Tertiary Research Articles

Classification of childhood obesity using longitudinal clinical body mass index and its validation.

Persistence of childhood adiposity is known to be associated with long-term adverse cardiometabolic risks. Yet, cross-sectional body mass index (BMI) is often used to classify obesity in clinical care and research. This study aimed to develop and validate a childhood BMI classification system using real life longitudinal clinical data. This observational study used electronic health record data from a tertiary care hospital, with replication in an independent cohort. For individuals with ≥ 3 BMI measurements, the median BMI percentile and persistence in the obesity class were used for longitudinal classification. The association between longitudinal BMI class and early onset obesity, socioeconomic status (SES), and adverse cardiometabolic risk was analyzed. Height, weight, and cardiometabolic risk measures were obtained for 22,352 children from 2014-18 in the primary cohort and 24,444 children in the replication cohort. Obesity (BMI ≥ 95th percentile [BMIpct95]) was observed in 24.1% and severe obesity (BMI ≥ 120% of BMIpct95) in 10.6%. Individuals with early onset obesity (age ≤ 6 years) remained in the same or higher obesity class; those in the high-SES group had lower odds of obesity. The proportion of individuals with cardiometabolic risk increased with obesity severity (p-value 0.01 - < 0.001). The AUC for cardiometabolic risk by longitudinal BMI class was higher compared to that for cross-sectional BMI (80.0% vs. 75.8%, p < 0.001). The Longitudinal BMI classification may better reflect long-term cardiometabolic risk in children. This classification can be useful for focused intervention strategies and for profiling of individuals for genetic testing.

A PTH Value at 6 Hours Post-Surgery Predicts the Diagnosis of Transient and Permanent Hypoparathyroidism.

Parathyroid hormone (PTH) levels after thyroid surgery are generally used to detect patients at risk of developing postoperative hypoparathyroidism. However, there is still a lack of consensus about the threshold value regarding its evaluation, the definition of gland function recovery and the classification of hypoparathyroidism as permanent. PTH levels (determined 6 hours after total thyroidectomy) could be effective for early prediction of the risk of post-surgical hypocalcemia and intravenous calcium requirements during hospitalization, comparing it with the predictive capacity of serum calcium levels at 24 and 48 hours after surgery. We also aim to study the efficacy of the measurement of PTH levels for the predictive diagnosis of permanent hypoparthyroidism. Prospective cohort study between September 2021 and November 2023. A public tertiary care hospital (Jaén, Spain). We collected data on 105 patients undergoing total thyroidectomy. PTH levels were measured 6 hours postoperatively (PTH6h). Additionally, corrected calcium levels, adjusted for total protein, were measured at 24 hours (Ca24h) and 48 hours (Ca48h) post-surgery. In our study, a PTH value at 6 hours post-surgery < 10.10 pg/ml, suggests, with high sensitivity and specificity, to be a very effective measure for identifying patients who would develop either transient (AUC=0.991, 95% CI 0.978-1) and permanent hypoparathyroidism (AUC=0.961, 95% CI 0.952-0.997). Measuring PTH levels at 6 hours post-thyroidectomy is an accurate method for predicting which patients are at risk of developing transient and/or permanent hypoparathyroidism.

Factors associated with beliefs and implementation of evidence-based practice among nurses: a cross-sectional study.

