Tertiary Care Center In India Research Articles

Unexpected Discrepancies in the Histopathological and Microbiological Diagnoses of Suspected Mucormycosis Cases at a South Indian Tertiary Care Center During the COVID-19 Pandemic

Unexpected Discrepancies in the Histopathological and Microbiological Diagnoses of Suspected Mucormycosis Cases at a South Indian Tertiary Care Center During the COVID-19 Pandemic

Maternal, Fetal, and Kidney Outcomes of Viable Pregnancies in Women with Underlying Kidney Disease: Experience from a Single Tertiary Care Center in India

Background There is a dearth of data from resource-limited settings on pregnancy outcomes in women with kidney disease. We investigated the maternal, fetal, and renal outcomes of pregnancies amongst women with kidney disease and compared these outcomes with normal pregnancy outcomes. Materials and Methods This was a single-center retrospective observational study. The maternal, fetal, and renal outcomes of women with kidney dysfunction who delivered at the study center after at least 22 weeks of gestation (viable pregnancy) between January 2012 and December 2021 were analyzed. The study results were also compared with the outcomes of normal pregnancy. Results Two hundred and one deliveries were included in the study, constituting 0.14% of all deliveries during the study period. Lupus nephritis (39.3%) and Immunoglobulin A nephropathy (11.4%) were the most common underlying kidney diseases. The mean (±SD) gestational age at delivery was 34.9 (±3.7) weeks. A higher cesarean section rates (45.3%) were observed in these high-risk pregnancies. Low birth weight was observed in 51.7% of all deliveries. Renal outcome regarding proteinuria and estimated glomerular filtration rate was excellent. Renal transplant patients had unfavorable outcomes. More than 45% of patients had term deliveries with normal birth weight. Conclusion Satisfactory maternal, fetal, and renal outcomes can be achieved with proper pre-pregnancy counseling and multidisciplinary care in women with kidney diseases, even in resource-limited settings.

Pattern and Clinical Reasons for Dental Extractions in Patients Visiting a Tertiary Health Care Centre in Southern District- Nuh of Haryana, India: A Retrospective Observational Study

Introduction: The causes of tooth extraction exhibit significant geographical and cultural variations between regions within a country and across different countries. To date, no study has been conducted on the pattern of tooth loss in a comparatively socially and economically disadvantaged population in Nuh, Haryana, India. Aim: To analyse the pattern and clinical reasons for tooth extraction in relation to factors such as age and gender among patients visiting the Dental Department of a tertiary care centre in India. Materials and Methods: A retrospective observational study was carried out in the Department of Dentistry, Shaheed Hasan Khan Mewati (SHKM) Government Medical College Nalhar, Nuh, Haryana, India, from January 2017 to December 2019. Data were collected from the available records of patients across different age groups during the period from January 2017 to December 2019. Data on age, gender, reasons for extraction, jaw type and tooth number were recorded. The total number of extracted teeth was used for statistical analysis using Microsoft Excel software. Results: During the study period, 2643 patients underwent tooth extraction, with 1304 (49.33%) being males and 1339 (50.66%) females. A total of 3358 teeth were extracted, with 1382 in males and 1976 in females. The number of teeth extracted was higher in females (58.84%, n=1976) compared to males (41.15%, n=1382). The majority of extractions occurred in the 21-30 years age group, 750 (21.73%) followed by the 31-40 years age group, 663 (19.71%). The most common reason for extraction was dental caries and its sequelae, 2462 (73.34%). The most frequently extracted tooth was the first molar in the fourth quadrant (9.26%) followed by the first molar in the third quadrant (8.72%). Conclusion: Given the paramount importance of first permanent molars, it is concerning to see many young patients losing this tooth in the present study. Therefore, it is crucial to raise awareness among the general population about maintaining oral hygiene, regular dental check-ups and treatment. The role of pit and fissure sealants in caries prevention for first permanent molars cannot be overstated.

