Tertiary Care Hospital In Kerala Research Articles

Drug Susceptibility and Mutation Profiles in Mycobacterium tuberculosis Isolates from a Tertiary Care Hospital in Kerala, India.

The rising prevalence of drug-resistant Mycobacterium tuberculosis (MTB) strains poses a significant challenge to global tuberculosis (TB) control efforts. This study aimed to analyze drug resistance patterns and investigate the molecular characteristics of 193 MTB clinical isolates to shed light on the mechanisms of drug resistance. Of the 193 MTB clinical isolates, 28.5% (n = 53) exhibited mono-drug or multidrug resistance. Pyrazinamide mono-drug resistance (PZAr) was the most prevalent (17%, n = 33), followed by isoniazid mono-drug resistance (3.6%, n = 7). Rifampicin resistance was associated with mutations in the rpoB gene (D435Y, D435V, S450L, L452P). Isoniazid resistance mutations were found in the katG (S315T), inhA (C[-15] T), and ndh (R268H) genes, whereas ethambutol resistance mutations were observed in the embB gene (M306V, M306I, M306L, G406S, Q497R). Surprisingly, 94% of PZAr isolates (n = 31) showed no mutations in the pncA or rpsA genes. The presence of the R268H mutation in the ndh gene, not previously linked to PZAr, was detected in 15% of PZAr isolates (n = 5), suggesting its potential contribution to PZAr in specific cases but not as a predominant mechanism. The specific molecular mechanisms underlying PZAr in the majority of the isolates remain unknown, emphasizing the need for further research to uncover the contributing factors. These findings contribute to the understanding of drug resistance patterns and can guide future efforts in TB control and management.

Histopathological spectrum of infectious diseases in endoscopic mucosal biopsies of the gastrointestinal tract: A one-year study at a tertiary care hospital in Kerala

Histopathological spectrum of infectious diseases in endoscopic mucosal biopsies of the gastrointestinal tract: A one-year study at a tertiary care hospital in Kerala

PERINEAL PAIN AND DISCOMFORT: A STRANGE PHENOMENON FOLLOWING INTRAVENOUS DEXAMETHASONE

Objectives: The objectives of this study were to estimate the incidence of perineal discomfort, to assess the type of perineal discomfort, and to determine the time frame in which the discomfort started and persisted following IV administration of Dexamethasone in patients in the wards of a tertiary care teaching hospital. Methods: This study was a descriptive cross-sectional study among 235 inpatients of a tertiary care hospital in Kerala receiving IV Dexamethasone. Study setting was in-patient wards of Government Medical College, Manjeri, Kerala. The study duration was 6 months from the date of IEC approval. Results: Out of the 235 patients enrolled to the study, 126 (55.6%) were male and 109 (44.4%) were female. The mean age of the patients enrolled was 55.85±16.657. About 63 (26.8%) patients developed abnormal discomfort or symptoms following IV Dexamethasone injection. Patients presented the symptoms mainly over perineal area, perianal area, and lower abdomen. About 50 (79.4%) presented with symptoms in perineal area. All the 63 (100%) patients who experienced the symptoms had sudden and spontaneous onset of symptoms while administering the injection and the duration of the symptoms varied from few seconds to 5 min. There was no significant relationship between gender and dosage with appearance of symptoms. Conclusion: In clinical practice, health-care professionals should be aware of such transient symptoms of perineal irritation and pruritus followed by IV Dexamethasone. Even though the exact mechanism is not known, this should be kept in mind and proper dilution and slow administration of the dexamethasone should be done to reduce such symptoms.

Case of lead poisoning secondary to intake of herbal medicine for diabetes mellitus in a tertiary care hospital in Kerala.

Although most published cases of lead poisoning come from occupational exposures, some traditional remedies may also contain toxic amounts of lead. Here, we report the case of a 58-year-old female who presented with abdominal pain, generalized tiredness, and decreased food intake, with anemia and elevated levels of lead. The patient was found to be taking herbal capsules for diabetes prior to the presentation. This case highlights the need for increased awareness that some herbal remedies may contain potentially harmful levels of heavy metals, and people who use them are at risk of developing associated toxicities. Individuals who support traditional medicine often incorrectly believe that herbal remedies for diabetes are free from side effects, leading them to favor these treatments over contemporary medications. Herbal medications are freely available online, even without a prescription. The accessibility of herbal medicines without prescriptions, coupled with the false belief in their lack of side effects, misleads educated individuals toward quackery treatments. Misinformation spread via social media exacerbates this issue. Heavy metals are present in toxic levels in the drugs, causing complications. Lead is the most common heavy metal found in such herbal medicines. Lead poisoning leads to anemia and other systemic complications which could have been fatal if not found in time.

