Tertiary Care Hospital In Kolkata Research Articles

Study of serum VEGF levels in patients with severe dengue infection admitted in a tertiary care hospital in Kolkata.

Dengue is the most common arboviral infection globally, but its pathogenesis is poorly explored. Vascular endothelial growth factor (VEGF) has an essential role in the host defense against viral infection. However, not much information is available regarding its status in dengue patients from the eastern zone of India. In the present investigation, the level of VEGF was investigated for its possible utility as a dengue severity marker. Accordingly, confirmed dengue cases were enrolled during 2016-2018. Serum from all the study subjects was subjected to the standard enzyme-linked immunosorbent assay test for VEGF analysis. In addition, we assessed the association of VEGF to dengue severity. The study revealed that VEGF titers (P < .0001) were significantly increased in severe dengue (SD) patients in contrast to those with a milder form of dengue. An association was obtained between VEGF and increased SGOT (r = 0.517 with P < .0001) while VEGF had a negative correlation with platelets in SD patients (r = -0.331 with P = .001). Enhanced VEGF titers along with decreased platelets had a good association with SD. The investigation revealed that high VEGF titers are novel indicators of dengue severity. However, our results must be verified in a study evaluating a larger number of dengue patients.

Carotid Intima Medial Thickness as A Surrogate Marker for Systemic Atherosclerosis in Type 2 Diabetes Mellitus

Background: The objective was to measure the correlation between carotid intima medial thickness (CIMT) with duration of type 2 diabetes mellitus (DM) and its correlation with biochemical markers and body mass index (BMI). Methods: The study was conducted in a tertiary care hospital in Kolkata. Total 100 patients were selected randomly who met the inclusion criteria. Among total patients, 20 cases were newly detected type 2 DM patients and 80 were cases of established diabetes, with different duration of DM. CIMT was measured by carotid artery ultrasonography using an echo tomography system having midfrequency of 7.5MhZ and detection limit of 0.1mm. Duration of diabetes was measured as present age minus age of detection of DM. BMI was measured by the guideline of WHO. The parameters were estimated such as microalbuminuria by radioimmunoassay, fasting blood sugar (FBS) level and HbA1C by HPLC method, uric acid by uricase method. Data was collected using a predetermined proforma and statistical analyses were done. Results: Duration of DM was positively correlated with CIMT and association was statistically significant (P<0.02). There was increase in CCA-IMT and ICA-IMT across increasing level of FBS and HbA1c (P<0.01). Microalbuminuria is considered a novel atherosclerotic risk factor, was found significantly associated with mean CIMT (P<0.001). CIMT was also significantly associated with HbA1C (P<0.001). The significantly (P<0.01) increased level of uric acid indicated higher carotid plaque. Conclusion: CIMT is an objective measure of subclinical atherosclerosis, which is a non- invasive, less expensive, duration and reproducible way of demonstrating subclinical atherosclerosis. Thus, it can serve as a window for atherosclerosis status in other major arteries like coronary artery and cerebral arteries. The CIMT is closely associated with several markers viz. uric acid, blood sugar, HbA1c, albumin and BMI during the progression of type 2 DM.

Spectrum of radiological presentations among the patients of intracranial metastasis

Background: Brain metastasis has been the most common primary intracranial space occupying lesion (ICSOL) in adult patients.The main systemic malignancies presenting with high tendency to invade brain parenchyma are –lung, breast, melanoma, renal and colon cancers etc.&#x0D; Aims and Objectives:&#x0D; &#x0D; To study the various radiological presentations in cases of intracranial metatstasis. &#x0D; To assess the radiological presentations to differentiate metastasis from other differential diagnosis.&#x0D; &#x0D; Materials and Methods: The present cross sectional study was carried out amongst 32 patients who had been visited tertiary care hospital in Kolkata with radiological features and histopathology suggestive of metastatic lesion.&#x0D; Results: The mean age of the subjects was 46.56 years and the maximum number of cases presented in 5th and 6th decades of life. CT Scan showed 75% patient had metastatic lesion appearing hyperdense on plain study and 25% had lesion hypodense on plain CT Scan. On T1 weighted images- In 75% of patient the metastatic lesions were hypointense to brain parenchyma and in 12.5% they were isointense and 12.5% they were hyperintense.T2 weighted images- In 62.5% of patient the metastatic lesions were hyperintense to brain parenchyma and in 25% patients they were isointense and in 12.5% they were hypointense. Contrast Images – 37.5% of patients had homogenous enhancement and 50% had heterogeneous enhancement and 12.5% had ring shaped enhancement. In Biopsy about 75% the metastatic lesion turned out to be metastatic carcinoma.&#x0D; Conclusion: A thorough and systematic approach to radiological investigation is crucial for proper identification of intracranial metastatic lesions.