Impact of Diabetes on Clinical Characteristics and Angiographic findings in Young Adults with ST-Elevation Myocardial Infarction: A Cross-sectional Study

Introduction: The prevalence of diabetes among young patients with ST-Elevation Myocardial Infarction (STEMI) is increasing, but its impact on this population remains understudied. Limited data on diabetes in young patients with STEMI exist. The presence of diabetes among young patients experiencing STEMI deserves special consideration, as it manifests with unique clinical patterns and can significantly impact their active lifestyle. Aim: To determine the effect of diabetes and associated clinical characteristics in young patients with STEMI. Materials and Methods: A cross-sectional study was conducted at a tertiary care centre in India between April 2018 and December 2019. Fifty-one STEMI patients aged below 40 years were enrolled and categorised into diabetic (n=23) and non diabetic (n=28) groups based on glycated haemoglobin (HbA1c) levels. Clinical characteristics, laboratory parameters and angiographic findings were compared between the groups. This study analysed continuous variables using Student’s t-test and Analysis of Variance (ANOVA) (expressed as mean±SD), and categorical variables using Chi-square or Fisher’s exact tests (shown as n, %). A p-value of < 0.05 was considered significant. Results: The mean age was 35.6±3.4 years, with 80.4% male predominance. Diabetic patients showed higher prevalence of dyslipidaemia (p-value=0.009), hypertension (p-value=0.043), and metabolic syndrome (p-value=0.002). They also exhibited significantly higher levels of total cholesterol, triglycerides and Low-Density Lipoprotein Cholesterol (LDL-C). Anterior Wall Myocardial Infarction (AWMI) was predominant in both groups (p-value=0.442). Single-Vessel Disease (SVD) was most common, but Triple-Vessel Disease (TVD) was observed exclusively in diabetic patients (p-value=0.198). The Left Anterior Descending (LAD) artery was the most involved vessel in both groups. Conclusion: Compared to non diabetic patients, young STEMI patients with diabetes demonstrated a more adverse cardiovascular risk profile and lipid abnormalities.

Incidence of Severe Acute Maternal Morbidity in Severe Preeclampsia

Background: Hypertensive disorders of pregnancy are among the most common complications, with an incidence ranging from 5 to 10%. It is the third leading cause of maternal mortality in India, contributing to 7% of all maternal deaths. Aims: This study aims to determine the incidence of severe acute maternal morbidity in women with severe preeclampsia. The most affected organ and perinatal outcomes in women with severe preeclampsia were evaluated as secondary objectives. The association between severe preeclampsia and severe acute maternal morbidity which is indicated by dysfunction of cardiovascular, respiratory, renal, coagulation and neurological systems was observed. The perinatal outcomes such as fetal growth restriction, preterm birth, fetal distress, neonatal encephalopathy, still birth, NICU admission and neonatal death were assessed. Methodology: This was a prospective observational study done at a tertiary care centre in India between May 2022 and July 2023. All antenatal and postnatal women i.e. up to 42 days from the day of delivery, diagnosed with severe preeclampsia were included in the study. Women without severe preeclampsia and those who were referred with Multiple Organ Dysfunction Syndrome (MODS) were excluded from the study. Results: A total of 12,359 women delivered during the study period. Out of these, 360 women were diagnosed with severe preeclampsia with an incidence of 2.91%. Amongst 360 women who were diagnosed with severe preeclampsia severe acute maternal morbidity was seen in 68 women with an incidence of 19%. Women with severe preeclampsia had eclampsia as the most common serious complication followed by thrombocytopenia. Most of the women had preterm delivery by caesarean section and more than half of the babies required NICU admission. A considerable number of babies were low birth weight and stillborn. Conclusion: This study has shown the adverse effects of severe preeclampsia on the mother and the fetus leading to morbid condition. Early diagnosis and referral to higher centre for early intervention can prevent the morbid condition.