Pharmacological Approaches in Rheumatoid Arthritis- An In-depth Analysis of Prescribed Medications

Inflammation, pain, swelling, and stability of the joints are some of the symptoms associated with rheumatoid arthritis (RA). A variety of treatment options are available to manage symptoms and slow the progression of RA, despite the fact that there is no cure. This cross-sectional study, which was conducted in a tertiary care hospital in Kerala, India, aimed to evaluate medication prescribing practices and therapeutic strategies in RA patients. The study included 280 RA patients and data on demographics, medications prescribed, dosage, and mode of administration were collected. The findings revealed that disease-modifying anti-rheumatic drugs (DMARDs) were the cornerstone of RA treatment, with hydroxychloroquine (HCQ), methotrexate (MTX), and sulfasalazine (SAAZ) being the most frequently prescribed DMARDs. Combination DMARD therapy, particularly the triple combination of HCQ + Folitrax + SAAZ, was prevalent among patients. Furthermore, the study highlighted the use of biologic DMARDs, such as rituximab and tofacitinib, albeit at a relatively lower rate due to the outpatient population’s milder disease severity. Supplement therapy, including vitamin D3 and folic acid, was commonly prescribed to address deficiencies and mitigate the side effects of medications like MTX. The prescription patterns also encompassed analgesics, anti-anxiety, and antidepressant medications to manage pain and psychological symptoms associated with RA. Steroids were administered initially to control inflammation, with a focus on minimizing long-term usage. The study underscores the complexity of RA management and the importance of individualized treatment approaches. It highlights the evolving landscape of RA therapeutics, emphasizing the need for clinicians to stay updated on emerging evidence and guidelines. Future research should focus on evaluating the long-term efficacy, safety, and cost-effectiveness of different treatment regimens to optimize patient outcomes in RA management.

Incidence and severity of hand-foot syndrome in cancer patients receiving infusional 5-fluorouracil or oral capecitabine-containing chemotherapy regimens.

Hand-foot syndrome is a common adverse effect of 5-fluorouracil infusion or oral capecitabine. Several types of research have shown that clinical presentations of hand-foot syndrome vary by ethnicity, so we tried to look at the incidence and severity of hand-foot syndrome in individuals receiving infusional 5-fluorouracil or oral capecitabine at a tertiary care hospital in central Kerala, India. To determine the incidence and severity of hand-foot syndrome in cancer patients receiving infusional 5-fluorouracil or oral capecitabine chemotherapy regimen. A prospective cohort study was conducted at the oncology department of a tertiary care hospital in Kerala, India. Our study subjects were those who underwent chemotherapy with infusional 5-fluorouracil or oral capecitabine and later developed hand-foot syndrome. The patients who developed hand-foot syndrome after chemotherapy were assessed to determine the incidence of hand-foot syndrome. Also, the severity of hand-foot syndrome among cancer patients was estimated using CTCAE version 5.0. Out of 104 study participants, 76.90% (N = 80) of the patients had hand-foot syndrome, whereas 23.07% (N = 24) did not. The onset of hand-foot syndrome symptoms varied depending on the patient. Most patients (60%) displayed grade-one symptoms in their third cycle. The remaining patients showed grade-one symptoms in cycle one (3.75%), cycle two (17.5%), and cycle four (18.75%). The study also showed t no association between the incidence of hand-foot syndrome and the type of regimen. The majority of the patients suffered from hand-foot syndrome. As well, most of the patients were afflicted by grade one hand-foot syndrome.

Concerns of Primary Caregivers of Children with Complex Chronic Conditions in Kerala: A Qualitative Analysis.

