Tertiary Care Hospital In Northern India Research Articles

Mental health of health care workers during the hour of crisis - A study from tertiary care hospital in North India.

This cross-sectional study aimed to analyze the psychosocial, behavioral, and sleep impact of coronavirus disease-19 (COVID-19) pandemic on healthcare workers (HCWs) at a tertiary-care hospital in Northern India. An online questionnaire including three psychological scales - peritraumatic distress inventory (PDI), insomnia Severity Index (ISI), and Depression anxiety stress scale was circulated among the HCWs at a tertiary-care hospital in Northern India. Three hundred and ninety-six HCWs (Mean age standard deviation: 34.8 [8.1%] years; 181 females) responded. Place of posting was active COVID area (27.2%), reserve active COVID team (23.2%), trained reserve pool (29.5%), and non-COVID areas (19.9%). More than half of all the respondents (51%) had abnormal PDI score (>14) with a propensity to develop posttraumatic stress disorder. Furthermore, there was a significantly higher prevalence of abnormal PDI scores in those involved in active COVID care units (74%) versus non-COVID care unit (24%, P = 0.001). More than 60% of all the respondents had abnormal ISI score suggesting significant insomnia. Stress was seen in 71% of all the respondents while 82% were anxious and 77% participants had depressive symptoms. Hence, the psychological morbidity among the HCWs was high. Our study found a much higher prevalence of peritraumatic distress, insomnia, anxiety, stress, and depression among the HCWs, more so in those working in COVID areas. Factors indigenous to Indian population in terms of psychological health must be studied and addressed to reduce this psychological morbidity since the battle with COVID is long.

Does Raised Transaminases Predict Severity and Mortality in Patients with COVID 19?

BackgroundThe most dreaded pandemic grappling world now, the Coronavirus Disease 2019 (COVID-19), chiefly involves the respiratory system; nevertheless, it is a multisystem disorder. Its involvement of the hepatic system is considerable; however, still emerging are its clinical implications and the effects on morbidity and mortality.AimThe aim of this study is to report on the various aspects of its hepatic involvement by describing the alterations in tests of liver function and its significance in the disease outcome in a cohort of hospitalized COVID-19 patients at a tertiary center in northern India.MethodsThis is a retrospective cohort study conducted in a tertiary-care hospital in northern India. All confirmed hospitalized COVID-19 cases aged 15 and above from Apr to Oct 2020 with no pre-existing liver disease were included. The primary endpoint was death at 28 days. Statistical analysis included descriptive analysis, sensitivity-specificity, and univariable and multivariable regression analysis as well as survival analysis.ResultsA total of 708 patients with COVID-19 fulfilled the inclusion criteria included 561 (79.2%) males and 147 (20.8%) females. The median age was 49 (IQR = 25) years. Mild and moderate/severe disease were seen in 508 (71.8%) and 200 (28.2) patients, respectively. Serum bilirubin, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were elevated in 6.92%, 69.91%, and 80.22% of patients, respectively. In univariable logistic regression, AST [odds ratio; OR 1.008 95% CI (1.005–1.012) per 1 IU/L increase] and ALT [OR 1.005 95% CI (1.002–1.007) per 1 IU/L increase] were significantly associated with the odds of moderate to severe disease but only AST was significant after adjustment to age, sex, and comorbidity [adjusted odds ratio; aOR 1.007 95% CI (1.003–1.011) per 1 IU/L increase]. Serum albumin was negatively associated with the odds of moderate to severe disease and remained significant in the adjusted model [aOR 0.217 95%CI (0.149–0.316) per 1 g/dL increase].Ninety-six patients succumbed to illness [case fatality rate; CFR 13.6%). In adjusted Cox Proportional-Hazards Model for mortality, AST [adjusted hazard ratio; aHR 1.002 95% CI (1.000–1.003) per 1 IU/L increase] and serum albumin [aHR 0.396 95% CI (0.285–0.549) per 1 g/dL increase] showed significant association with mortality.ConclusionLiver function abnormalities are common in patients with COVID-19. In particular, AST and serum albumin levels are effective predictors of disease severity and mortality and can be used as markers of fatal disease in the management as well as prognostication of COVID-19.

