Tertiary Care Center Research Articles

Horizontal extraocular muscle insertion locations in children undergoing extraocular muscle surgery.

The location of extraocular muscle (EOM) insertions is clinically relevant in ophthalmologic surgery. The spiral of Tillaux has been a reference for normal EOM insertion since the nineteenth century. Research on EOM insertions is limited and has focused on adult cadaveric eyes. In this study we investigated the location of EOM insertions in children undergoing EOM surgery. Children who underwent EOM surgery for strabismus or anomalous head position at a large tertiary care center were consecutively identified from October 2022 to December 2023. Intraoperative measurements of medial rectus (MR) and lateral rectus (LR) insertions were compared to the spiral of Tillaux and within patient groups using one-sample and independent-samples t tests, respectively. Associations of EOM insertions with age, refraction, and axial length were evaluated with Pearson correlation. In 292 children who underwent EOM surgery, 528 previously unoperated EOM insertions were recorded. Mean insertions were closer to the limbus than expected by the spiral of Tillaux (MR, 5.21 vs 5.5 mm [P < 0.001]; LR, 6.76 vs 6.9 mm [P = 0.001]). Esotropia was associated with closer EOM insertions than exotropia (MR, P = 0.021; LR, P = 0.045). Males had farther MR insertions than females (5.33 vs 5.03 mm [P < 0.001]). Age was weakly associated with farther EOM insertions (MR, r = 0.215, P < 0.001; LR, r = 0.232, P < 0.001). Myopia was very weakly associated with farther MR insertions (r = -0.145, P = 0.024). In children undergoing EOM surgery, MR and LR insertions were closer to the limbus than expected relative to the spiral of Tillaux. This finding may have implications for surgical planning and outcomes.

P0990 Real-world effectiveness of upadacitinib induction therapy in Crohn’s disease, with a focus on patients with concomitant IMIDs

Abstract Background Upadacitinib (UPA), a selective JAK1 inhibitor, has demonstrated efficacy across immune-mediated inflammatory diseases (IMIDs) and is approved or in development for conditions beyond Crohn’s disease (CD). Effective therapies are essential for managing CD, especially in complex cases involving multiple IMIDs. This study evaluates UPA as induction therapy in CD patients, focusing on outcomes for both CD and associated IMIDs. Methods This retrospective study at a Spanish tertiary care centre included adults with moderate-to-severe CD who initiated UPA in routine practice. Data on baseline characteristics, prior therapies, disease duration, and IMIDs were collected. The primary outcome was CD remission at week 12, assessed by Physician Global Assessment (PGA). Secondary outcomes included IMID remission by PGA, adverse events, and discontinuation. Results Thirty-four patients were included (mean age 45.5 years, 55.8% female, median CD duration 6 years). All had prior advanced therapy exposure, with 26.5% treated with at least three therapy lines. Ileal involvement was seen in 62%, with 30% showing upper GI involvement,24% stricturing disease and 56% had non-stricturing, non-penetrating disease. IMIDs were present in 35%, including psoriasis, juvenile idiopathic arthritis, uveitis, atopic dermatitis, spondyloarthritis, rheumatoid arthritis, and giant cell arteritis. At week 12, 30.4% of CD patients achieved clinical remission, and 84.8% had at least a partial response. Among those with IMIDs, 33.3% achieved remission, with at least a partial response in 83.3%. In patients with both CD and IMIDs, 41.7% achieved remission in both conditions, and 75% showed at least a partial response in both. Most patients (88%) began with a 45 mg/d dose, with 9% requiring extended induction (&amp;gt;12 weeks) at the same dose. Maintenance dosing was 30 mg in most cases, except for 6% who received a lower dose (15 mg). Discontinuation occurred in 32% of patients, primarily due to lack of response (54%) and adverse events (13%). Conclusion Upadacitinib (UPA) shows potential in improving both CD and associated IMIDs, with a notable proportion achieving remission or partial response in both conditions at 12 weeks. These findings suggest UPA may be a valuable option for managing complex cases with multiple IMIDs, though further research is needed to confirm efficacy and optimise treatment.