Contraception among the mothers attending a tertiary care hospital of Kolkata

Contraception among the mothers attending a tertiary care hospital of Kolkata

Patterns of uveitis at a tertiary care hospital in Kolkata, Eastern India

Purpose: The purpose of this study is to study the pattern of uveitis at a tertiary care hospital in Eastern India. Materials and Methods: This is a prospective study of new cases of uveitis attending our tertiary care hospital in Kolkata, Eastern India, from July 1, 2016, to June 30, 2019. Data regarding patient demographic profile, clinical features, anatomical locations, and etiological diagnosis were evaluated. Results: Among 331 patients, 142 (42.9%) were male and 189 (57.1%) were female (P < 0.05). The mean age at uveitis onset was 32.4 ± 21.13 years (range: 5–61 years). Uveitis was mostly unilateral (77.64%) and nongranulomatous (85.2%). A specific etiology was identified in 187 patients (56.5%). Anterior uveitis was the most common form (183 patients; 55.29%), followed by posterior uveitis (79 patients; 23.87%), panuveitis (51 patients; 15.4%), and intermediate uveitis (18 patients; 5.44%). The most common cause of anterior uveitis was idiopathic (92 cases; 50.27%), followed by seronegative spondyloarthropathy (25 cases; 13.66%). In intermediate uveitis, a specific diagnosis was obtained in eight (44.45%) cases. Presumed tuberculosis, sarcoidosis, and seronegative spondyloarthropathy were among the specific etiological causes. In posterior uveitis, toxoplasmosis was the leading etiological cause (18 cases; 22.78%), followed by presumed tuberculosis and Behçet's disease. In panuveitis cases, a specific diagnosis was established in 33 cases (64.71%). The most common etiology was Behçet's disease (11 cases; 21.57%), followed by Vogt–Koyanagi–Harada disease and presumed tuberculosis. Conclusion: Anterior uveitis was the most common form of uveitis. A specific etiology was found in 56.5% of cases. Behçet's disease, seronegative spondyloarthropathy, presumed tuberculosis, and toxoplasmosis were the leading causes of uveitis.

Assessing Depression among Patients with Dermatological Conditions Attending Skin OPD of a Selected Tertiary Care Hospital in Kolkata

Assessing Depression among Patients with Dermatological Conditions Attending Skin OPD of a Selected Tertiary Care Hospital in Kolkata

Pattern of antimicrobial usage in neonatal septicemia at neonatal intensive care unit of a tertiary care hospital in Kolkata

Introduction: Antimicrobials are the mainstay treatment in neonatal septicemia (NS). National treatment guidelines for antimicrobial use in infectious diseases issued by the Government of India has paved the way for rationalizing antibiotic use, but it needs tailoring according to the prevalent local microbiota and individual patient's needs. A periodic surveillance of the microbial etiology and antibiotic use patterns in NS may be useful in rational selection of empirical antimicrobial therapy. Aims and Objectives: We observed the utilization pattern of antimicrobials and quantified the same in neonates admitted to neonatal intensive care unit (NICU) with septicemia along with the prospective follow-up of the clinical response to individual regimen. Materials and Methods: This hospital-based prospective observational study was conducted from January 2017 to June 2017 on 102 consecutive cases of NS admitted to NICU. Data regarding demographic parameters, antimicrobials used, and outcome were collected through a predesigned case record form. Antimicrobial usage was quantified as days of therapy (DOT) per 1000 patient days. Results: Common antimicrobials used in descending order of DOT were amikacin, colistin, and meropenem. Ampicillin, cefotaxime, and gentamicin were rarely found suitable for use based on the reported antibiograms. Piperacillin-tazobactam + amikacin regimen was the most commonly used empirical regimen. The case fatality rate was 4% in our study sample. Conclusion: Ampicillin, cefotaxime, and gentamicin had limited effectiveness in the majority of cases. Although there is a need of alignment with national treatment guidelines in NS, yet, the concurrent scope of periodic survey and research must be available for changeover to evidence-based local individualization of empirical antimicrobial therapy wherever required.