Study of below knee amputation in patients with diabetic foot ulcer in a tertiary care centre in India

Background: This study aims to evaluate the predictive factors affecting the clinical outcome of below knee amputation performed in diabetic foot patients who had developed foot ulcers. Methods: This is a retrospective study of 25 random patients who underwent below-knee amputation for diabetic foot ulcers. These patients were admitted in the Department of Surgery, Shri MP Shah Medical College, Jamnagar, between November 2017 and October 2019. Results: The patient’s age ranged from 30 to 80 years, with a mean age of 62.92 years. 60% were between the ages of 51 and 70. Of the total, 14 were male and 11 were female, suggesting that males due to generally more active lifestyles, may be at higher risk for foot injuries leading to diabetic ulcers. 64% were from a lower socio-economic background. All 25 patients had previous admissions, 12 had a history of previous amputation, while 13 treated conservatively. Most patients presented with infected or non-healing ulcers, cellulitis and/or gangrene. Primary healing occurred in 13 patients, 7 required refashioning for healing, 3 required transfemoral amputation and 2 patients unfortunately passed away. The mean duration of hospital stay was 49.82±28.07 days. Conclusions: Lack of awareness, poor glycaemic control and duration of diabetes where the main factors causing diabetic foot problems. For patients with infected feet, difficulty with mobility and prolonged immobilization were common issues. Timely below-knee amputation helped restore movement and improved the ability to use prosthetic limbs, allowing for greater mobility and independence.

A deep dive into penetrating ocular trauma: Insights from a South Indian tertiary eye care center

Penetrating ocular trauma is a significant cause of visual impairment and blindness worldwide. In India, with its vast and diverse population, understanding the epidemiology and patterns of Penetrating ocular trauma is crucial for effective prevention and management. This study aims to investigate the prevalence, characteristics, and outcomes of penetrating ocular trauma in the South Indian population. By analyzing data from a tertiary eye care center in South India, this research seeks to contribute to the existing knowledge base and inform evidence-based interventions to reduce the burden of penetrating ocular trauma in this region.To analyze the clinical profile, management, and outcomes of penetrating ocular trauma cases at a tertiary eye care center in South India.A retrospective review of medical records from January 2024 to June 2024 was conducted. Data collected included demographic details, mode of injury, clinical presentations, management approaches, and visual outcomes.Out of 150 cases, 120 were male (80%) and 30 female (20%). The majority of cases occurred in the 20-40 age group (60%). Common causes included workplace accidents (45%), domestic injuries (30%), and road traffic accidents (15%). Initial visual acuity varied from no light perception to >6/18. Surgical intervention was required in 90% of cases. Post-operative follow-up indicated that 60% achieved a visual acuity of 6/60 or better, while 20% had no light perception.Penetrating ocular trauma predominantly affects young males in South India, with workplace injuries being a major cause. Early surgical intervention improves visual outcomes. Public awareness and safety measures could reduce the incidence of such injuries.

Increasing Trends of Syphilis and Histopathological Correlates: Study in a Tertiary Care Centre in India

Increasing Trends of Syphilis and Histopathological Correlates: Study in a Tertiary Care Centre in India

Clinical and Molecular Profile of Neurofibromatosis Type 1 Patients Using Revised Diagnostic Criteria - A Retrospective Cohort Study.

To catalog and correlate the clinical features and mutational spectrum of neurofibromatosis type 1 (NF1) patients attending a tertiary care center in India. NF1 patients with confirmed molecular diagnosis from 2014 to 2021 were included in the study. The molecular tests used for the diagnosis were exome sequencing, targeted gene sequencing, and Multiple Ligation Probe Assay. Forty-two clinically diagnosed NF1 patients who had confirmed molecular diagnosis, which is now part of the revised diagnostic criteria, were included in the analysis. Nonsense variants were the most frequently observed (35.71%), followed by frameshift (23.8%), splice site (14.29%), deletion (11.9%), missense (9.5%), and in-frame deletions (4.76%) in our case series. Three variants (c. 5269-1G > C, c. 1541_1542del AG, and c. 6853_6854insA) were identified in more than one patient, suggesting that the variants are widely distributed in the gene and lack any mutational hotspot. This study supports the previous findings that patients with the variant c. 2970_2972delAAT do not develop neurofibromas; however, it was not necessary for those with whole gene deletion to have dysmorphic features as reported by other studies. The study could not establish any correlation between the type of variants and specific clinical features. Around 28% of mutations could be identified by screening exons 14, 28, 37, 46 and intron 37 in this population. This study will contribute to a better understanding of the phenotypic variability of neurofibromatosis patients. The variable expressivity seen in NF1 suggests that modifying genes may be involved in the development of particular clinical features in addition to NF1 mutations.