Evidence-based practice (EBP) is vital for improving patient outcomes and healthcare quality. However, its integration remains limited in many settings, particularly in developing countries. This study aimed to assess EBP beliefs and implementation among nurses in India and identify associated sociodemographic factors. A cross-sectional survey was conducted at the All India Institute of Medical Sciences, New Delhi, a tertiary care hospital in Northern India, with 220 nurses completing validated scales measuring EBP beliefs and implementation. The inclusion criteria were nurses working in intensive care units or wards who met the shift requirements and volunteered to participate. Data were collected using self-administered, paper-based questionnaires. Descriptive statistics, cluster analysis, correlation analysis, analysis of variance, and multiple regression were used to analyze data. Cluster analysis revealed that 46.8% (103/220) of nurses had poor EBP beliefs, and 37.7% (83/220) demonstrated good implementation. Factors positively correlated with implementation were resource beliefs (r = 0.155, p = 0.021), EBP value beliefs (r = 0.140, p = 0.038), and difficulty/time beliefs (r = 0.158, p = 0.019). Nurses with > 5 years' experience scored significantly higher on both beliefs (56.27 ± 16.98) and implementation (51.01 ± 12.65) than less experienced nurses (p < 0.001). Multiple regression analysis identified professional experience as a significant predictor of EBP beliefs (β = 0.174, p = 0.023) and implementation (β = 0.262, p = 0.001), after adjusting for other factors. Other sociodemographic variables, including sex, marital status, education, and designation, were not significantly associated with EBP beliefs and implementation. Despite good levels of EBP implementation, nearly half of the nurses exhibited poor beliefs about EBP. Professional experience was the strongest predictor of both EBP belief and implementation. These findings highlight the importance of targeted interventions, such as structured mentorship, continuing education, and hands-on training, to support less-experienced nurses in adopting EBP. Strengthening these competencies may enhance clinical decision-making and ultimately improve patient care.

Correlation of Facial Nerve Function and Electrical Stimulation During Vestibular Schwannoma Surgery.

The aim of the present study is to identify electrophysiological parameters in facial nerve monitoring that provide the best predictive values in vestibular schwannoma surgery. Retrospective study. Tertiary care hospital. In total, 76 patients undergoing translabyrinthine vestibular schwannoma resection were included. Facial nerve monitoring was conducted with free-running electromyography and direct electrical stimulation. Direct electrical stimulation protocol was predicated on a constant-current delivery at the root exit zone before and after tumor excision; specifically, recordings were made with increasing current settings: 0.05, 0.1, and 0.3 mA. The maximum amplitude measured from either of the two muscle groups was used for further correlations. Facial nerve function was graded according to the House-Brackmann (HB) scale before and after tumor excision. Immediate postoperative facial nerve outcomes were HB I (21%), HB II (40%), HB III (18%), HB IV (9%), and HB V (12%). Long-term facial nerve outcomes were distributed as follows: 66% HB I, 21% HB II, 12% HB III, and 1% HB IV. Results show that patients with a higher amplitude ≥ 1024 μV at orbicularis oris and/or frontalis had a >90% estimated probability of an HB I-II score in the long term. In contrast, patients with a low amplitude of, for example, 128 μV at orbicularis oris had an estimated 53% probability of an HB score of III or IV in the long term. Facial nerve monitoring is an indispensable objective measure during vestibular schwannoma surgery. Higher amplitudes lead to more favorable results for patients. Amplitudes 500 and 1000 μV seem to be useful cutoff points to help guide patient expectations with respectively >84% and >90% estimated probability of an HB I-II score in the long term.

A Study to Assess Knowledge and Attitude Regarding Infant Feeding Practices Among Mothers Attending Family Clinic and OPD of Tertiary Care Hospital in South Mumbai

Background The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months of life, with the addition of complementary feeding at six months with continued breastfeeding until at least at age two1 .Infants and young children are at an increased risk of malnutrition from six months of age onwards, when breast milk alone is no longer sufficient to meet all their needs and complimentary feeding should be started2 . Abandonment of breastfeeding by mothers due to various reasons leads to improper nutritional status of the child 3 .  Methodology A descriptive approach using convenient sampling technique was used. The data was collected by structured interview tool from mothers who attended the family clinics and OPD of the hospital.  Results It was found that 88% of mothers have knowledge that the first feed of the baby is breast milk and 54.04% of them fed their babies two hourly. Only 76.10% had fulfilled the criteria of exclusive breast feeding. There is no significant relation between knowledge and demographic variables like parity and mother’s education (p value &gt;0.05).  Conclusion The study finding implies that all mothers received adequate information regarding infant feeding practices from community resources. It is recommended to place emphasis on educating the mothers on certain areas where knowledge was found to be below expectation.