Pulmonary Arterial Hypertension in a Patient Presenting to a Tertiary Care Hospital in Kolkata : Case Report

Pulmonary Arterial Hypertension in a Patient Presenting to a Tertiary Care Hospital in Kolkata : Case Report

An epidemiological study on sociodemographic and antenatal factors associated with low birth weight in a tertiary care hospital of Kolkata, West Bengal

Background: Birth weight is a critical determinant of child survival and growth and a valuable indicator of maternal health, nutrition, and quality of life. Antenatal care (ANC) provides an array of available medical, nutritional, and educational interventions intended to reduce the incidence of low birth weight (LBW). Objective: This study was done to find out the sociodemographic and antenatal factors associated with LBW among babies delivered in a tertiary care health facility in Kolkata. Materials and Methods: It was a cross-sectional institution based observational study conducted from November 2016 to October 2018 among 410 postnatal mothers in the postnatal ward of the Department of Obstetrics and Gynaecology, Medical College, Kolkata, West Bengal. Data were obtained by interview method along with record analysis (medical and hospital records). Dependent variable was LBW (

Comparison of Digital X-Ray and USG Detected bone Erosion in Newly Diagnosed Rheumatoid arthritis Patients (less than 2 years) Attending a Tertiary Care Hospital in Kolkata

Comparison of Digital X-Ray and USG Detected bone Erosion in Newly Diagnosed Rheumatoid arthritis Patients (less than 2 years) Attending a Tertiary Care Hospital in Kolkata

Gestational Diabetes Mellitus in a Tertiary Care Hospital of Kolkata, India: Prevalence, Pathogenesis and Potential Disease Biomarkers.

Prevalence of gestational diabetes mellitus (GDM) may vary across a country like India. Risk factors and disease-pathogenesis were also not fully elucidated. This study aimed to examine prevalence of GDM among pregnant women visiting antenatal clinic of a tertiary-care hospital of Kolkata, India; possible mechanism of disease pathogenesis and potency of associated parameters as disease biomarkers were also explored. 735 pregnant women were screened for GDM according to DIPSI (Diabetes in Pregnancy Study Group India) guideline and risk-factors were analyzed. Case-control study was conducted with 114 GDM and 114 matched non-GDM control. Blood sample was collected before glucose load for complete blood count, measurement of reactive oxygen species (ROS) and assessment of DNA damage. Prevalence of GDM was found to be 17.2%(127/735). Maternal age, diabetic family history and acanthosis nigricans seemed to be important risk factors. Total ROS, lymphocyte DNA damage (measured by comet-assay) and some inflammatory hematological parameters were significantly higher in GDM compared to control. ROS, comet-tail DNA%, WBC, neutrophil-lymphocyte ratio (NLR) and mean platelet volume (MPV) were established as independent determinants of disease condition after adjustment for pre-gestational body mass index. In receiver operating characteristic analysis, ROS>155.7 arbitrary fluorescent unit, NLR>2.12 and MPV>11.05 fL showed 82.5 & 98.2%, 71.9 & 84.2% and 71.9 & 82.5% sensitivity & specificity respectively in disease prediction. Prevalence of GDM seemed to be high in Kolkata on Indian scenario. Oxidative-stress, related DNA-damage and inflammation seemed to have important contribution in pathogenesis of GDM independent of obesity. ROS, NLR and MPV with respective cut-off scores might be used as diagnostic and prognostic biomarkers for better management of the disease.

Effective treatment options in amoebic liver abscess in a tertiary care setting in West Bengal: an observational study, India

Background: Conservative management and image guided drainage have emerged as mainstay of the treatment in Amoebic Liver Abscess (ALA), with surgery used in complicated cases. The current study was conducted with an objective to demonstrate the effectiveness of the different treatment options in ALA.Methods: An observational study was conducted on 100 patients, aged 19 to 60 years, admitted with sonographic evidence of Amoebic Liver Abscess (ALA) in the General Surgery wards of a tertiary care hospital in Kolkata. Patients coming for regular follow-up after completing treatment were included. On completion of the treatment before discharge a repeat ultrasonography of the upper abdomen was done to confirm remission.Results: Majority of the patients were male, Muslim, rural resident and within 30 – 40 years age. Chief complaints were pain (100%), fever (60%) and abdominal swelling (80%). Tender hepatomegaly (80%) and icterus (36%) were present. Majority patients had the left lobe of the liver affected (72%) and abscess dimension &lt;6 cms (66.67%). Out of the participants with unruptured abscess 21.87% had multiple abscesses. Out of 64 patients subjected to conservative therapy, 44 were successfully managed. Success rate of 72.73% was observed among 44 patients receiving ultrasound guided needle aspiration. All twenty patients subjected for pigtail catheter drainage were cured. Four patients underwent laparotomy and open drainage following intraperitoneal rupture.Conclusions: Conservative treatment was observed to be sufficient in majority of cases of amoebic liver abscess of lesser size with percutaneous catheter drainage useful in large abscess. Surgical intervention was required in ruptured or complicated abscesses.