Computed tomography of the head with and without contrast in imaging focal and unknown epilepsy – A prospective observational study

PurposeBrain imaging is needed when investigating epilepsy. Imaging options available include MRI and CT scan which may be non-contrast (NCCT) or contrast-enhanced (CECT). The specific clinical question and probable epilepsy substrate in the epidemiological context and socioeconomic milieu are important in determining the choice of imaging. In patients with well-controlled focal or unknown epilepsy who are unlikely to be surgical candidates, is CECT essential or can NCCT be an acceptable choice? MethodsA prospective observational study was conducted at a tertiary care centre in India. Consecutive patients with focal or unknown epilepsy who were relatively well-controlled on medical treatment underwent NCCT followed by CECT brain. Three neuroradiologists independently reported the images. Proportion of abnormalities missed on NCCT and picked only on CECT were determined. How often abnormalities picked on CECT changed patient management was also analysed. ResultsTwo hundred and nineteen patients with focal (87 %) or unknown (13 %) epilepsy underwent NCCT followed by CECT brain. Most had epilepsy for >3 months and an annual seizure frequency of 2–10 seizures. There was a nearly perfect inter-observer agreement between 3 neuroradiologists in reporting the NCCT and CECT as 'normal' or 'abnormal' with kappa (κ) values of 0.9 and 1.0 respectively. The sensitivity of NCCT compared to CECT in detecting an abnormality was 97 % (CI 92.6 - 99.5 %) and the specificity was 99 % (CI 94.9 - 99.9 %). There was no significant difference in the proportion of NCCTs and CECTs found abnormal (50.22 % vs 51.14 %, p = 0.91). A solitary calcified granuloma was the most common abnormality reported on NCCT as well as CECT, 21.0 % and 19.1 % respectively. New findings picked on CECT alone, did not change management in any patient. ConclusionWhen imaging focal or unknown epilepsy, an NCCT performs as well as a CECT, especially in regions where calcified lesions contribute a significant etiological burden. The role of imaging in epilepsy varies between patients and a universal recommendation of an MRI or a CECT in all patients is neither cost-efficient nor evidence-based. In drug responsive focal or unknown epilepsy of longstanding duration, CT scans are either normal or have calcified lesions that are easily picked on NCCT.

Which antidiabetic drugs do patients of T2DM prefer in India and why? A discrete choice experiment

ABSTRACT Background: Uncontrolled diabetes persists despite guideline-based treatment, partly attributed to inadequate patient involvement. This research addresses shared decision-making by eliciting patient preferences in Type 2 Diabetes Mellitus (T2DM) treatment based on certain key attributes and explores their correlation with socio-demographic-clinical profiles. Methods: A discrete choice experiment (DCE) was conducted among T2DM outpatients in an Indian tertiary care center. A choice card was developed using the contextual choice framework, having six second-line antidiabetic drugs (ADs) from different classes incorporating seven attributes. Face-to-face interviews were conducted with patients, and elicited preferences were analyzed using descriptive statistics, Chi-square analysis, and multinomial logistic regression. Results: Out of the 87 evaluated participant choices, the most preferred drug was Glimepiride (51.7%), followed by Dapagliflozin (22.9%) and Teneligliptin (17.2%). Overall, the most important attributes were the effect on weight (29%), followed by route of administration (24%), and additional benefits offered by the drug (18%). Significant associations were found between participants’ drug preferences and their age (P = 0.002), socioeconomic status (P = 0.04), occupation (P = 0.004), and monthly income (P = 0.03). Age was not a significant predictor of drug choice for any of the drugs. Multinomial logistic regression showed that the overall model was statistically significant (P = 0.025), and it correctly predicted drug choice for 58.6% of the participants. Conclusion: Glimepiride was the most preferred option overall while the effect on weight was the most important attribute for patients in determining their preference. The study highlighted the importance of shared decisions and can guide practitioners in considering patient preferences when prescribing antidiabetic drugs.

