Tertiary Care Hospital In India Research Articles

CLINICAL PROFILE OF PATIENTS WITH MUSCULOSKELETAL TUBERCULOSIS VISITING A TERTIARY CARE CENTRE IN INDIA

Background: Musculoskeletal tuberculosis a major cause of mortality and morbidity in India and other developing countries. Musculoskeletal TB comprises around 10 to 30% of all EPTB cases. Even though skeletal tuberculosis is an important debilitating disease, the literature in statistical data regarding the socio-demographic distribution and clinical presentation of disease is very scarce. Objective: To study the socio- demographic and clinical profile of musculoskeletal tuberculosis patients reaching the Orthopaedics Department in a tertiary care hospital in India. Methodology: 186 patients with musculoskeletal tuberculosis who have completed treatment were called for a follow up and data regarding demographic, person and illness related factors affecting disease were collected and were tabulated and represented in various charts and diagrams, and analysed. Results: Almost equal sex distribution was seen. Maximum proportion (26%) of the patients were belonging to 40-49 age group, with a mean age of 49.6 years. Patients with age <40 had less incidence compared to middle aged and elderly patients. Maximum number of patients were belonging to upper lower class (102 out of 186). Spine was the commonest site involved among the 138 cases. Spinal involvement was predominant in dorso- lumbar junction followed by thoracic spine and lumbar spine. 100% patients had pain as the presenting complaint and other complaints were not consistent. Only 16% of the patients had history of pulmonary tuberculosis and history of contact with tuberculosis case was present in 25% cases. 28% cases were diabetic and other comorbidities were less frequent. 19% of the cases had multi drug resistance. Conclusion: It was seen that Musculoskeletal tuberculosis is most frequently seen in middle age with majority of spine affected cases. The study reinforces the acquaintance of tuberculosis with low socioeconomic status and to some extend the debilitating diseases. It often has an atypical presentation leading to delay in diagnosis.

Clinico-radiologic Spectrum and Outcome of Pediatric Acquired Demyelinating Disorders of Central Nervous System: A Retrospective Indian Tertiary Care Hospital Cohort.

Pediatric acquired demyelinating syndrome (ADS) constitutes a group of treatable disorders with acute neurologic dysfunction. Neuroimaging has played a significant role in diagnosis of ADS. We describe clinico-radiologic spectrum, outcomes, and comparison of the groups: acute disseminated encephalomyelitis (ADEM), neuromyelitis optica spectrum disorder (NMOSD), clinically isolated syndrome (CIS), multiple sclerosis (MS), and myelin oligodendrocyte glycoprotein antibody-associated disorders (MOGAD). Retrospective review of 70 children with ADS at a tertiary care hospital over 15 years (2008-2023) was performed. Diagnosis was assigned as per International Pediatric Multiple Sclerosis Study Group criteria 2016. Fisher's exact and chi-square tests were applied. Thirty-nine boys and 31 girls aged 8.2 ± 4.0 years with CIS (n = 27), ADEM (n = 16), NMOSD (n = 13), MS (n = 1), and MOGAD (n = 13) were included. Clinical syndromes with positive significant association included polyfocal symptoms, encephalopathy in ADEM, optic neuritis (ON) in MOGAD, brainstem, area postrema syndrome in NMOSD. MOGAD presented with atypical presentations like prolonged fever (PF; 76.9%) and aseptic meningitis (23%). Seropositivity for myelin oligodendrocyte glycoprotein immunoglobulin-G was 62% and for NMO-IgG 2.6%. Neuroimaging of MOGAD showed lesions predominantly in basal ganglia/thalami (69.2%), optic nerve (46.2%), and cerebellum (46.2%). Imaging patterns between ADEM and MOGAD were comparable except for more ON (p = 0.004), spinal cord (p = 0.01), and cerebellar lesions (p = 0.03) in MOGAD. Area postrema lesion was unique to NMOSD. All patients received immunotherapy, of whom 91.4% (n = 64) had good recovery, 8.6% (n = 6) had functional limitation on modified Rankin scale at discharge, and 12 (17.1%) relapsed. The largest group was CIS. Seropositivity of MOG was high with atypical presentations like PF and aseptic meningitis. Specific neuroimaging patterns correlated with ADS categories. Short-term outcome with immunotherapy was favorable in spite of relapses.

