comparing strong staining intensity and negative samples (p &amp;lt; 0.0005) or samples with weak staining intensity (p &amp;lt; 0.005). Moreover, the abundance of CD8+ and CD68+ cells was significantly higher (p &amp;lt; 0.0001) in samples with high FAP expression (H-score ≥ 100). LARGE SCALE DATA The data underlying this article will be shared upon reasonable request to the corresponding author. LIMITATIONS, REASONS FOR CAUTION This study proves the presence of FAP-positive fibroblasts in endometriosis by immunohistological methods. However, to translate targeting FAP into endometriosis diagnostics, these results have to be compared to imaging data and FAP inhibitor (FAPi) PET/CT has to be validated in a structured way on a large patient cohort. Moreover, we show that FAP expression is intertwined with the immune cell infiltrate in the microenvironment of endometriosis. To explore and to understand mechanisms contributing to chronic inflammation, immune evasion and fibrosis, more studies including more immune cell subtypes and functional experiments, are needed. WIDER IMPLICATIONS OF THE FINDINGS FAP-positive activated fibroblasts not only impact the immune microenvironment of endometriosis and are linked to increased macrophage and cytotoxic T cell infiltration, as we showed, but could also provide new options for non-invasive diagnostic methods and an improvement of the diagnostic workup prior to surgery. FAPi PET/CT should be considered when exploring new diagnostic options in endometriosis. STUDY FUNDING/COMPETING INTEREST(S) This work was funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) “Clinician Scientist Program in Evolutionary Medicine” (project number 413490537 to FK). The authors declare that they have no conflicts of interest.

The Natural History of Inflammatory Bowel Disease in Adults with Common Variable Immunodeficiency: A case series from a single US tertiary care center

The Natural History of Inflammatory Bowel Disease in Adults with Common Variable Immunodeficiency: A case series from a single US tertiary care center

Effectiveness and safety of therapeutic plasma exchange in neurological disorders; measuring the response to treatment using Modified Rankin Scale – A single-center study

Abstract INTRODUCTION: Therapeutic plasma exchange (TPE) is commonly used as a treatment modality in varying neurological disorders. Response to TPE in neurological disorders is usually noted in “subjective” terms. We, measured response to treatment, objectively, using Modified Rankin Scale (MRS). MATERIALS AND METHODS: This was an observational prospective study in patients diagnosed with autoimmune neurological disorders (AND) who underwent TPE, in addition to intravenous immunoglobulin, and/or prednisolone. This study was carried out at a tertiary care center. Demographic data, procedure details including adverse reactions, and clinical responses were collated. Clinical response was assessed by applying MRS, in different neurological disorders, before (pre-TPE) and after TPE (post-TPE). Pre- and post-TPE clinical conditions were compared using the Wilcoxon matched-pairs signed-ranks test. RESULTS: Fifty-three patients were included, with 15 females and 38 males, who had a median age of 48 years. Seven different AND were; myasthenia gravis (n = 11), Guillain–Barre syndrome (n = 18), neuromyelitis Optica spectrum disorders (n = 6); chronic inflammatory demyelinating polyneuropathy (n = 5); autoimmune encephalitis (n = 6); transverse myelitis (n = 6); and multiple sclerosis (n = 1). Patients received a median of 5 cycles of TPE and a mean 1.5 plasma volume was exchanged. The improvement in the MRS scale was significant when post-TPE scores were compared with pre-TPE scores. The most common adverse reaction was shivering (n = 5; 1.85%), which was managed conservatively. CONCLUSION: TPE was shown to be an effective and safe treatment modality in providing relief to patients with neurological disorders.