P0684 Real world experience with granulocyte and monocyte adsorptive apheresis (ADACOLUMN®) in patients with refractory inflammatory bowel disease: a retrospective observational multicenter cohort study

Abstract Background Granulocyte and monocyte adsorptive apheresis (GMA) with ADACOLUMN® (JIMRO Takasaki Japan) is an effective and safe therapeutic option for patients with mild to moderate inflammatory bowel disease (IBD) refractory to pharmacological therapy, especially ulcerative colitis (UC). The aim of this study was to report effectiveness of GMA in patients with IBD. Methods All consecutive active, non-operated UC patients and Crohn’s disease (CD) patients treated with GMA in 15 French tertiary-care centres from 2007 to september 2024 were assessed. Patients received 4 to 8 weekly sessions of GMA alone or in combination with previously failing advanced therapy. Patients were assessed for effectiveness at week 14 and at week 54 for those continuing GMA as maintenance therapy and at every visit for safety. Clinical remission, steroid-free clinical remission, clinical response, colectomy as well as safety were ascertained. Results One hundred and twenty-nine patients with IBD (75 males, median age: 40.9 IQR[29.3-58.1] years, 102 with UC, IBD duration: 7.0 [2.9-13.1] years) were included. One hundred patients (77.5%) were previously treated with immunosuppressants and 97 (72.2%) with at least one anti-TNF. In patients with UC, baseline median total Mayo score was 7 [6-12] and mean CRP level was 23.3 ± 86.0 mg/L. In patients with CD, baseline median Harvey-Bradshaw index was 9 [7.25-10.75] and mean CRP level was 21.9 ± 27.3 mg/L. In patients with UC, week 14 clinical remission, steroid-free clinical remission and response rates were 33.3%, 27.5% and 52.0%, respectively. In patients with CD, week 14 clinical remission, steroid-free clinical remission and response rates were 33.3%, 29.6% and 66.7%, respectively. At week 14, nine patients with UC and 3 patients with CD required emergent surgery. At week 14, adverse events were reported in 26 (20.2%) and were mainly related to flare of IBD in 16 (12.4%). Other adverse events which were never classified as serious included headache in 3, arthromyalgia in 3 and abdominal pain, diarrhea, grade-1 increase in liver enzymes and mild hypotension in one. At week 54, 48 patients were still treated with maintenance GMA therapy including 13 with CD and 35 with UC. At week 54, steroid-free clinical remission rates were 38.5% (5/13) in patients with CD and 60% (21/35) in patients with UC. Conclusion In this real world cohort of patients with refractory IBD, GMA induced steroid-free clinical remission in one third of patients with CD and UC at W14. In patients continuing GMA maintenance therapy, steroid-free clinical remission was observed in one third of patients with CD and two thirds of patients with UC. Safety profile was favourable mostly related to relapse of IBD.

Medulloblastoma Molecular Subgrouping and Outcomes Data of a Single Center From a Low- and Middle-Income Country.

Medulloblastoma (MB) is the most common malignant childhood brain tumor. Molecular subgrouping of MB has become a major determinant of management in high-income countries. Subgrouping is still very limited in low- and middle-income countries (LMICs), and its relevance to management with the incorporation of risk stratification (low risk, standard risk, high risk, and very high risk) has yet to be evaluated in this setting. We describe molecular findings from a tertiary care center in Pakistan and their implications for outcome. Children aged between 3 and 18years diagnosed with MB from April 2014 to December 2020 at Aga Khan University Hospital (AKUH) were included. Subgrouping was performed by NanoString through a collaboration with The Hospital for Sick Children, Toronto. Thirty-seven patients (30 males) were included in this study; median age was 9years. Twenty patients (54.1%) were high-risk, including 12 with metastatic disease. In 30 children, there was a clear molecular subgroup: 4 wingless (WNT) (10.8%), 6 sonic hedgehog (SHH) (16.2%), 3 Group 3 (8.1%), and 17 Group 4 (45.9%) MBs. Molecular subgrouping was inconclusive for three patients (8.1%) and not done in four patients (10.8%). All patients underwent surgery; 26 patients received radiation therapy at AKUH, and 9 were referred outside for radiotherapy; 24 patients received chemotherapy at AKUH (10 outside AKUH). Overall survival (OS) at 5years was 100%, 66.7%, 66.7%, and 88.2% for WNT, SHH, Group 3, and Group 4 patients, respectively (p=0.668). Low- and standard-risk patients had a 5-year OS of 100%, whereas very high-risk patients exhibited a significantly lower OS of 0% (p<0.001). WNT and Group 4 patients had excellent results despite one WNT patient having metastatic disease and eight Group 4 patients being high risk. Our study depicts that molecular subgrouping aids in accurately predicting survival, suggesting the potential benefit of tailored testing and treatment in the LMIC setting.