Serum Interleukin-6 Levels in Children with Febrile Seizures

To compare levels of Interleukin-6 (IL-6) in children with febrile seizures and febrile controls. Study conducted in a tertiary-care hospital in Northern India from November 2013 to April 2015, enrolling 160 children (80 each with febrile seizures and febrile controls), aged 6 - 60 months. Serum IL-6 estimated by ELISA method. Iron study done as per standard technique. All the cases of febrile seizure were followed up at 1 week, 3 months and 6 months for recurrence of seizures. The mean serum IL-6 levels in children with febrile seizures was 62.0 (63.9) pg/mL and febrile controls was 86.9 (70.6) pg/mL (P=0.025). Serum IL-6 levels were significantly lower in children with febrile seizures as compared to febrile controls.

ADRB2 Polymorphism and Salbutamol Responsiveness in Northern Indian Children with Mild to Moderate Exacerbation of Asthma.

The primary objective was to determine the association between beta-2 adrenergic receptor (ADRB2) gene polymorphism (rs1042713, c.46A>G, p.Arg16Gly) and the response to inhaled salbutamol in North Indian children aged 5 to 15 years, with mild to moderate exacerbation of asthma. This cross-sectional study was done at a tertiary-care hospital in Northern India from June 2011 to May 2013. 120 children with asthma with mild to moderate exacerbation underwent spirometry at baseline and after administration of three doses of salbutamol. An increase in FEV1 =15% was considered as positive response. Blood samples from these children were analysed for ADRB2 polymorphism (p.Arg16Gly). 94 non-asthmatic adult controls were also studied to determine the prevalence of ADRB2 polymorphism. In asthmatic children, the frequency of AA, GG, AG genotypes were 24.2%, 24.2% and 51.7% compared to 20.2%, 20.2% and 59.6%, respectively in the non-asthmatic adults. Salbutamol responsiveness showed no correlation with the studied ADRB2 polymorphism (p= 0.55). A trend towards greater bronchodilator responsiveness amongst AA genotype, compared to GG genotype was observed (Median change in percent predicted FEV1 14.5% and 7.5%, respectively). No correlation was found between salbutamol responsiveness and ADRB2 genotype in Northern Indian children with asthma with mild-to moderate exacerbation.