Abstract PO1-13-06: Androgen Receptor Isoform V7 (AR-V7): A Promising Biomarker for Prognosticating Breast Cancer Aggressiveness

Abstract Androgen Receptor (AR) is an emerging endocrine therapy target in Breast Cancer (BrCa) with up to 80% expression in clinical cases. AR-V7 is a constitutively activated splice variant of AR having a truncated ligand-binding domain (LBD). This confers ligand-independent transcriptional activity to AR-V7 and makes it susceptible to nonsteroidal antiandrogens such as Bicalutamide or Enzalutamide which target the LBD of AR. Higher levels of AR-V7 in metastatic prostate cancer leads to therapeutic resistance and enhanced metastasis. We assessed AR-full length (AR-FL) and AR-V7 expression in BrCa cell lines of different molecular subtypes. This was extended for a clinical correlation of AR-FL and AR-V7 in validated treatment naïve BrCa patients undergoing surgical intervention at a tertiary care hospital in India. Transcriptomic and proteomic analysis was performed using qRT-PCR and Western Blotting. Immunocytochemistry and immunohistochemistry were used to examine protein expression and localisation in cells and tissues. AR-FL and AR-V7 were variably expressed in cell lines which got elevated with Dihydrotestosterone (DHT) treatment. Cell lines stimulated with Bicalutamide or Enzalutamide showed significant downregulation in AR-FL expression. From a cohort of 82 clinical cases, more than 50% originated from the urban setting, post-menopausal stage, and in the age groups of 61 to 70 years. ER, PR, HER2, and AR were positive in 65%, 55%, 24%, and 67% respectively. We were able to correlate aggressive clinical traits and higher pathological grades with increased expression of AR-V7 in the AR-positive BrCa fraction. This was consistent with the cell line-based preclinical research. This study affiliates AR-V7 as an important prognostic biomarker for predicting breast cancer aggressiveness. It can serve as a screening marker of poor clinical outcomes and aid in appropriate therapeutic intervention. These outcomes, however, seek extensive prospective validation. Citation Format: Tryambak Pratap Srivastava, Joyeeta Talukdar, Rohit Kumar Verma, Subhradip Karmakar. Androgen Receptor Isoform V7 (AR-V7): A Promising Biomarker for Prognosticating Breast Cancer Aggressiveness [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-13-06.

Estimation of serum Fetuin A and GALECTIN-3 levels in gestational diabetics in a tertiary care hospital in India: A pilot study

Estimation of serum Fetuin A and GALECTIN-3 levels in gestational diabetics in a tertiary care hospital in India: A pilot study

Comparison of the Outcomes of Enhanced Recovery after Surgery and Traditional Recovery Pathway in Robotic Hysterectomy for Benign Indications: A Randomised Controlled Trial

ObjectiveThe present study aimed to evaluate the impact of implementation of the ERAS program in patients undergoing robotic hysterectomy for benign indications in comparison with conventional management DesignRandomized controlled trial SettingNorth Indian tertiary care hospital ParticipantsPatients aged 40-60 years willing to sign the informed written consent were included while cases with contraindications for neuraxial anesthesia were excluded. 130 subjects undergoing robotic hysterectomy, divided into ERAS (N=65) and conventional (non-ERAS) (N=65) groups. InterventionsComponents of the ERAS protocol included preoperative counselling, carbohydrate loading, early removal of catheter, and early ambulation. Both groups underwent optimization of medical conditions, standardized anesthesia, and venous thromboembolism prophylaxis. ResultsOutcome measures included length of hospital stay (LOHS), time to tolerance of diet, postoperative complications, readmission rates, and quality of life assessed by WHO-QOL BREF. Baseline characteristics were comparable between groups. ERAS group showed significantly lower docking time (4.82±0.73 versus 5.31±0.92 minutes), faster tolerance of diet (0.14±0.35 versus 1.14±0.35 days), and earlier resumption of ambulation (0.42±0.5 versus 1.26±0.44 days). Time for 'fit for discharge' (1.43±0.61 versus 2.97±1.1 days) and LOHS (2.85±1.09 versus 3.78±1.29 days) were significantly lower in the ERAS group. Postoperative complications and readmission rates were comparable. Quality of life scores favoured the ERAS group at postoperative day 1 and 30. ConclusionThe combination of ERAS and robotic surgery improves patient outcomes, shortens hospital stay, and enhances postoperative recovery without increasing complications. This research serves as a pioneering effort in assessing ERAS impact on robotic hysterectomy for benign indications, providing valuable insights for future multicentric studies and supporting the integration of ERAS protocols to enhance patient outcomes and quality of life.Clinical trial registration: Clinical trial registry of India: https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NjczODM=&Enc=&userName=)