Trait mindfulness in early pregnancy and adverse perinatal outcomes: a prospective cohort study

BackgroundMindfulness centered therapy has been shown to improve perinatal mental health outcomes. There is emerging evidence that mindfulness training (MT) can also be harnessed to improve somatic outcomes. Yet, little is known about which perinatal populations might benefit the most from mindfulness training interventions. We aimed to evaluate the association between trait mindfulness and adverse pregnancy outcomes.MethodsThis is a planned secondary analysis of a prospective cohort study of nulliparous participants recruited between May 2019 and February 2022 from a single, high volume tertiary care center. Participants completed the validated Mindfulness and Attentive Awareness Scale prior to 20 weeks gestation. Trained research staff abstracted pregnancy and delivery data. The primary outcome was unplanned cesarean delivery (CD). Secondary outcomes included gestational diabetes, hypertensive disorders of pregnancy and a neonatal morbidity composite. We examined outcomes by mindfulness quartile (Q), adjusting for covariates determined a priori.ResultsOf the 281 participants with full outcome data, 47.9% experienced one or more of the adverse perinatal outcomes and the median trait mindfulness score was 4.6 (IQR 3.9–5.3). After adjusting for potential confounders, there were significantly lower rates of CD rates in those in Q2 and Q3 compared to Q4 (adjusted odds ratio [aOR] Q2 0.42, 95% confidence interval [CI] 0.20 – 0.87, Q3 aOR 0.23, 95% CI 0.10–0.51). There were no differences in rates of gestational diabetes, hypertension or composite neonatal outcomes by trait mindfulness quartile.ConclusionsIn this prospective cohort of nulliparous people, those with trait mindfulness in the 2nd and 3rd quartiles had lower rates of CD. Given prior literature suggesting active MT decreases adverse outcomes, there may be a component of the active practice of mindfulness, rather than trait mindfulness levels, associated with improved outcomes.

Response to functional restoration in non-specific chronic low back pain with Modic type 1 changes.

Little information exists on the potential differential response to functional restoration between non-specific chronic low back pain (NSCLBP) individuals with and those without Modic type 1 changes. Therefore, this case-control study investigated the response profile of NSCLBP patients with and without Modic type 1 changes undergoing functional restoration. The present study included patients participating in a functional restoration program (day-hospital program lasting five weeks) at a French tertiary care center from 2009 to 2019. Each case with Modic type 1 changes was matched to one to two controls without Modic type 1 changes by sex, working incapacity, and lumbar spine surgery history. The primary effectiveness outcome was the Quebec Back Pain Disability Scale (QBPDS) score (0-100, with higher scores indicating higher disability). There were multiple secondary outcomes, such as subjective improvement and return to work. The study included 83 patients (cases: median [IQR] age 47.8 [11.6] years, 77.4% women; controls: median [IQR] age 46.0 [16.2] years, 75.0% women). At three months, there were no statistically significant differences between cases and controls in the QBPDS score (34.0 versus 31.5), subjective improvement (67.7% versus 69.2%), return to work in those who were not working at the inclusion (72.7% versus 52.6%), and the consumption of different analgesics. The response profile of NSCLBP adults undergoing functional restoration did not statistically differ between the groups with and without Modic type 1 changes. These findings suggest that patients may benefit from such a program irrespective of their Modic type 1 status.

Predictors of failure of percutaneous endoscopic gastrostomy tube placement: a retrospective study in a tertiary care center in the USA.

Percutaneous endoscopic gastrostomy (PEG) tube placement is a common procedure used to initiate enteral feeding. To our knowledge, there are no previous studies that analyze predictors of PEG failure. This study aims to identify risk factors for failure of inpatient PEG placement. A retrospective chart review was conducted of inpatients in the Montefiore Health System who were scheduled to undergo PEG placement from 2016 to 2020 (n=1,138). Patient, endoscopist, and procedural characteristics were summarized using descriptive statistics, both overall and stratified by whether the PEG was successfully placed. The overall success rate of PEG placement was 89%. The most common indications included stroke (31%), dementia (27%), and ventilator use (24%). Patient characteristics, including body mass index (BMI) (p=0.16) and indication for PEG placement (p=0.06), were not significantly associated with PEG failure. Instead, endoscopist and procedural characteristics were found to be significant, including type of attending (p<0.001), location of case (p=0.02), and category of anesthesia (p<0.001). PEG placement remains a highly successful procedure. Endoscopist and procedural characteristics, not patient characteristics, were associated with PEG placement success. Notably, patient BMI and indication for PEG placement could not be used to risk stratify candidates for PEG placement.