Prognostic Factors Affecting Mortality Among Patients Admitted to the Intensive Care Unit with Acute Hypoxemic Respiratory Failure

Background/Objectives: Acute hypoxemic respiratory failure is a significant condition commonly seen in intensive care units (ICUs), yet specific prognostic markers related to it for mortality remain largely unstudied. This study aimed to identify parameters that influence mortality in ICU patients diagnosed with type 1 respiratory failure. Methods: A retrospective cohort study was conducted at a tertiary care hospital, including patients admitted to the ICU between March 2016 and March 2020. The study included patients with type 1 respiratory failure, while exclusion criteria were prior long-term respiratory support, type 2 respiratory failure, and early mortality (&lt;24 h). Data on demographics, comorbidities, support requirements, laboratory values, and ICU scoring systems (APACHE II, SOFA, SAPS II, NUTRIC) were collected. Binomial regression analysis was used to determine independent predictors of 30-day mortality. Results: Out of 657 patients screened, 253 met the inclusion criteria (mean age 70.6 ± 15.6 years; 65.6% male). Non-survivors (n = 131) had significantly higher CCI scores; greater vasopressor requirements; and elevated SAPS II, APACHE, SOFA, and NUTRIC scores. Laboratory findings indicated higher inflammatory markers and lower nutritional markers (albumin and prealbumin, respectively) among non-survivors. In the regression model, SAPS II (OR: 13.38, p = 0.003), the need for inotropic support (OR: 1.11, p = 0.048), NUTRIC score (OR: 2.75, p = 0.014), and serum albumin (inverse; OR: 1.52, p = 0.001) were independently associated with mortality. The model had an AUC of 0.926 and classified 83.2% of cases correctly. When combined, SAPS II and mNUTRIC had more AUC compared to either standalone scoring. Conclusions: SAPS II, vasopressor requirements, mNUTRIC score, and low serum albumin are independent predictors of 30-day mortality in patients with acute hypoxemic respiratory failure. These findings support the integration of nutritional assessment, a combination of available scoring systems and comprehensive scoring into routine ICU evaluations for this patient group.

&lt;b&gt;Impact of Uterine Artery Embolization in Symptomatic Uterine Fibroids: A Single Central Study&lt;/b&gt;

Background: Uterine fibroids are the most common benign tumors in women, significantly contributing to gynecologic morbidity worldwide. Uterine fibroid embolization (UFE) offers a minimally invasive, uterus-sparing treatment alternative but remains underutilized in developing countries, where disease burden is substantial and local outcome data are limited. Objective: To evaluate the impact of UFE on clinical symptoms and imaging outcomes in women with symptomatic fibroids treated at a tertiary care hospital in Karachi, and to explore the relationship between radiological changes and symptom improvement. Methods: This retrospective and prospective cohort study included 51 women with symptomatic uterine fibroids undergoing UFE from June to December 2024. Baseline and three-month follow-up MRI assessed uterine and dominant fibroid volumes, while symptom severity scores were collected at baseline and six months post-UFE using a validated questionnaire. Statistical analyses compared pre- and post-procedure measures and assessed correlations between volume reduction and symptom change. Results: Mean reductions were 43.7% for dominant fibroid volume, 40.1% for uterine volume, and 37.8% for symptom severity score (all p&lt;0.001). No significant correlation was observed between volume reduction and symptom score improvement (ρ = –0.08, p = 0.568 for uterine volume; ρ = –0.14, p = 0.278 for dominant fibroid volume). Conclusion: UFE achieved significant clinical and radiological improvements in this cohort, independent of baseline fibroid burden, supporting its broader adoption as a safe and effective alternative to hysterectomy.