Assessment of quality of life in patients with female pattern hair loss in a tertiary care hospital in India

Background: Female pattern hair loss (FPHL) is the most common cause of hair loss in women. Although it is a mild dermatological disorder, psychologists and dermatologists have observed that even clinically imperceptible hair loss is capable of damaging the quality of life (QoL) of patients due to the loss of self-image and diminished self-esteem. Methods: After obtaining consent from patients 66 females filling in inclusion criteria were selected for study. Data was collected from OPD case papers once and a fifteen-minute interview regarding the illness and symptoms was conducted as per the questionnaires (Hairdex, VAS, DLQI) to evaluate the QoL. Results: The QoL subscales results showed the younger age group (≤30 years) was more affected in all Hairdex subscales. They fared significantly poorly with higher scores than older patients (>30 years) as far as symptom score and stigmatization were concerned (p<0.05). Even DLQI scores was highest in patients less than 20 years of age. Mean dermatology life quality index (DQLI) score of younger subjects was significantly higher than older subjects (p<0.05). Conclusions: Our study showed that there is statistically significant decrease in QoL in patients with FPHL more so in younger patients. Younger patients seem to be more stigmatized, have poor functioning and emotional stability.

Primary Small Cell Carcinoma of Hypopharynx-A Case Report of a Rare Tumor from a Tertiary Care Hospital in India

Introduction. Primary hypopharynx involvement of small cell carcinoma is very rare and very few cases have been reported in the texts. Here, we report a case of primary small cell carcinoma of hypopharynx with metastases to left humerus in a female patient of north india. Case Report. A 54 year old woman presented with a 4month history of shortness of breath and neck swelling in the left side. Fibreoptic laryngoscopy and biopsy revealed small cell carcinoma of the hypopharynx. Discussion. Small cell carcinoma of the hypopharynx still does not have any clear modality of treatment due to being a rare entity. Systemic chemotherapy and radiotherapy should be preferred over other treatment modalities.

Determinants of Conception and Adverse Pregnancy Outcomes in Women with Endometriosis: A Longitudinal Study.

Endometriosis, affecting approximately 10% of reproductive-aged women globally, poses significant challenges, including chronic pelvic pain, dysmenorrhea, and infertility. In low- and middle-income countries like India, accessibility to affordable infertility care remains a concern. This multicenter prospective cohort study, conducted across six tertiary care hospitals in India from 2017 to 2022, aims to explore the natural progression of conception and pregnancy outcomes in women with endometriosis. Of the 257 participants, 19.1% conceived during the study, revealing significant geographic and income-based variations (p < 0.001, p = 0.01). Dysmenorrhea (p < 0.001) and dyspareunia (p=0.027) were correlated with conception, while no such associations were found with chronic pelvic pain or menstrual factors. Lesion type, number, and severity showed no conclusive link with conception. Natural conception occurred in 70% of cases, with an average post-surgery conception time of 282.1 days. Live birth rate was 85.7%, while complications included placenta previa (16.4%), preeclampsia (4.1%), and preterm births (4.1%). This study, one of the first in India on endometriosis-related fertility progression, emphasizes the need for comprehensive understanding and management of conception and pregnancy outcomes. Considering India's substantial endometriosis burden, the study recommends prioritizing larger multicenter investigations for a better understanding and effective strategies for infertility management.