Exploring data on primary caregiver experiences of dealing with chronically ill children (CIC) strengthens the ability of paediatricians to improve the quality of care by detecting unmet needs in paediatric palliative care and understanding their original concerns instead of presumed needs. Hence, this study aims to identify and describe the primary concerns and challenges faced by caregivers of children with complex chronic conditions in a tertiary care hospital in Kerala. Primary caregivers of 25 children aged <13 years with non-malignant life-limiting illnesses, admitted to the paediatric department of a government medical college in Kerala between 1 July 2021 and 28 February 2022, underwent in-depth interviews to analyse their most worrisome issues. Thematic analysis was the method chosen for qualitative data analysis. The main themes identified were medical issues, unmet needs, caregiver health issues, and social and financial issues. Among the medical issues, poor seizure control and infected bedsores, sleep deprivation in both patient as well as caregivers, and difficulty in maintaining the personal hygiene of patients were the major issues. Parents of almost all the CICs reported that they required diapers more than any other material or device. Maternal depression was the major caregiver health issue. The unavailability of antiepileptic drugs in peripheral health centres resulted in missing doses and undue expenses for travel to tertiary centres to obtain the same. Caregivers reported their dismay when they finally realised that they were given false hopes of a cure by different systems of medicine. The challenges faced by caregivers of children with complex chronic conditions are multifaceted. Their most problematic issues related to medical issues are the occurrence of breakthrough seizures and development of infected bedsores. The most important material hardship reported was diaper needs. Caregiver issues such as sleep deprivation and maternal depression must be identified and addressed while providing comprehensive palliative care.

Effectiveness of Lipid-lowering Therapy for the Secondary Prevention and Achievement of Therapeutic Goals in Atherosclerotic Cardiovascular Diseases in Accordance with the American College of Cardiology/American Heart Association 2018 Guidelines on the Management of Blood Cholesterol

Introduction: According to the India Report 2020, Kerala had the highest prevalence of atherosclerotic cardiovascular diseases (ASCVDs). Dyslipidemia is a modifiable risk factor that can prevent secondary events. American College of Cardiology/American Heart Association 2018 Guidelines for the management of blood cholesterol for secondary prevention of clinical ASCVD recommend high-intensity statins and moderate-intensity statin combination therapy for achieving target low-density lipoprotein-cholesterol (LDL-C). We conducted a study to evaluate the achievement of therapeutic goals in accordance with the guidelines in a tertiary care hospital in Kerala. Materials and Methods: Three hundred and twenty adult patients prescribed with high-intensity statin monotherapy (atorvastatin 40 mg, rosuvastatin 20 mg, and rosuvastatin 40 mg) or moderate-intensity statin combination therapy (atorvastatin 10 mg and fenofibrate 145 mg) for the secondary prevention of ASCVD event were included. Data were collected from the medical records and patient interviews. Achievement of the therapeutic goal of LDL-C ≤70 mg/dL in accordance with guidelines was evaluated and compared; the mean percentage change in LDL-C was at the baseline and after 3 months. Patients were counselled on lifestyle modifications and educated about hypolipidemic agents. Since we are aiming for secondary prevention, the patients were given appropriate counselling concerning their disease and medications they are on. Dietary lifestyle modifications were also taught. Results: One hundred and thirty-eight patients achieved the therapeutic goal, with atorvastatin 40 mg (89.37%) being the most prescribed drug, followed by rosuvastatin 20 mg (5.62%) while rosuvastatin 40 mg had a higher efficacy with mean LDL reduction 65.71 ± 15.93 at 3 months follow-up. Comparing the adherence scores before and after patient counseling, the P value was found to be &lt; 0.001, indicating it is significant. Conclusion: Lifestyle modifications and lipid-lowering therapy are crucial to tackle dyslipidemia. Poor achievement of therapeutic goals implies the need for adopting measures to improve adherence and health-related outcomes for patients with ASCVD.