Evaluating the Effect of Various Pure Tone Averages on Cochlear Implant Candidacy Screening.

To provide evidence to use an extended frequency pure tone average to screen for cochlear implant evaluation candidates as recommended by the American Cochlear Implant Alliance. Additionally, to determine whether traditional low frequency, high or low frequency, high frequency, or extended frequency pure tone average most accurately predicts cochlear implant candidates based on speech perception scores from aided AzBio sentence testing or aided consonant-nucleus-consonant (CNC) testing. Adults from a tertiary care center who completed aided sentence testing during cochlear implant evaluation between 2014 and 2024 were assessed. Pure tone averages at low, high, low or high, and extended frequency ranges were evaluated with individual ear's aided AzBio or aided CNC scores as an outcome. Sensitivity, specificity, negative predictive value, and positive predictive value were assessed and compared using a paired study design. There were 675 observations from 363 patients with AzBio as an outcome variable and 665 observations from 364 patients with CNC scores as an outcome variable. High or low frequency achieved the highest sensitivity at 96.3% AzBio as an outcome and 95.6% with CNC as an outcome, which was significantly better than low frequency (p < 0.001). Low frequency achieved the best specificity at 63.6% with AzBio as an outcome 76.9% with CNC as an outcome. Extended frequency pure tones resulted in greater sensitivity in predicting CI candidates compared with the traditionally used low frequency pure tone average. Screening with wider frequency values will lead to a greater number of patients being identified for a cochlear implant evaluation. Level 3 Laryngoscope, 2025.

Revisiting ascending aortic resection in the elective valve-sparing root replacement: assessing the benefits and necessity of hemiarch replacement at three centres.

The aim of this study was to determine the indication and optimal timing for performing a hemiarch procedure in patients undergoing valve-sparing root replacement (VSRR). We conducted a retrospective study on 986 patients undergoing VSRR at three tertiary care centres. Inclusion criteria were all patients undergoing elective VSRR. Exclusion criteria were age <18 years, Stanford type A dissection, dissection in the arch, total aortic arch replacement or previous aortic arch replacement. We performed propensity score matching in a 1:1 ratio. The primary endpoint is a composite outcome that includes mortality, aortic arch reintervention, new aortic dissection during follow-up, and cerebrovascular incidents within the first 30 days. A total of 401 patients (41%) had a hemiarch replacement, while 585 (59%) did not. Root phenotype was present in 565 (57%). The mean follow-up time was 4.7 years (SD ± 4.6).In the matched population, there was no significant difference in the 10-year freedom from the composite outcome between the non-hemiarch and hemiarch groups (87.3% vs. 85.0%, p > 0.999). Similarly, no difference was found for aortic reinterventions (p = 0.13) or survival (p = 0.5). This was also true for patients with heritable thoracic aortic disease. However, in patients with a bicuspid aortic valve, the intervention rate was significantly higher in the hemiarch group (10.8% vs. 0%, p = 0.016).There was no significant difference in the 30-day incidence of cerebrovascular accidents between the groups (5% vs. 2.7% in the hemiarch group, p = 0.117). Only the distal ascending diameter showed a tendency with better outcome over 45mm for the hemiarch procedure, otherwise we found no reliable cut-off values based on asecending length, diameter-to-height index, or ascending length-to-height index. Our findings conclusively demonstrate that concomitant hemiarch replacement does not increase the perioperative risk in young patients undergoing VSRR. However, concomitant replacement does not seem to protect from aortic reinterventions during medium term follow-up.