Is the Rule of Halves Still Relevant today? A Study from a Tertiary Care Hospital in India

Introduction: Hypertension significantly increases the risk of heart disease, stroke and kidney failure. It impacts approximately one-third of adults in Southeast Asia, yet a considerable number remain unaware or lack access to adequate treatment. Introduced by Wilber and Barrow in 1972, the ‘rule of halves’ governs the prevalence of hypertension. The study aimed to re-evaluate the rule of halves and suggest measures for early detection and treatment compliance. Materials and Methods: A hospital-based study was conducted from (August, 2023 to October, 2023) involving 1518 employed individuals selected through non-probability sampling, excluding those seriously ill or absent. Data were gathered through a semi-structured questionnaire. Results: Out of all 1518 study subjects, 206 (14%) were diagnosed with hypertension. Among them, (42) 20% were aware and within this aware group, 81% received treatment. Of those receiving treatment (25), 73% received treatment adequately. Conclusion: The findings suggest that, although the proportion of diagnosed hypertension was lower, the rates of treatment and adherence amongst individuals with diagnosed hypertension were higher. There is a need to revisit the rule of halves for India.

Diagnostic Efficacy Study Comparing Tzanakis Scoring System With Alvarado Scoring System in Effective Diagnosis of Acute Appendicitis.

Objective Among the common causes of abdominal emergencies, acute appendicitis ranks at the top, particularly in the young population. While negative appendectomy is not uncommon, the risk of appendicular perforation is substantial if the diagnosis is missed or delayed. This study evaluated the diagnostic efficacy of the Tzanakis scoring system for acute appendicitis, comparing it with the Alvarado scoring system, considering the histopathological finding as the gold standard. Materials and methods This prospective observational study, conducted in the General Surgery department in a tertiary care hospital in India, included clinically diagnosed acute appendicitis cases posted for open or laparoscopic appendicectomy. Results The mean age for the 60 participants included in the study was30.97±13.44, and the median was 24.5 yrs. The sensitivity ofultrasonography (USG)in diagnosing histopathological positive acute appendicitis was 89%, and the specificity was 50%. The sensitivity, specificity, positive, and negative predictive values of the Tzanakis score were 87%, 50%, 96%, and 22%, respectively, and those of the Alvarado score were 54%, 75%, 96%, and 10%, respectively. Conclusion The receiver operator characteristic (ROC) curve for the Alvarado and Tzanakis scores showed that the area under the curve (AUC) was greater for the Tzanakis scoring system (0.670) than for the Alvarado scoring system (0.598). Differences between the AUCs were not statistically significant. Although the Tzanakis scoring system is more sensitive than the Alvarado scoring system in diagnosing acute appendicitis, studies with larger samples are needed to show the superiority of this scoring system over the Alvarado scoring system.

Study of Immature Platelet Fraction, Mean Platelet Volume and Interleukin-6 in Acute Coronary Syndrome: A Study at a Tertiary Care Hospital in India

Background: In the pathophysiology of acute coronary syndrome (ACS), platelets play a key role. The immature platelet fraction (IPF) is thought to be a possible indicator of activation of platelets and turnover processes. Younger platelets have a higher thrombotic potential and combine with collagen faster, which might compromise their ability to maintain hemostasis and lead to the development of thrombus. MPV measurements show platelet activation. IL-6 plasma levels seem to indicate the degree of latent plaque inflammation and, thus, may indicate susceptibility to plaque rupture. Aims and Objectives: To estimate the levels of IPF, MPV and IL-6 in ACS and to find out the association and correlation of IPF, MPV and IL-6 with ACS. Material and Method: Seventy patients of ACS fitting the Universal criteria of Myocardial infarction as cases and 70 healthy controls were included in the study. MPV, IPF, and IL6 were analyzed in all the cases and controls using various statistical tools. Result: MPV (fl) was the best predictor among all parameters at a cutoff point of &gt;4.2, with an AUC of 0.855 for correctly predicting STEMI. IPF came out to be a reasonably good marker for predicting STEMI, with a mean of 8.71 ± 5.39. IL-6 in NSTEMI was significantly higher than in controls ( P = .004) and was comparable with UA ( P = .09). Conclusion: The current study’s findings seem to confirm that elevated MPV and IPF are important ancillary indicators in the assessment of ACS.