Bacteriological Profile and Antibiogram of Urinary Tract Infections at a Tertiary Care Hospital in Kerala, India: A Retrospective Study

Introduction: Urinary Tract Infections (UTIs) are caused by microbial invasion of the urinary tract, extending from the renal cortex of the kidney to the urethral meatus. Over the past years, resistance levels to the traditional drugs used for the treatment of UTIs have been gradually increasing. Therefore, a therapy based on the individual culture report and antibiotic sensitivity test is highly encouraged. Aim: To determine the age-wise and sex-wise prevalence of UTI, as well as to determine the bacteriological profile and antimicrobial sensitivity pattern of isolated uropathogens. Materials and Methods: This retrospective record-based study was conducted in the Department of Microbiology at Travancore Medical College in Kollam, Kerala, India. Samples were collected from patients with clinically suspected UTI attending the Outpatient Department (OPD) and Inpatient Department (IPD) of Travancore Medical College, Kollam, Kerela, India over a period of six months from July 2022 to December 2022. Both male and female patients with clinically suspected UTI were included in the study. The clinical diagnostic criteria included dysuria, frequency, urgency, and fever. Data were retrieved from the culture register maintained in the Microbiology laboratory, LIS (ELLIDER), and the WHONET software system. Urine culture was performed using a semiquantative technique. A growth of &gt;105 Colony Forming Units (CFU)/mL was considered indicative of an active UTI with significant bacteriuria. Organisms were identified using Gram stain, motility testing, and biochemical reactions following standard microbiological techniques. Antimicrobial sensitivity testing was conducted using the Kirby-Bauer Disc diffusion method. The data were entered into a Microsoft Excel worksheet, and the results were analysed using simple descriptive statistics involving percentages and proportions using Statistical Package for Social Sciences (SPSS) software version 16.0. Results: Of the total 2,794 samples, 319 (11.4%) samples yielded significant bacteriuria. Among the positive samples, 204 (64%) were from females and 115 (36%) were from males. UTIs were most commonly seen in the age group of 61-80 years. Escherichia coli (E.coli), with 148 isolates (46.4%), was the predominant organism, followed by Klebsiella pneumoniae with 72 isolates (22.6%). E. coli showed the highest susceptibility to meropenem, with 137 isolates (92.6%), and imipenem, with 136 isolates (91.9%), followed by cefoperazone/sulbactam with 129 isolates (87.2%), and piperacillin/tazobactam with 128 isolates (86.5%). Klebsiella pneumoniae was most susceptible to imipenem, with 42 isolates (60%), followed by meropenem, with 29 isolates (41.4%). Most non fermenters were highly susceptible to carbapenems, cefoperazone/sulbactam, and piperacillin/tazobactam. Among the gram-positive organisms, Enterococcus spp. was the most frequently isolated, showing 100% sensitivity to vancomycin and linezolid. Conclusion: In this study, UTI was found to be more prevalent among elderly females. Gram-negative organisms were the most commonly isolated pathogens in UTI, with E. coli being the most frequent agent. Urinary pathogens exhibited resistance to commonly used antibiotics such as ampicillin, cephalosporins, quinolones, and cotrimoxazole. Based on this study, it can be concluded that the resistance to commonly used antibiotics is very high. Due to the changing trends in the sensitivity patterns of various antibiotics, it is important to understand the antibiogram of common isolates in a specific area or hospital to ensure better empirical treatment.

Prevalence of childhood trauma in patients with psychiatric disorders and its association with perceived social support and suicide attempts: A cross-sectional observational study in a tertiary hospital in South India

Background: Adverse childhood experiences include exposure of children to physical abuse, physical neglect, emotional neglect, emotional abuse, and sexual abuse. Children exposed to severe maltreatment and trauma during their early childhood are at a higher risk of early onset of psychiatric disorders. Aim: To find the prevalence of childhood adverse experiences in psychiatric patients and its association with perceived social support and suicidal attempts. Materials and Methods: A cross-sectional observational study was conducted in the psychiatry outpatient department at a tertiary care hospital in Kerala. Patients with a diagnosis of substance use disorders, psychotic disorders, mood disorders, and neurotic disorders according to ICD-10 (F10-F45) and in remission were included in the study. Institutional Ethical Committee approval and informed consent from the participants were obtained. Socio-demographic and clinical details were obtained. Childhood Trauma Questionnaire-Short Form and Multidimensional scale of Perceived Social Support were administered. Descriptive statistics and Chi-square test were employed for data analysis. Results: Eighty-five per cent of the subjects had a history of at least one type of childhood trauma. Emotional abuse was the most commonly reported type of trauma. Among patients with childhood trauma, 47.2% reported high levels of perceived social support, whereas 18.5% individuals reported a history of at least one suicide attempt. Conclusions: A significant proportion of patients with psychiatric disorders in an Indian setting have experienced childhood trauma. Childhood trauma in psychiatric disorders is associated with a higher risk of attempting suicide.