Occurrence of BlaVIM in carbapenem resistant isolates of Klebsiella pneumoniae in a tertiary care hospital

Occurrence of BlaVIM in carbapenem resistant isolates of Klebsiella pneumoniae in a tertiary care hospital

ROLE OF 2% XYLOCAINE GEL IN MANAGING POSTOPERATIVE SORE THROAT IN GENERAL ANESTHESIA PATIENTS

Background: Postoperative sore throat (POST) is a common complication following endotracheal intubation, causing significant patient discomfort. Aim: This study evaluated the efficacy of 2% Xylocaine gel in reducing POST incidence and severity in patients undergoing general anesthesia. Material and Methods: A prospective observational study was conducted on 84 patients (42 intervention , 42 control) at a tertiary care hospital. The intervention group received topical 2% Xylocaine gel prior to intubation, while the control group received standard care without anesthetic gel. POST incidence, severity (measured on a 10-point VAS), time of onset, and duration were assessed postoperatively. The Xylocaine group demonstrated significantly lower POST incidence (16.7% vs 52.4%, p&lt;0.001) and reduced severity (mean VAS 3.1 vs 6.8, p&lt;0.001). Symptom onset was delayed (3 vs 1 hour, p=0.008) and duration shortened (6 vs 12 hours, p=0.003) in the intervention group. Patient-reported effectiveness was high (mean 8.4/10), with no adverse effects observed. Conclusion: Topical 2% Xylocaine gel effectively reduces the incidence, severity, and duration of POST, offering a safe and cost-effective strategy to improve postoperative recovery. These findings support its routine use in clinical anesthesia practice.

Comparison of colistin susceptibility testing by VITEK 2 compact automated system and broth microdilution method for gram-negative isolates in a tertiary care hospital

Comparison of colistin susceptibility testing by VITEK 2 compact automated system and broth microdilution method for gram-negative isolates in a tertiary care hospital

Role of Negative Automatic Thoughts and Gender in Predicting Self-Harm among Youth

Background: Deliberate self-harm (DSH) is a maladaptive behavior mostly found in youth. This study examines problem-solving skills (PSS), coping strategies, and cognitive distortion in youth who engage in DSH. Objectives: The study investigated the association of coping strategies, problem-solving skills, and personality with self-harm behaviors and the severity of anxiety and depression. Methods: This cross-sectional observational study was conducted in a tertiary care hospital in Eastern India. Seventy-five participants of both genders, aged 15-29 years, were selected. Socio-demographic details, PSI, coping strategies, dichotomous thinking (DTI), and personality traits were assessed using appropriate psychological tools. Anxiety and depression were measured with the Hamilton Anxiety Rating (HAM-A) and Hamilton Depression Rating (HAM-D) scales. Results: The mean age of the 75 participants was 22.7 years. Gender analysis showed minimal differences in problem-solving and coping strategies. Positive correlations emerged between problem-solving and coping skills (r=0.347, p=0.002) and problem-solving and independence (r=0.238, p=0.040). Anxiety was associated with self-control (r=0.283, p=0.014) and tough-mindedness (r=-0.565, p&lt;0.001). Conclusions: The study showed how thinking patterns, emotions, and personality traits affect self-harm in young people, highlighting the need for tailored therapies like cognitive behavior therapy and DBT.

Mortality among inpatients with systemic lupus erythematosus in a tertiary care hospital