A study on microbiological profile and risk factors of breast abscess cases attending a tertiary care hospital in Kolkata

INTRODUCTION: Primary breast abscesses occur both in the puerperal and nonpuerperal settings and affect women of all ages. Breast abscesses are a common complication of the postpartum period afflicting 9%–33% of all lactating women. Incision and drainage with postoperative antibiotic drugs has been suggested as the treatment of choice but data regarding the bacteriological profile and antibiotic susceptibility is lacking. AIMS AND OBJECTIVES: To find out the risk factors, bacteriological profile along with antibiotic susceptibility pattern of breast abscess cases. MATERIALS AND METHODS: A total of 136 breast abscess cases were studied over a period of 1 year to identify the risk factors and to isolate the organisms. RESULTS: Among 136 cases 88 (64.7%) were suffering from puerperal breast abscess whereas 48 (35.3%) patients suffered from nonpuerperal breast abscess. Staphylococcus aureus was the predominant pathogen, of which 57.35% showed methicillin resistance. Young age, primiparous, difficulty in lactation came out to be the most important risk factors for development of puerperal breast abscess whereas diabetes mellitus was the predominant risk factor for nonpuerperal breast abscess. DISCUSSION: This is the first study from India in recent past to evaluate the susceptibility patterns of bacterial isolates from breast abscesses as well as risk factors for development of breast abscesses which highlights probably the emergence of community-acquired methicillin-resistant S. aureus as a predominant pathogen of breast abscess cases.

Clinical-epidemiological profile of dengue fever in children admitted in a tertiary care hospital in Kolkata, West Bengal, India

Background: Dengue infection has been known to be endemic in India for centuries. In recent years, the disease has changed its course manifesting in its severe form as Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS), with increasing frequency of outbreaks. The objective of the present study was to study the clinical and epidemiological profile of dengue fever in children admitted in a tertiary care hospital.Methods: Clinical records of children aged 0-15 years with serologically confirmed dengue infection admitted at the Institute of Child Health, Kolkata during the Dengue outbreak (June 2016 to November 2016) were reviewed.Results: Out of 958 cases of Dengue fever majority were boys 565 (59%), with M: F ratio of 1.4:1, and among them majority (40%) were in the age group of 5-10 years. Maximum number of cases were seen in the month of September 282 (29.4%). 65.6% cases had dengue fever without warning sign, while 28.6% had dengue fever with warning sign and 5.7% had severe dengue. Among the severe dengue cases 72% were less than 5 years of age while only 28% were more than 5 years of age. Out of 958 cases we had 63 (6.6%) cases of dengue with atypical manifestations. Seizure was the most common atypical manifestation. Six children expired with a Case Fatality Rate of 0.6%. Dengue shock syndrome was the leading cause of death.Conclusions: Dengue affects all age groups, but children less than 5 years are more prone for developing severe dengue. Atypical manifestations are becoming more common in dengue fever, which can delay the diagnosis so careful observation from the clinician side is required to prevent any serious morbidity or mortality.

A cross-sectional study on renal involvement among HIV-infected patients attending a tertiary care hospital in Kolkata.

The HIV-associated renal diseases represent a spectrum. Indian data on this is sparse. This study was undertaken to find out the prevalence and clinicopathological spectrum of renal involvement in HIV among antiretroviral therapy (ART) naïve patients (Group 1) and among those on ART (Group 2). Systematic random sampling was undertaken to select 109 patients each from virology outpatient department (VOPD) and ART centre of a tertiary care hospital. They were screened and further investigated if renal involvement was found. Renal involvement was present in 25/109 (22.94%) and 15/109 (13.76%) patients of Groups 1 and 2, respectively. Among patients of Groups 1 and 2, 9/24 (37.5%) and 2/13 (15.4%), respectively, had clinically significant proteinuria, but none in the nephrotic range. Statistically significant relationships of renal involvement were observed with CD4 count <100/μl and with low BMI. Of the patients of Group 2, 20% of those on a tenofovir-based regimen had renal involvement with tubular changes, while only 4.6% of those on other regimens had renal involvement. This difference was statistically significant (p<0.05; OR=5.25). Renal involvement was less common among those on ART. Low CD4 count and body mass index (BMI) were associated with renal dysfunction. Patients on a tenofovir-based regimen had more renal involvement compared with not on a tenofovir-based regimen.