Clinical Course and Outcomes of Brain Tumor Patients Admitted to Medical Intensive Care Unit: A Descriptive Analysis

Background: There is a shortage of data on brain tumor patients admitted in to intensive care unit (ICU) from developing countries. We aimed to assess the clinical course and 30-day mortality with factors affecting the mortality of brain tumor patients who were admitted to medical ICU.Methods: This study was a single-centre retrospective observational cohort study and was conducted in a medical ICU of a tertiary care center in India. We included 42 patients admitted in to the medical oncology ICU over 3 years. Data regarding demographics, baseline characteristics, clinical and laboratory data, need for organ support, and 30-day mortality were collected. Factors associated with increased mortality in these patients were determined.Results: Overall 30-day mortality was 30.95%. The most common indication for ICU admission was altered sensorium (57.1%) followed by sepsis (23.8%). Age [odds ratio, OR: 0.843 (95% confidence interval, CI: 0.721–0.986)], and need for invasive mechanical ventilator (IMV) support [OR: 484.62 (95% CI: 2.707–8676.02)] or vasopressor support [OR: 523.83 (95% CI: 2.12– 3,023.13)] were directly associated with 30-day mortality. Severity indices such as Sequential Organ Failure Assessment (SOFA) score, SAPS II (Simplified Acute Physiology Score II), and Acute physiology and chronic health evaluation II (APACHE II), APACHE III and APACHE IV scores were higher in non-survivors than survivors.Conclusion: Advancing age and need for IMV or vasopressor support may be associated with worse prognosis in brain tumor patients admitted in to ICU. A scoring system could be used along with clinical judgement to triage brain tumor patients for ICU admission.

Multicenter comparison of non-operative techniques of intussusception reduction: saline versus air versus barium

Purpose: Intussusception is a common pediatric surgical emergency and non-operative reduction is its first line of management. We aimed to compare 3 contemporary techniques of intussusception reduction.Methods: A retrospective study was performed in 3 tertiary care centers in India from January 2017 through December 2019. In the 3 centers, the primary reduction techniques were ultrasound-guided saline reduction (USR), fluoroscopy-guided pneumatic reduction (FPR), and fluoroscopy-guided barium reduction (FBR), respectively. As per these techniques used, we compared clinical characteristics, such as the successful reduction.Results: A total of 255 patients underwent one of the 3 reduction techniques in the study period. Reduction was successful in 90.3%, 85.1%, and 87.7% in the USR, FPR, and FBR groups, respectively (P = 0.961). Mean time to reduction was shorter in the FPR group (30.8 ± 8.9 seconds), compared with the USR (575.0 ± 242.3 seconds) and FBR groups (495.0 ± 118.4 seconds; P < 0.001). Recurrence rates were 11.8%, 20.3%, and 15.8% in the USR, FPR, and FBR groups, respectively (P = 0.522). No association was found between the patients’ age or symptom duration and the successful reduction. One patient in the USR group, 3 in the FPR group, and 4 in the FBR group reported second recurrences. Perforation occurred in 1 patient in the FPR group while no complications occurred in the other groups. There was no in-hospital mortality.Conclusion: All 3 techniques are equally effective, with FPR requiring a shorter time than the other 2 techniques. The reduction technique should be chosen based on the strengths and weaknesses of each technique, as well as local availability.

Xpert MTB/RIF Ultra as a diagnostic tool for pleural tuberculosis: a study at Indian tertiary care centre.

Despite the advent of Xpert MTB/RIF, pleural tuberculosis (TB) diagnosis in pleural fluid is still difficult. Hence, we assessed the diagnostic efficacy of its advanced version, Xpert MTB/RIF Ultra for pleural TB diagnosis using pleural fluid as sample. Tuberculosis pleuritis (TBP) suspects (n=261) were enrolled in the study of which 29 were excluded. The remaining patients (n=232) were categorized into definite TBP (n=31), probable TBP (n=28), and non-TB controls (n=173) based on composite reference standard consisting of smear, culture, histopathology, and Xpert MTB/RIF as well as follow up/clinical response to anti-tuberculosis therapy. Among the TBP suspects, 59 were diagnosed as TBP patients. The sensitivity of Xpert MTB/RIF Ultra (52.5%) using pleural fluid for TBP diagnosis was higher than sensitivity obtained with smear (22.4%), culture (17.6%), and Xpert MTB/RIF (25%) alone, carried using either pleural fluid or pleural biopsy or both the samples. In cases of probable TBP, where none of the laboratory tests were positive, Xpert MTB/RIF Ultra use led to an increased diagnostic percentage of definite TBP from 52.5% to 69.4% Overall, the Xpert MTB/RIF Ultra showed promising results for a definitive diagnosis of TBP in pleural fluid samples.