Background Systemic lupus erythematosus (SLE) is associated with significant morbidity and mortality, particularly during hospitalisation. Differentiating between infection and disease activity is crucial but challenging. Regional variations in infection rates and disease manifestations necessitate region-specific studies. Objectives To evaluate whether infections at or during hospitalisation are associated with increased mortality among SLE patients and identify additional predictors of adverse outcomes. Methods This retrospective case-control study included SLE patients hospitalised between January 2012 and December 2021. Cases ( n = 111) were patients who expired during hospitalisation, matched 1:2 with controls ( n = 222) discharged alive, based on age (±3 years) and sex, stratified annually. SLE diagnosis was based on ACR 1997 or SLICC 2012 criteria. COVID-19 cases were excluded. Patients were categorised by admission cause as ‘Infection’, ‘Disease-associated’, or ‘Mixed’. Data on demographics, clinical features, laboratory parameters, and treatments were extracted, and multivariable logistic regression identified independent predictors of mortality. Results The hospital mortality rate was 8.9%. Infection (with or without disease activity) significantly contributed to hospital admissions among non-survivors (57%) compared to survivors (25%; p &lt; 0.001). Acinetobacter baumannii was the most frequent pathogen. Multivariable analysis showed infection at hospitalisation (OR 3.37, 95% CI 1.85–6.13), pulmonary involvement (OR 3.06, 95% CI 1.52–6.18), cardiac involvement (OR 2.13, 95% CI 1.07–4.25), and serum creatinine levels as independent predictors of mortality. Higher serum albumin was protective (OR 0.53, 95% CI 0.35–0.79). Juvenile lupus subgroup analysis ( n = 38) revealed similar infection-related mortality patterns. Conclusions Our study highlights the significant impact of infections, particularly hospital-acquired infections, on mortality among hospitalised SLE patients. Enhanced clinical vigilance, early interventions, and rigorous infection control measures are needed to improve outcomes in hospitalised SLE patients.

Comparative study on stress and burnout among senior residents in anaesthesia versus medicine working in critical care units at a tertiary care hospital

Comparative study on stress and burnout among senior residents in anaesthesia versus medicine working in critical care units at a tertiary care hospital

Molecular identification of SCCmec lineages in methicillin resistant Staphylococcus aureus from a tertiary care hospital

Molecular identification of SCCmec lineages in methicillin resistant Staphylococcus aureus from a tertiary care hospital

The Impact of Health-Related Quality of Life and Comorbidities in Chronic Kidney Disease: A Hospital-Based Cross-Sectional Study

Background: Chronic kidney disease (CKD) is a primary global health concern, often progressing silently and leading to severe complications in later stages. Methods: A hospital-based cross-sectional study was conducted over six months among 196 CKD patients (stages 3–5D) at a tertiary care hospital. Health-related quality of life (HRQoL) was assessed using the validated Malayalam version of the KDQOL-SF™ 1.3 questionnaire. Sociodemographic, clinical, and biochemical data were collected, and CKD staging was based on the CKD-EPI equation. The impact of 12 common comorbidities was analyzed using patient history, clinical evaluation, and laboratory data. Statistical analysis included ANOVA, chi-square tests, Pearson’s correlation, and logistic regression, with p &lt; 0.05 considered statistically significant. Results: Quality of life (QOL) declined notably as CKD progressed from stage 3 to stage 5, with stage 5 patients exhibiting higher creatinine, lower hemoglobin, and increased serum uric acid and urea levels. HRQoL scores, measured by KDQOL-SF 1.3, worsened across all dimensions, with stage 3 patients having higher SF-36 scores than those in stages 4 and 5. Comorbidities such as hypertension, diabetes, hyperlipidemia, and heart issues were prevalent and significantly impacted CKD progression. Regression analysis highlighted that age above 55, proteinuria, hyperuricemia, unhealthy BMI, and lower GFR were linked to having multiple comorbidities in CKD patients, accelerating progression to stage 5 and increasing treatment burdens. Conclusion: Chronic kidney disease (CKD) significantly impairs health-related quality of life, with the impact intensifying in advanced stages and in the presence of multiple comorbidities. Keywords: chronic kidney disease, diabetes, hypertension, quality of life

Arabic translation and psychometric testing of the prenatal eating behaviors screening tool