Tuberculomas Mimicking Posterior-Circulation Stroke

Dear Editor, Posterior-circulation stroke is of grave concern to any physician versed with the mortality and morbidity associated with the condition. Various nonvascular neurological and nonneurological conditions may mimic posterior-circulation stroke. We report a 29-year-old male with no prior comorbidities who presented to the emergency room of a tertiary-care hospital in northern India with sudden-onset alteration in consciousness following severe vertigo with multiple episodes of vomiting and gait imbalance. Detailed history-taking revealed the presence of pain in the nape of the neck and low-grade fever for the previous 10 days and a history of chiropractic neck manipulation for the previous 7 days. The possibility of acute posterior-circulation stroke following vertebral artery dissection was considered, and a computed tomography (CT) scan of the head was performed on an emergency basis. The CT scan revealed a large hypodensity in the midbrain, pons, and cerebellum (Fig. 1A). However, CT angiography of the neck and the intracranial vessels did not show any evidence of vertebral artery dissection. Routine hemogram, biochemistry, and chest X-ray findings were normal. The possibility of an alternative diagnosis was considered, based specifically on the history of preceding fever and the normal CT angiography findings. Magnetic resonance imaging (MRI) of the brain revealed multiple ring enhanced lesions in the cerebellum with significant surrounding perilesional edema (Fig. 1B and C). Cerebral spinal fluid (CSF) analysis showed a total count of 250 cells/mm3, predominantly lymphocytes, with proteins 90 at mg/dL and sugar at 35 mg/dL. Cryptococcal antigen, acid fast bacilli stain, and fungal smear findings were negative in the CSF. The blood sugar level was 121 mg/dL. The possibility of multiple infratentorial tuberculomas was considered, and the patient was started on antitubercular therapy with steroids. The patient was completely asymptomatic after 6 months of treatment. Fig. 1 A: Contrast enhanced CT head showing hypodensity of pons and cerebellum. B and C: Shows multiple ring enhancing lesions in cerebellum on contrast enhanced, T1 weighted MRI brain. Posterior-circulation stroke is associated with grave mortality and morbidity statistics.1 A population-based case-control study2 found that chiropractic manipulation was positively correlated with vertebrobasilar accidents, specifically in subjects aged <45 years. There are abundant data in the Western literature that have increased public concern about the safety of chiropractic manipulation, but the situation is different in developing countries. Various nonvascular neurological and nonneurological conditions may mimic posterior-circulation stroke, including acute peripheral vestibular dysfunction, acute intracranial hemorrhage, subarachnoid hemorrhage, basilar migraine, hypoglycemia, central pontine myelinosis, postinfectious disorders, tumors, and many toxic and metabolic disturbances.3 Although chronic infectious and inflammatory disorders may also simulate this condition, a hyperacute presentation should always be addressed immediately. Tuberculosis is a imitator. In 1961, Sievers4 termed tuberculosis as the second great imitator after syphilis, based on his observations in the Indian population of southwestern United States suffering from tuberculosis. Tuberculomas of the brain account for 20–30% of lesions occupying the intracranial space in India, and multiple such lesions are present in 15–30% cases.5 Tuberculomas can affect any part of brain, but those with an infratentorial origin are rare. There are isolated cases of brainstem or cerebellar tuberculomas reported in the literature. Though uncommon, infratentorial tuberculomas can be life-threatening.6 Gadolinium-enhanced MRI of the brain is a more sensitive modality for detecting tuberculomas. A retrospective analysis after performing brain MRI in the present patient produced consistent findings. While CT can be performed in most centers, it is not the diagnostic modality of choice, specifically when considering infratentorial lesions. Though clinically hyperacute presentations always warrant consideration of a vascular event, it must be remembered that tuberculosis is a great mimic, and can present with hyperacute presentations as described in the present case.

Health Related Quality of Life in Indian Children with Cystic Fibrosis.

This study was devised to translate Cystic Fibrosis Questionnaire-Revised to Hindi and administer it to Indian children and adolescents diagnosed with cystic fibrosis. Cross-sectional study. This study was carried out in cystic fibrosis patients attending Pediatric Chest Clinic of a tertiary-care hospital in Northern India from July 2012 to December 2012. 45 children (6-13 years) and their parents, and 14 adolescents. Patients with unstable health in the past two weeks were excluded. Cystic Fibrosis Questionnaire- Revised translated in Hindi was administered. Clinical evaluation and scoring, throat swab cultures and spirometry were also done during the same visit. Health Related Quality of Life scores were the primary measures, and clinical scores, swab cultures and spirometry were secondary measures. Cronbachs alpha ranged from 0.020-0.863.The Factor analysis indicated that most test-items correlated more with competing scales than the intended scales. Convergence between self and proxy-rating was found to be dependent on the domain. The Cystic Fibrosis Questionnaire- Revised scores correlated well with clinical scores (r=0.65,P=0.011), Pseudomonas spp culture data and pulmonary function tests. There was an inverse relation between Health Related Quality of Life scores and age at diagnosis (r=-0.339, P=0.02). Hindi versions of Cystic Fibrosis Questionnaire- Revised: Child, Adolescent and Parents instruments will act as an important step towards data on Health Related Quality of Life of Indian patients with cystic fibrosis.