Outcomes of Severe Sepsis among Adults in a Tertiary Care Hospital in Kolkata - A PreliminaryStudy

Outcomes of Severe Sepsis among Adults in a Tertiary Care Hospital in Kolkata - A PreliminaryStudy

Knowledge, attitude and practice of food hygiene among street food vendors near a tertiary care hospital in Kolkata, India

Background: Health care set ups in Indian cities are being catered by a number of street food vendors on whom the patients, visitors, doctors, medical students and staff depend. Thus, ensuring proper food hygiene among them is of uttermost importance. The purpose of the study was to determine knowledge, attitude and practice of food hygiene among them and various factors that influence it.Methods: A cross sectional study was conducted on 106 street food vendors surrounding a tertiary care hospital in Kolkata. A predesigned pretested schedule was used to collect information on socio-demographic profile, knowledge and attitude on food hygiene through interviews and practice was observed. Statistical analysis was done using Pearson’s Chi-squared test.Results: The mean age of food vendors was 37.74±10.70 years and majority were familiar with the terms “food hygiene” and “food borne illness”. The median score of attitude on food hygiene was 9.5 and significant (p&lt;0.05) association was found with age, gender and education. Less than one third of street food vendors had acceptable practice and significant (p&lt;0.05) association was found with education, marital status and type of food vendor.Conclusions: The street food vendors were aware of food hygiene and had favourable attitude towards it, but it wasn’t translated in their hygiene practice. This study can help to identify the factors that influence food hygiene practice and incorporate them in food hygiene training.

Thalidomide in Axial Spondyloarthropathy: An Eastern Indian Experience

ABSTRACT Background Axial spondyloarthropathy (SpA) is seronegative arthritis which mainly affects young adults and causes much morbidity. Tumor necrosis factor-alpha (TNF-α) is one of the main mediators of inflammation in joints and enthuses in SpA. Nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), and biologics like TNF-α inhibitors are the mainstay of therapy in SpA. However, in India, the cost is one limiting factor in the use of biologics for the treatment of SpA in eligible patients. Thalidomide is an oral TNF-α inhibitor which has reported benefit in axial SpA, and it is a cheap option in the Indian setting. However, there is almost no Indian data on its efficacy. Materials and methods This is a retrospective analysis of patients receiving thalidomide for axial SpA in the rheumatology clinic of a tertiary care hospital of Kolkata. In this clinic, thalidomide was used at 100 mg/day. Patients receiving thalidomide, who had completed at least one year follow up were included in the analysis. Assessment of SpondyloArthritis International Society (ASAS)-20, ASAS-40, and ankylosing spondylitis disease activity score with C-reactive protein (ASDAS-CRP) were measured three monthly during the follow-up. Side effect profile of thalidomide was also recorded. Results The completed data of 66 patients were analyzed. All patients were human leukocyte antigen (HLA) B27 positive. Ninety-five point percent fulfilled ASAS-20 criteria at 12 months and 71.2% fulfilled the ASAS-40 criteria at 12 months. Three patients were nonresponders. The average ASDAS-CRP score also decreased from 2.9 to 1.5 over one year. Conclusion In our study, oral thalidomide resulted in significant improvements in axial SpA. Further randomized controlled trials are needed to find the relative efficacy of thalidomide with respect to other forms of treatment.

Co-Circulation of All Dengue Serotypes among Patients Attending a Tertiary Care Hospital in Kolkata

Co-Circulation of All Dengue Serotypes among Patients Attending a Tertiary Care Hospital in Kolkata

Estrogen receptor and progesterone receptor status of breast cancer patients of eastern India: A multi-institutional study.

Context:There is a paucity of any significant data on the estrogen receptor (ER) and progesterone receptor (PR) status of breast cancer patients from the eastern part of India.Aims:This study aims to document the ER and PR status of breast cancer patients in the eastern Indian population, as catered by two premier tertiary care hospitals in Kolkata.Subjects and Methods:All breast cancer patients registered between January 1, 2013 and December 31, 2015, in the Departments of Oncology, of IPGMER and SSKM Hospitals and R. G. Kar Medical College and Hospital, Kolkata, who had at least undergone a core biopsy or surgery, were analyzed retrospectively for documentation of their ER and PR status, using the 2010 American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) interpretation guidelines.Results:Over a period of 3 years, a total of 927 patients were included for the study. A total of 825 (89%) patients had their ER and PR data available for evaluation. ER and PR positive was seen in 312 (37.82%) patients, ER and PR negative in 399 (48.36%) patients, ER positive and PR negative in 71 (8.6%) patients, and ER negative and PR positive results was found in 43 (5.21%) patients.Conclusions:This is the first multi-institutional documentation of ER and PR status from eastern India, having a modest number of patients and one of the earliest documentations using the latest ASCO/CAP interpretation guidelines. These findings resemble the data from the south and also reiterate the fact that majority of the Indian breast cancer patients are still ER and PR negative in spite of the changes in the interpretation guidelines.