Abstract Background Early detection and treatment of eating behavioral problems among pregnant women are essential due to the associated adverse impact on pregnancy and the health of the offspring. Prenatal Eating Behaviors Screening (PEBS) tool, a 12-item self-administered questionnaire, can be used to screen for eating disorders (ED) during pregnancy. This study performed an Arabic translation of PEBS and a psychometric analysis to determine its validity and reliability. Methods The standard forward-backward translation method was used to generate PEBS-Arabic. The 12-item Likert scale questionnaire was completed by 116 antenatal women in the tertiary maternity care hospital in Qatar. Content validity was determined by the content validity index (CVI) using input from five experts. Reliability was assessed using Cronbach’s alpha, and confirmatory and exploratory factor analysis (CFA &amp; EFA) to test construct validity. The correlations between PEBS-Arabic scores and maternal characteristics were explored. Results The mean total PEBS score in the cohort was 16.3 (± 5.2), with nulliparity and higher educational level resulting in statistically significantly higher mean scores. The PEBS-Arabic had a very good item-CVI and scale-CVI of 1.00. The overall Cronbach’s alpha was 0.77, which demonstrated good and acceptable reliability. The CFA using a single-factor solution showed an acceptable correlation for most items. In the EFA, a two-factor solution resulted in most items loading accurately into the pre-determined factors (bulimia and anorexia) with acceptable correlations. Conclusion The PEBS-Arabic is the first translated version of this pregnancy-specific screening tool for ED. This tool demonstrates good reliability, content and construct validity. This study is a valuable step towards understanding and detecting the prevalence and determinants of ED in pregnancy, with the aim of improving maternal, fetal and child health.

Incidence of ventilator associated pneumonia and effectiveness of ventilator bundle care in adult intensive care unit of a tertiary care hospital

Incidence of ventilator associated pneumonia and effectiveness of ventilator bundle care in adult intensive care unit of a tertiary care hospital

Evaluating the predictive value of screening and confirmatory tests for asymptomatic bacteriuria in pregnant women attending a tertiary care hospital in Mehsana, North Gujarat

Evaluating the predictive value of screening and confirmatory tests for asymptomatic bacteriuria in pregnant women attending a tertiary care hospital in Mehsana, North Gujarat

Changing trends in candidemia: A four-year prospective study at a rural tertiary care hospital

Changing trends in candidemia: A four-year prospective study at a rural tertiary care hospital

Attitude of interns toward mental illness and psychiatry: A study from tertiary care hospital

ABSTRACT Background: The rising prevalence of psychiatric disorders in India, as high as 14.9 per 1000, is juxtaposed with a significant shortage of psychiatrists, with only 0.75 psychiatrists per 1 lakh population against the recommended 3 per 1 lakh, this mental health gap is further exacerbated by negative attitudes and stigma toward psychiatry among medical professionals. Limited exposure to psychiatry in undergraduate medical education, coupled with misconceptions, contributes to this gap. This study assesses the attitudes of medical interns toward psychiatry and mental illness before and after their postings in a tertiary care hospital. Aim: To assess the attitudes of medical interns toward psychiatry and determine if exposure to psychiatry postings improves these attitudes. Study Setting and Design: This cross-sectional and comparative study was conducted at a tertiary care hospital in Hyderabad for a period of 4 months. Materials and Methods: Institutional Ethics Committee approval was obtained before conducting this study. The study included 100 medical interns attending a 2-week psychiatry posting as the part of their compulsory rotatory internship. Participants completed an intake pro forma, attitude toward psychiatry (ATP) 30 scale, and Modified Kuppuswamy Scale on the 1st day of posting. ATP 30 scale was administered on the first and last days of posting. Results: The mean ATP score increased from 109.47 ± 10.5145 before the posting to 115.12 ± 12.5081 after the posting, indicating a significant improvement in attitudes (P &lt; 0.05). Improvements were observed across all the domains. Interns with personal or familial experiences of psychiatric illness had higher ATP scores, although not statistically significant. Conclusions: A structured 2-week psychiatry posting significantly improves medical interns’ attitudes toward psychiatry. The study underscores the importance of psychiatric education in reducing stigma and fostering a positive outlook toward psychiatry among future medical professionals.