Screening For Occult Heart Failure in Type 2 Diabetes Mellitus Using NT-proBNP: Real-World Evidence From a Tertiary Care Center in India.

Objective Heart failure (HF) is an important underrecognized complication of type 2 diabetes mellitus (T2DM). Recent literature and recommendations support screening for HF among T2DM people attending the outpatient department (OPD) in non-emergency settings using a biomarker. The present study is a retrospective cross-sectional study that assesses the prevalence of screen positivity (S+) for undiagnosed HF among T2DM people (with normal electrocardiogram (ECG) and no history of heart disease) attending the OPD at a tertiary care center in India using N-terminal pro-B-type natriuretic peptide (NT-proBNP). It also highlights the risk factors for S+ for HF. Methods This is a retrospective cross-sectional study of the practice of NT-proBNP screening in T2DM to diagnose stage B HF. A total of 1,049 consecutive people with T2DM (age range: 18-75 years) attending the OPD of a tertiary care institute in India were screened for HF using NT-proBNP (cut off S+ >125 pg/mL). Demographic variables, vitals, smoking status, family history, status of hypertension, medications for diabetes, and glycemic control were recorded and correlated with the risk of S+ for HF. Results Of the 1,049 people with T2DM, 336 (32.03%) had S+ for HF. Those with S+ had higher age (62.5+9.3 vs 54.2 +10.6 years), longer duration of T2DM (14.4 +7.8 vs 9.6 +6.1 years), positive history for smoking (94 [28%] vs 55 [7.7%]) and tobacco chewing (66 [19.6%] vs 24 [3.4%]), higher blood pressures (both systolic [152.1+19.9 vs 134.6 +15 mmHg] and diastolic [87.7+9.6 vs 83.9+7.8 mmHg]), higher glycated hemoglobin (HbA1c) (8.4+1.4 vs 7.6+1 years), higher BMI (28.3+2.8 vs 27.2+2.1 kg/m2), presence of chronic kidney disease (CKD) (210 [62.5 %] vs 118 [16.5%]), and a positive family history of cardiac ailments (185 [55.1%] vs 122 [17.1%]) (p<0.05 for all). The above factors also correlated with increased chances of S+ for HF on regression analysis. Conclusion S+ for HF is common in people with T2DM attending OPDs. The S+ was associated with increasing age, longer duration of T2DM, smoking and tobacco chewing, uncontrolled hypertension and T2DM, obesity, the presence of CKD, use of pioglitazone and insulin, and positive family history. It is the need of the hour to widely extend routine screening for HF in T2DM patients using NT-proBNP in the OPD setting so that benefits of guideline-based therapy can be extended.

Use of fibrin sealant in vein anastomosis in renal transplantation and its effect in preventing blood loss and postoperative peri-graft collection.

This study is to assess efficacy of fibrin sealant in vein anastomosis in renal transplantation in preventing blood loss and postoperative peri-graft collection. This is a retrospective analytical case-control study of renal transplantations done in a tertiary care center in India in a 1-year period. Fibrin sealant was randomly used in vein anastomosis during the period. All the data were extracted and retrospectively analyzed. Those with fibrin sealant use were the study group and without sealant use were the control group. Primary objective was to assess effectiveness of fibrin sealant in preventing blood loss and postoperative peri-graft collection. Secondary objectives were to evaluate patients' demographic profile, hospital stay and other intraoperative and postoperative characteristics. During the study, 163 patients were enrolled, 82 study group and 81 control group. Warm ischemia, cold ischemia and operative times of study group were 2.57 ± 2.03, 44.23 ± 8.89 and 189.6 ± 51.6min, respectively, and that of control group were 2.67 ± 2.07, 42.37 ± 8.5 and 178.8 ± 54.6min, respectively. The mean intraoperative blood loss in study and control groups was 124.83 ± 110.89 and 155 ± 50.27ml, respectively, and the difference was statistically significant (p .027). The mean peri-graft collection in study group and control group were 72.33 ± 29.18ml and 134.67 ± 102.84ml, respectively, but the difference was not statistically significant (p .086). The study also demonstrated that the duration of hospital stays significantly differed between two groups (p < .043). In this study, fibrin sealant has demonstrated both safety and efficacy in effectively managing bleeding, sealing vascular anastomoses, and mitigating peri-graft collection.