Correlation of intraoperative squash smear and histopathology in central nervous system lesions: A 6-year retrospective study in a tertiary care hospital in Kerala

Intraoperative squash smear cytology is considered to be of great value in intraoperative consultation of CNS pathology. It is a simple and reliable tool for rapid intraoperative diagnosis of CNS tumors. The study was undertaken to assess the accuracy of intraoperative squash smear in the diagnosis of CNS lesions and to correlate the squash cytology diagnosis with histopathological diagnosis taking the latter as the gold standard. A retrospective study of 38 cases of CNS lesions from which samples were collected by surgery or biopsy for intraoperative consultations and histopathological diagnosis. Radiologically confirmed cases were only included in the study. Smears were prepared from the biopsy sample obtained at the time of operation and were stained with hematoxylin and eosin. Remaining tissue submitted for histopathology was later correlated with intraoperative cytology diagnosis. Out of 38 cases, histopathological diagnosis was compatible with cytological diagnosis in 36 cases, two cases showed discrepancies. The diagnostic accuracy of squash cytology was 94.73%. Even though two cases were diagnosed differently in cytology, it was proved to be a malignant tumor both in squash cytology and histopathological diagnosis. Hence sensitivity, specificity, positive predictive value and negative predictive value in detecting the neoplastic condition on cytology was 100% respectively. Squash smear is a rapid, self-sufficient and cost effective method for the intraoperative diagnosis of CNS tumors. It can be considered as a mirror image to histopathological diagnosis and is of great value in intraoperative consultation of CNS pathology.

Prevalence of Oral Manifestations in COVID-19-Diagnosed Patients at a Tertiary Care Hospital in Kerala.

COVID-19, a pandemic since 2019, is still causing significant healthcare burden across the world. Although the disease primarily presents with respiratory symptoms, a multitude of signs and symptoms may be manifested elsewhere in the body. This study was to estimate the prevalence of oral manifestations in COVID-19 diagnosed patients and thereby understand the effects of corona virus disease on oral health. A total of 472 patients were evaluated using a questionnaire and further examined visually using a mouth mirror and a light source.The patients were evaluated for erythema, ulcers, macule, papule, vescicles, bullae or any other abnormal changes within the oral cavity. 103 patients (21%) were found to have oral lesions and 41 (39.8%) of them presented with palatal enanthem which was macular in nature. Candidiasis was noted in 19 (18.4%) patients, ulcer in 4 (3.8%), mucositis in 5 (4.8%), angular cheilitis in 3 (2.9%), white coating on tongue in 25 (24.2%) & depapillated tongue with glossitis in 6 (5.8%). Multivariate analysis was done using logistic regression.Tobacco chewing, malignancies and altered taste sensation were found to be independently associated with oral lesions. The study thus confirms the presence of oral lesions in diagnosed COVID-19 patients prompting healthcare professionals on a multidisciplinary approach towards this novel disease.

Glycemic control versus quality of life in a cohort of diabetic children from South Kerala

Background: Assessment of HRQOL (Health related quality of life) in clinical practice is important to determine the course of the disease, early recognition of problems and the type of insulin therapy that would be adequate to maintain satisfactory metabolic control with less impact on HRQOL in every patient. Methods: A cross-sectional analytical study was conducted in the tertiary care hospital in Kerala. All children’s who aged 4-18 years with type 1 diabetes mellitus (DM) attending pediatric OPD in a tertiary care hospital in Kerala were included. The study period was 18 months. PedsQL diabetes module 3.0 (pediatric quality of life inventory 3.0 diabetes module) and PedsQL generic core module 4 (pediatric quality of life inventory 4.0 generic core scale) were used as tools. Results: The study population included 30 children with type 1 DM. The average duration of diabetes was 5.60±2.990 years. Based on HbA1c level, 16 [53.3%] children had well controlled diabetes and 14 [46.7%] had poorly controlled diabetes. Eighteen [80%] patients had complications in the form diabetic ketoacidosis or hypoglycemia in the past 1 year. Diabetes specific quality of life mean scores were [child report and parent proxy report] 88.4 and 85.9 for poorly controlled diabetes group and 94.4 and 93.0 for well controlled group respectively which showed a significant difference (p value 0.004). Children with better glycemic control also showed better generic score (p value-0.004). Conclusions: Metabolic control, measured by HbA1c value, was significantly associated with QoL in patients with diabetes. Good glycemic control is associated with better quality of life and less diabetes related symptoms.