A Cross-Sectional Study on the Observation of Clinical Profiles and Associated Electrolyte Disturbances in Patients Admitted to the Pediatric Intensive Care Unit (PICU) at a Tertiary Care Center

A Cross-Sectional Study on the Observation of Clinical Profiles and Associated Electrolyte Disturbances in Patients Admitted to the Pediatric Intensive Care Unit (PICU) at a Tertiary Care Center

Amitraz Poisoning: An Observational Study from a Tertiary Care Center in North Karnataka

Amitraz Poisoning: An Observational Study from a Tertiary Care Center in North Karnataka

Challenges in Burns Management in a Tertiary Care Center in Albania

Introduction: Burn injuries represent a significant public health concern globally, with a substantial impact on morbidity and mortality rates, particularly in low- and middle-income countries. This study provides valuable insights into the epidemiology of burn injuries in Albania. It highlights the critical need for targeted interventions to reduce the incidence and severity of burns in the population. Materials and Methods: This retrospective cohort study examined burn patients at the Department of Burns and Plastic Surgery at Mother Teresa University Hospital Center in Tirana from January 2022 to January 2024. Data were collected from medical records in Tirana, Albania. Formal approval was obtained from the Ethics Committee of Mother Teresa Hospital. The data were recorded in Excel and analyzed using the SPSS statistics program. Results: This retrospective cohort study included 303 burn patients admitted between January 2022 and January 2024. Data on patient demographics, burn causes, total body surface area (TBSA), and burn severity were collected and analyzed using SPSS software. The mean patient age was 36.1 years, with children aged 0-10 most affected, especially 2-year-olds. The youngest patient was seven months old, and the oldest was 89. Male patients comprised 60.7% of the cohort. The leading cause of burns was scalding from hot liquids (39.9%), followed by flames (20.4%) and electrical burns (8.2%). The average TBSA affected was 23.06%. The mortality rate was 7.3%. Conclusion: Burn injuries present significant physical and psychological challenges. Despite advancements in burn care, the importance of preventive measures and public awareness campaigns must be addressed. These remain the most effective strategies to reduce burn incidence and severity. These findings underscore Albania's need for improved burn prevention and public safety initiatives.

Cutaneous Findings in Neonates: A Clinical Study from a Tertiary Care Center

Cutaneous Findings in Neonates: A Clinical Study from a Tertiary Care Center

Post-COVID-19 laryngo-tracheal sequelae: a comprehensive study at a tertiary care centre

BackgroundThe laryngo-tracheal framework is a complex structure responsible for several functions, including phonation, airway formation for breathing, and preventing aspiration. These functions rely on precise neurological and structural coordination. The COVID-19 pandemic primarily affected the lungs and upper respiratory tract, and the patients were classified into mild, moderate, and severe categories to determine appropriate management strategies, including home isolation and hospital admission. Mild cases typically underwent home isolation, while moderate-to-severe cases required hospitalization. Moderate cases often necessitated oxygen supplementation through various means such as oxygen masks, non-rebreather masks, and high-flow nasal cannula, while severe cases required mechanical support and emergency procedures like intubation, continuous positive airway pressure, and tracheostomy. These interventions, along with other factors like viral neuritis and comorbid illnesses, result in various laryngo-tracheal sequelae; in this study, we have tried to look for the laryngo-tracheal sequelae in post-COVID-19 patients.MethodsA sample of 348 patients who were diagnosed with COVID-19 using reverse transcription polymerase chain reaction were identified retrospectively, and their demographics, comorbidities, intubation/tracheostomy, and management data were collected; then all the patients were subjected to video-laryngoscopy, and findings were noted and analysed.Type of studyRetrospective cross-sectional observational study.ObjectivesPrimary objective of the study was to assess the rates of laryngo-tracheal sequelae occurring in post-COVID-19 patients.Secondary objective was to assess the role of various factors along with COVID-19 that have led to the sequelae.ResultsThe study population included 348 participants, with an age distribution ranging from 21 to over 60 years.Post-COVID-19 symptoms were seen in 22.7% of all the patients included out of which hoarseness of voice 32.9%, difficulty in breathing 24.05%, and other related symptoms such as cough 18.98%, foreign body sensation 8.8%, throat irritation 7.5%, throat pain 5.06%, throat dryness 1.2%, and difficulty in swallowing 1.2% of the patients.Majority of our patients had history of hospital admission which was predominant (87.1%) over home isolation (10.3%). Most common comorbidity was diabetes mellitus (DM) (62.4%) along with hypertension.The various findings were noted in 10.1% of total patients included in the study including vocal cord polyps 19.9%, vocal cord paresis 19.9%, vocal cord granulomas 8.5%, vocal nodule 5.7%, and chronic congestion of laryngeal inlet 17.1% of the patients.Significant associations were observed between sequelae and factors such as hospital admission, intubation and tracheostomy, duration of O2 support, and diabetes mellitus.ConclusionsLaryngo-tracheal sequelae are commonly present and are persistent for months after recovery from COVID-19 in hospitalized and intubated/tracheostomized patients due to various factors related to the disease and its treatment.