Prevalence of food-related misbeliefs among postoperative patients at a tertiary care health center: a pilot survey and future directions

Background: Effective postoperative recovery is significantly influenced by nutrition, yet pervasive food-related misbeliefs can impede this process. This is particularly prevalent in regions with high rates of medical misinformation and cultural dietary restrictions. Methods: A survey was conducted with 917 postoperative patients at a tertiary care center in India from July 2019 to December 2019. A structured questionnaire was used to identify prevalent dietary misconceptions and their potential impact on wound healing. Results: The survey revealed that 18.9% of patients harboured detrimental food-related misbeliefs, with the majority avoiding high-protein foods such as meat and dairy due to unfounded fears of adverse effects on wound healing. Conclusions: The findings highlight a critical need for targeted educational interventions to correct these misbeliefs and promote nutritional practices that support recovery. Given the scope of this issue, further research is recommended to explore the broader implications of dietary misconceptions on post-surgical outcomes across different regions and cultures.

A real-world study on the clinicopathological profile, treatment outcomes and health-related quality of life, anxiety and depression among patients with desmoid tumor at two tertiary care centers in India.

The medical management of DT comprises tyrosine kinase inhibitors (TKIs), hormonal agents, anti-inflammatory drugs with the recently approved gamma secretase inhibitor nirogacestat being the current standard of care. Real-world data on evolving treatment landscapes of DT remains scarce. This is a retrospective study of patients with DT registered between 1995 and 2020 at All India Institute of Medical Sciences, New Delhi and Tata Medical Center, Kolkata. Baseline characteristics were analyzed in form of median values and interquartile range. Categorical and continuous variables were compared by chi square and independent samples T- tests respectively. Anxiety, depression and QoL were prospectively measured among 30 patients using Hospital Anxiety and Depression (HADS) and Functional Assessment of Cancer Therapy-General (FACT-G) scales respectively between 2022 to 2023. 200 patients were included with a male-predominant (n=111, 55.5%) population and median age 26.5 (2.5-75) years. Extremity (n=100, 50%) and abdomen (n=65, 32.5%) were commonest primary sites and median of 2 (1-4) lines of treatment were received. First-line included surgery (n=116, 58%), systemic therapy (n=67, 33.5%), radiotherapy (10, n=5%) and active surveillance (n=7, 3.5%). First-line systemic agents included tamoxifen (n=55, 27.5%), imatinib (n=7, 3.5%), sorafenib (n=1, 0.5%) and chemotherapy (n=4, 2%). 2019 onward, 3% and 63% underwent active surveillance and surgery respectively. Best radiological response obtained with tamoxifen was stable disease (SD) (n=76, 59%) and partial response (PR) (n=31, 24.2%). Best radiological response obtained with sorafenib was PR (n=17, 60.7%) and SD (n=9, 32.1%). Thirty patients underwent HADS and FACT-G scale assessment. Mean HADS-Anxiety subscale score was 3.6 (+/-3.9 SD) and HADS-Depression sub-scale score was 2.6 (+/-3.5 SD) with clinically significant anxiety and depression in 2 (6.7%) patients each. The overall mean FACT-G score was 87.5 (+/-12.6 SD) and lower mean physical well-being (p=0.006) and emotional well-being (0.017) scores were significantly associated with higher HADS-anxiety (>/=8) scores. Assessment of anxiety, depression and QoL are paramount to gauge the psychological impact of DT. This study gives an overview of clinical and management profile of patients with DT in India, with limitations of selection bias, heterogeneous population and small sample size for QoL assessment.