Clinical profile of newly diagnosed leprosy patients with special references to deformities and disabilities

Background: After leprosy was declared eliminated as a public health problem in India on December 2005, the focus has shifted to the prevention of disability and deformities. This indirectly measures the effectiveness of health education and awareness. Aims and Objectives: This study was conducted to assess the clinical profile and different patterns of disabilities and deformities among newly diagnosed leprosy patients. Materials and Methods: A cross-sectional study was conducted for a period of 1 year on newly diagnosed leprosy patients attending a tertiary care hospital in Kerala. 32 patients included in the study were examined and disabilities observed were graded using WHO disability grading system. The variables are mentioned as numbers and percentages. Results: 50% of the subjects had different grades of deformity/disability (6.25% had Grade 1 disability while 43.75% had Grade 2 disability). The mean duration of disease in patients with and without deformities was 44.19 and 20.5 months, respectively, which was statistically significant (P=0.025). A positive family history of Hansen’s disease was present among 5 (15.63%) patients. The different disability/deformity observed were ulcers, scars, muscle weakness, and redness of eyes. Feet were the most commonly affected site. Conclusion: Proper health education and awareness activities that will promote early recognition of symptoms and reporting are crucial to decrease deformities.

A predictive score for severity in patients with confirmed dengue fever in a tertiary care hospital in Kerala, India.

The study aimed to identify predictors of severe dengue during the 2017 epidemic and to develop and validate a simple predictive score for severity. A retrospective analytical study was conducted using clinical and laboratory data from adult dengue patients with a confirmed microbiological diagnosis. The study included patients who presented to a tertiary care centre in Kerala, India, during the febrile phase (≤4d) between June 2017 and February 2019. Using appropriate statistical tests, we derived predictors of severe disease and computed a risk score model. Of the 153 patients (mean age 50±17y; 64% males), 31 (20%) had severe dengue and 4 (3%) died. Petechial lesions, hypoalbuminemia (<3.5 g/dl), elevated alanine aminotransferase (>40IU/l) and urea >40IU/l were significant predictors. Our scoring system (cut-off: 2) showed excellent performance, with an area under the receiver operating characteristics curve of 0.9741, sensitivity of 100%, specificity of 96% and accuracy of 98%. The risk score was secondarily validated on 48 patients hospitalized from March 2019 to June 2019. Our scoring system is easy to implement and will help primary healthcare practitioners in promptly identifying severe dengue cases upon hospital presentation.

A cross-sectional study of neonatal hearing impairment: understanding its prevalence and risk factors in a tertiary care hospital in Kerala, India

Background: Congenital hearing loss is one of the most prevalent sensory impairments with severe consequences when undetected. The objective of neonatal hearing screening is to identify hearing impairments shortly after birth to initiate treatment as soon as possible and to allow affected children to enjoy normal development. The aim of the study was to determine the prevalence and identify the predisposing factors of HI among neonates in a tertiary care centre in Idukki district of Kerala using a universal neonatal hearing screening (UNHS) program, in an attempt to initiate early interventions in affected neonates. Methods: This was a cross-sectional study conducted in the department of ENT, Al Azhar Medical College and Super Specialty Hospital, Thodupuzha, Kerala over a period of 1 year involving 646 neonates. The study excluded any newborn whose parent/guardian did not give consent for the study, or neonates with microtia grade II and above. Results: The overall prevalence of HL in neonates in our study was 3.1 in 1000 live births out of which 61% were males and 39% females. The risk factors found in our study were preterm babies, maternal age &gt;35, low birth weight, teenage pregnancy, primigravida, and neonatal jaundice requiring blood transfusion. Conclusions: In a standard neonatal population, both at-risk and non-at-risk neonates warrant the immediate adoption of a universal hearing screening program for all neonates in India. Hence, we would like to stress the importance of identifying infants with HL, administering early treatment and performing appropriate screening tests in infants at the right time period.