Anesthesia for pregnant patients with symptomatic neurological disease: 13 years’ experience from a tertiary care center

BackgroundImprovements in diagnostics and clinical care have allowed more women of childbearing age, suffering from neurological diseases, to safely have pregnancy, reducing peripartum complications. However, these patients remain at risk and are a constant challenge for anesthesiologists in the delivery room.MethodsTo assess the type of anesthesiologic management performed for delivery in obstetric patients with preexisting neurological disease and who reported significant neurological symptoms during pregnancy, a retrospective observational study was carried out between 1 October 2008 and 30 September 2021.ResultsData from 49,202 pregnant women were assessed over 13 years; 239 pregnant women with a diagnosis of preexisting neurological disease and who reported significant neurological symptoms during pregnancy were identified (prevalence 0.49%). The main neurological disorders that affected pregnant women included vascular abnormalities and intracranial bleeding (N = 42, 17.6%), central nervous system tumors (N = 35, 14.6%), epilepsy and episodic and paroxysmal disorders of the central nervous system (N = 34, 14.2%), diseases of the neuromuscular junction and muscles (N = 26, 10.9%), demyelinating central nervous system diseases (N = 24, 10%). A total of 234 (97.9%) pregnant women with neurological disorders and significant neurological symptoms underwent cesarean section: 192 (80.3% of the total cesarean sections) were elective, 39 (16.3%) were urgent type 2 and 3; 3 (1.2%) were emergency cesarean sections. General anesthesia was administered to 73 patients (30.5%), while 166 patients (69.5%) were managed with neuraxial techniques. 2 patients who had had neuraxial block reported worsening neurological symptoms that required a change in medical therapy. Postoperative multiparameter monitoring was performed for less than 24 h in the recovery room for 226 patients (94.6%). 3 patients (1.2%) were observed with multiparameter monitoring in the post-anesthesia care unit (PACU) for more than 24 hours; 10 patients (4.2%) were moved to the postoperative intensive care unit (ICU). The median hospitalization duration was 4 days (with an interquartile difference of 3–6 days).ConclusionsIn our experience, when neuraxial anesthesia was feasible, it proved to be a safe option for pregnant patients with symptomatic neurological disease, resulting in uncommon maternal complications.

The clinical observation of none-promyelocytic AML patients inducted with idarubicin or daunorubicin included standard regimens: a tertiary care center experience

BackgroundFew Chinese study compared the impacts of idarubicin and daunorubicin based “3+7” intensive chemotherapies on early and long-term outcomes of AML patients through exploring their real-world data.Patients and methodsOur none promyelocytic AML patients inducted with “3+7” regimens were studied to find out the factors relating with induction response and long term survival.ResultsIdarubicin induction was related with less chemotherapy refractory rate comparing with daunorubicin induction (10% vs 25%, P = 0.02). But cytogenetic molecular risk classification was the only independent factor relating with achieving CR after initial induction or chemotherapy refractory (P = 0.000 and 0.036). Both to overall survival (OS) and progress free survival (PFS), having transplantation and chemotherapy refractory were independent factors related, MLL rearrangement and DNA methylating related genes’ mutations as well. CR at time of transplantation and MLL rearrangement were independent factors relating both with OS after transplantation and relapse free survival after transplantation.ConclusionTraditional “3+7” chemotherapy regimen with idarubicin plays better in CR induction than that with daunorubicin. But the patient’s long-term survival related with clinical practice aspects, like having stem cell transplantation, as well as genetic alterations equally, like MLL rearrangement and DNA methylating related genes’ mutations.