Clinico-epidemiological profile of dermatology patients: a one-year study at a newly established tertiary care centre in India

Background: Dermatology is predominantly an outpatient specialty focused on the diagnosis and treatment of dermatoses affecting the skin. We conducted a study on the demographic and clinical characteristics of patients attending the outpatient clinic to better understand the clinico-epidemiological profile and to predict morbidity patterns within the specific geographical region. Methods: A retrospective study was conducted over the past year, encompassing all patients who visited the outpatient dermatology clinic at AIIMS, Raebareli. The study systematically documented a range of dermatoses, including disorders affecting the skin, hair, and nails. Results: A total of 4,188 patients were included in the study, comprising 2,681 (64%) adults, 978 (23.4%) geriatric patients, and 529 (12.6%) pediatric patients. Among these, 1,311 patients primarily suffered from infections, followed by 752 patients with dermatitis. Of those with infections, 1,024 (78%) were diagnosed with fungal infections, while scabies was observed in 126 patients (9.6%). In the adult group, 756 (28.2%) patients had infections, while 429 (16%) patients were affected by dermatitis. Similar patterns were observed in both the geriatric and pediatric groups, with infections being the most prevalent, affecting 214 and 341 patients, respectively. Conclusions: Based on the findings of this study, it can be concluded that infections, particularly fungal infections, are the most prevalent dermatological conditions across all age groups in the population studied. Dermatitis also emerged as a significant concern, particularly among adult patients. The high prevalence of infectious dermatoses, especially in geriatric and pediatric patients, highlights the need for targeted public health interventions and preventive measures.

Emerging Colistin Resistance: Experience from an Intensive Care Unit of a Tertiary Care Center in India.

Resistance to the currently available classes of antimicrobials has emerged as a major health concern, with a growing number of isolated organisms demonstrating resistance to available antimicrobials. With the escalation of carbapenem resistance, the use of polymyxin B/E (colistin) has increased over the years, which has, in turn, contributed to the worldwide emergence of colistin resistance. The available data on colistin resistance from Southeast Asian nations, including India, is limited, especially in intensive care unit (ICU) settings. The primary objective of our study was to analyze the clinical profile of patients with polymyxin B/E (colistin) resistant positive cultures and to study their outcome in terms of length of ICU stay and outcome at discharge. This observational, single-center, prospective study was conducted in a 20-bed adult ICU serving both medical and surgical patients at a 1,600-bed tertiary care institute in northern India between Jan 2020 and Dec 2021. In this study, all adult patients, defined as individuals older than 18 years of age, admitted to our ICU with cultures detecting polymyxin B/E (colistin) resistant organisms were included as cases, and all adult ICU patients (age >18 years) with polymyxin B/E (colistin) sensitive cultures were taken as controls. Clinical, laboratory, and demographic parameters, along with ICU variables like severity of illness, length of ICU stay, mechanical ventilation, days of shock, renal replacement therapy (RRT), etc., and outcome at discharge were collected. Identification of resistance to colistin and minimal inhibitory concentration (MIC) of colistin is based on Clinical and Laboratory Standards Institute (CLSI) guidelines. For statistical analysis, Mann-Whitney U test, Fisher's exact test, and binary logistic regression were used. Twenty-eight cases and 55 controls (n = 83) were included for analysis. Abdominal [gastrointestinal (GI)] sepsis was the most common diagnosis (41.8%) at admission to the ICU, and Klebsiella pneumoniae was the most common species isolated in both the cases (96.4%) and the controls (50.9%). The most common site of isolation of Gram-negative bacteria in both cases and controls was blood (71.4 vs 74.5%), followed by deep-seated pus (21.4 vs 23.64%). The most common class of drugs to which the cases were sensitive was tetracyclines in 60.7%, followed by ceftazidime-avibactam. Factors such as prior exposure to colistin, exposure to monobactams in the ICU, and ICU stay in days were identified as independent predictors for colistin resistance. Overall mortality was not statistically different between cases and controls (p -value 0.38). Factors like prolonged ICU stay, exposure to monobactams in the ICU, and a history of prior exposure to colistin in the previous 90 days are independent predictors of colistin resistance. The most common organism to develop colistin resistance identified was K. pneumoniae, and the most common site of isolation was blood. There was no difference in mortality between colistin-resistant and colistin-sensitive patients.