Spectrum of neuroendocrine neoplasms of GIT – a histomorphological study in a tertiary care centre

Background. Neuroendocrine neoplasms are diverse in terms of sites of origin, functional status, and degrees of aggressiveness. Since neuroendocrine cells are ubiquitous in the human body, these neoplasms can arise in different organs, with gastrointestinal tract being most frequently involved. The past few years have seen a surge in the diagnosis of these neoplasms, which were earlier considered to be rare. Their nomenclature, classification, and diagnostic criteria are revamped frequently, as new knowledge emerges. Aim. To study the histopathological spectrum of neuroendocrine neoplasms of gastrointestinal tract and assess the immunohistochemical expression of neuroendocrine markers in them. Material and methods. Ours is a descriptive study of the distribution and pathologic characteristics of gastrointestinal neuroendocrine neoplasms in a tertiary care hospital in Kerala, over a three year period. Neoplasms were categorised based on 2019 updated WHO classification. Results. Among the 59 cases, we observed a male predominance. (Male to female ratio - 1.8:1). Most patients were in 6th and 7th decades of life. Duodenum was most frequently involved followed by rectum and appendix. NET G2 and G1 constituted the predominant histologic grades (47% and 24% respectively). NEC and MiNEN were infrequent. All cases were positive for synaptophysin, with variable positivity for chromogranin. Ki67 helped establish the histologic grade. We also came across a rare case of neuroendocrine tumor with coexisting mucinous neoplasm in appendix. Conclusions. With evolving knowledge and advanced imaging modalities, the incidence of these neoplasms is increasing with time. Histopathology is the mainstay of diagnosis and plays a decisive role in influencing management protocols and prognosis.

Psychopathology and Pattern of Remission of Cannabis-Induced Psychotic Disorder.

Objective: To analyze the psychopathology and pattern of remission in cannabis-induced psychotic disorder with treatment.Methods: This was a prospective cohort study of a group of patients admitted with new-onset psychosis, cannabis use, and no evidence of other drug abuse from January 1 to June 31, 2019, to the psychiatry inpatient department of a multispecialty tertiary care hospital in Kerala, India. Patients were evaluated at admission and after 1 week in the hospital and 1 month after discharge using the Structured Clinical Interview for the Positive and Negative Syndrome Scale and the Clinical Global Impressions-Severity of illness scale.Results: Fifty-six male subjects were recruited for the study. The mean age of the subjects was 22.2 years, and the majority were active smokers of nicotine and cannabis. Total duration of abuse and family history of substance use in first-degree relatives correlated with severity of psychosis. Hostility, excitement, and grandiosity were the predominant positive symptoms, and these symptoms showed a steady reduction toward the end of the study. The most frequent negative symptoms were emotional withdrawal, passive or apathetic social withdrawal, and difficulty in abstract thinking, and these symptoms also showed significant improvement (P < .001 for all). For symptoms such as somatic concern and guilt feelings, significant treatment response was noted only in the initial week (P < .001).Conclusions: Cannabis-induced psychosis in the Indian setting presents with predominant positive symptoms and minimal affective symptoms. The steady improvement noted with complete cessation of cannabis indicates a possible contributory role for cannabis in precipitating psychosis.

Peripherally Inserted Central Catheters-associated blood stream infections-occurrence, risk factors, and pathogens, a single center study.

Peripherally inserted central catheters (PICCs) are central venous catheters inserted peripherally but terminate in great vessels. PICCs are widely used for patients requiring long-term intravenous therapy in both in-patient and out-patient settings. This study was carried out to understand PICC-related complications, specifically infections and causal pathogens, in a tertiary care hospital in Kerala, South India. A retrospective analysis of PICC insertions and follow-up during a 9years period to look at patient demographics and infections related to PICC was carried out. The overall PICC-related complication rate is 28.1% (4.98 per 1000 PICC days). Commonest complication was thrombosis followed by infection, either PICC-associated bloodstream infection (PABSI) or local infection (LI). PABSI noted in this study was 1.34 per 1000 catheter days. The majority (85%) of PABSI were due to Gram-negative rods. The average duration of PICC days for occurrence of PABSI was 14days and the majority occurred in in-patients. Thrombosis and infection were the commonest PICC-related complications. PABSI rate was comparable to that of previous studies.

Coercion experience of patients with mental illness in a tertiary care hospital in Kerala

Coercion experience of patients with mental illness in a tertiary care hospital in Kerala