“Prospective Analytical Comparative Study of Visual Inspection of Cervix with Acetic Acid with Cervical Cytology in Screening Cancer Cervix at Tertiary Care Centre VIMS,Ballari”

“Prospective Analytical Comparative Study of Visual Inspection of Cervix with Acetic Acid with Cervical Cytology in Screening Cancer Cervix at Tertiary Care Centre VIMS,Ballari”

Co-infection of Dengue and hepatitis A virus among pediatric population: A study from a tertiary care center in central India during 2022-2023.

Co-infection of dengue virus and acute hepatitis A virus in paediatric population is a major health concern in endemic countries. This cross sectional retrospective study was conducted to evaluate the prevalence of hepatitis A virus among the clinically dengue suspected paediatric cases presented at our tertiary care centre during the two-year period (2022-2023). A total of 747 dengue suspected paediatric clinical specimens were included in this study. Serological diagnosis of DENV and HAV was done using Dengue IgM capture ELISA kit and anti-HAV IgM ELISA kits. Out of the 747 dengue suspected paediatric patients, 245 (32.8%) were seropositive for either DENV, HAV, or both viruses and among these 135 (18.07%) were positive for DENV, 110 (14.72%) were positive for HAV, 22 (2.94%) were co-infected with both DENV and HAV. Further, among DENV seronegative cases, 88 (11.78%) clinical samples were found to be HAV positive. Among all the age groups, the highest prevalence of DENV and HAV was observed in 6-10 yrs. The monsoon season observed the highest number of seropositive cases compared to winter season and summer seasons. Fever was found to be most prevalent clinical symptom followed by nausea/vomiting and stomach discomfort. This study underlines the significance of differential diagnosis for the detection of concurrently transmitted viral diseases during the common seasons in the endemic areas. Diagnostic challenges like misdiagnosis events can be solved by advising differential diagnosis especially in paediatric cases.

Response to neoadjuvant chemotherapy leads to better survival outcomes in upper tract urothelial carcinoma.

To evaluate the benefit of neoadjuvant chemotherapy (NAC) for patients with high-risk upper tract urothelial carcinoma (UTUC) using a large, well-curated multi-institutional database. This study was a multi-institutional retrospective analysis conducted by the UTUC Collaborative Network (UCAN), combining data from 2276 patients with UTUC who underwent radical nephroureterectomy at seven high-volume tertiary care centres in the United States. The UCAN data were analysed to evaluate the impact of response to NAC on survival outcomes in patients with UTUC. A total of 378 patients in the UCAN database underwent NAC. On final surgical pathology, 101 patients (26.8%) had ≤ypT1N0 disease and were defined as NAC treatment responders. Patients who responded to NAC had significantly longer overall survival (OS) and progression-free survival (PFS) compared to non-responders. At 5 years post-surgery, 81.5% of responders were alive compared to 59.8% of non-responders. The median OS and PFS times among non-responders were 7.0 years (95% confidence interval [CI] 5.6-9.7) and 6.0 years (95% CI 4.6-9.3) respectively, while the median OS and PFS were not reached among responders. Limitations of this study include its retrospective design, heterogeneity in chemotherapy regimens, and the absence of clearly defined patient selection criteria for treatment. These data suggest that NAC can play a pivotal role in the treatment of well-selected UTUC patients who respond positively. Non-responders had clearly inferior outcomes. More work is needed to find predictors of response which can improve patient selection.

A Cross-sectional Study for the Impact of Primary Caesarean Section on Future Pregnancy Outcome at Rural Based Tertiary Care Centre in Gujarat, India

A Cross-sectional Study for the Impact of Primary Caesarean Section on Future Pregnancy Outcome at Rural Based Tertiary Care Centre in Gujarat, India

Evaluation of Incidence of Displacement of PPIUCD Inserted After Vaginal and Caesarean Delivery in Tertiary Care Centre: A Comparative Study

Evaluation of Incidence of Displacement of PPIUCD Inserted After Vaginal and Caesarean Delivery in Tertiary Care Centre: A Comparative Study

Psychological burden and its correlates in patients with chronic plaque psoriasis attending three tertiary care centers in Sri Lanka.

Psoriasis is associated with psychological distress among the affected due to unsightly skin lesions, chronicity and the cultural and social stigma linked with the disease. The pathophysiological link between psoriasis and depression creates a vicious cycle in the skin and brain axis. This study evaluates the psychological comorbidity of patients with chronic plaque psoriasis (CPP). A cross-sectional study was conducted among 297 patients aged 18 years or more attending dermatology clinics at National Hospital, Galle and General Hospitals at Matara and Hambantota. The Sinhala validated Kessler Psychological Distress Scale (K10), and patient health questionnaire (PHQ-9) were used to assess psychological status and depression, respectively. The quality of life (QoL) was assessed using the Dermatology Life Quality Index (DLQI) and Psoriasis Disability Index (PDI). Mean (SD) age of patients was 52(12) years and 57.6% were males. According to the K10 score, 73% (n = 218) were likely to be mentally robust while 15% (n = 45) had mild mental disorder and 11% (n = 34) had moderate to severe mental disorder. Screening using PHQ-9 showed 17%(n = 51) prevalence of depression and 14% (n = 42) reported to have had suicidal ideation at some stage of the illness. Psychological distress showed weak correlations with age (ρ= -0.19, p < 0.01), degree of itch (ρ = 0.16, p < 0.01), disease severity (body surface area ρ = 0.16, p < 0.01 and psoriasis area severity index ρ=+0.15, p < 0.05). Both K10 and PHQ-9 showed significant correlations with PDI (ρ = 0.51 and ρ = 0.48, p < 0.01) and DLQI (ρ = 0.34 and ρ = 0.39, p = < 0.001). The presence of arthralgia was associated with psychological distress and depression (OR 1.8, 95% CI: 1.09, 3.05: p = 0.019, and OR 2.48, 95% CI: 1.32, 4.65: p = 0.004, respectively). There was no association between the psychological distress with gender, duration of the disease, or smoking status. Psychological distress is common in patients with CPP and it is associated with reduced QoL. Depression and suicidal ideation were notable concerns, and arthralgia was linked to higher levels of distress. These findings highlight the importance of addressing both physical and mental health in managing psoriasis.

Analysis and long-term outcomes of spontaneous cerebrospinal otorrhea repair via the middle cranial fossa approach

Background The incidence of spontaneous CSF otorrhea is increasing and knowledge about treatment management is growing. Objectives To analyse the cases operated via the middle cranial fossa approach (MCFA) for spontaneous CSF otorrhea in our clinic and to evaluate the long-term surgical results in the light of the literature. Methods Demographic data, presenting complaints, complications, hearing outcomes, recurrence rates and long-term success of patients operated with MCFA between 2012 and 2022 in our tertiary care centre were evaluated. Results The mean age of the 12 patients who met the inclusion criteria was 58.3 ± 13.4 years. Hearing loss and ear fullness in five patients and persistent otorrhea after ventilation tube insertion in three patients were the most common symptoms. The mean body mass index (BMI) was 35.03 ± 3.39. More than one defect was detected in seven patients. No perioperative or postoperative complications were observed in any patient. The mean airway hearing threshold (ASH)±SD was 40.6 ± 13 preoperatively and 24.4 ± 6.3 postoperatively, a statistically significant decrease (p = 0.003). The mean follow-up period was 80.8 ± 32.5 months and no recurrence was observed in any patient. Conclusion Our experience and results support the use of MCFA in the repair of spontaneous CSF otorrhea as safe, highly successful, and beneficial.