Novel Staging Protocol for Management of Post Covid Mucor Mycosis

Introduction: There is an upsurge of Mucor Mycosis infection following Covid -19 pandemic. Disordered immune system due to covid19 infection coupled with indiscriminate use of steroids is believed to be responsible for this upsurge.Objectives: This study is aimed at analysing the preliminary epidemiological data of Mucormycosis patientsadmitted in a single tertiary care centre, stage them at presentation and to devise a treatment protocol according to their stage . To study the various surgical interventions, postoperative follow-up and treatment outcomes in terms of recovery rate and recurrence.Patients and Methods: This is a prospective longitudinal study, one of the largest of its kind involving around1841 patients diagnosed as Mucormycosis and admitted in a tertiary care hospital in India. A detailed case history, Diagnostic nasal endoscopy, CECT scan and MRI Scan were done. A novel staging was devised and patients were managed medically and surgically as per the stage. Debrided tissue was sent for microbiological and histopathological confirmation. Patients were followed-up and their recovery rates were analysed.Results: Among 1841 patients of mucor mycosis studied, 1288 were Rhino orbital and 78 were Rhino cerebraltype. 1229 patients under went surgical debridement according to the stage of disease, and rest were managed conservatively. Recovery rates fell from 90% to 26% from stage I to stage IV due to in volvement of CNS and Orbits. The mortality was as low as 17%. Re -do surgeries were done in only 12% of cases.Conclusion: Staging of mucor at presentation helps in planning, assessing response of treatment and prognosis.

IJCM_154A: Feasibility and Adherence of the Multimodal Oncology Rehabilitation Exercise (MORE) program amongst head and neck cancer survivors in a tertiary care hospital in India – A Cross Sectional Study

Background: Owing to the improvements in the diagnostic and treatment modalities, survivorship outcomes have improved drastically among cancer survivors across the globe. A mounting body of evidence states that exercise can significantly benefit physical and mental health during the various stages of anti-cancer treatment. A frequently used outcome measure used to determine exercise adherence rates and the causes for adherence and non-adherence is the Exercise Adherence Rating Scale (EARS). Objective: To assess the adherence of a tailored home Multimodal Oncology Rehabilitation Exercise (MORE) program amongst head and neck cancer survivors in a tertiary care hospital in India using the Exercise Adherence Rating Scale (EARS). Methodology: The EARS tool was provided to a sample of 22 head and neck cancer (HNC) survivors with stages III to IVb during the 3rd month follow-up. The home exercise program consisted of a template provided to the survivors on the day of discharge. The program consisted of tailored exercises i.e., cognitive motor strategies, a physical exercise program and relaxation strategies. Additionally, the participants were provided with an activity log to record the time, duration and any adverse events occurring during the exercise program. Results: The 6-item EARS tool was administered to the 22 HNC survivors. 45.5% of the 22 survivors regarded ‘lack of time’ as a barrier to exercising regularly. 18% of the survivors claimed to often forget exercising on a regular basis as recommended by the therapist. However, 50% of the survivors performed most or all of the exercises on a regular basis. Conclusion: Lack of time, forgetting to exercise and not fitting the exercises into regular routine can be regarded as essential barriers to adherence to the exercise regimen. The participants did not report any adverse events during the course of the exercise routine.

Unravelling Neurodevelopment: A Comprehensive Neuroimaging Exploration of Paediatric Disorders in a Tertiary Care Setting

Background: Paediatric neurodevelopmental disorders, including autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), intellectual disability (ID), and specific learning disabilities (SLD), present a growing healthcare challenge globally. This study, conducted at a tertiary care hospital in India, aims to explore the utility of neuroimaging techniques in understanding the structural and functional abnormalities associated with these disorders, considering the unique demographic and healthcare landscape of India. Methods: A multidisciplinary team collaborated in a cross-sectional observational study involving paediatric patients diagnosed with neurodevelopmental disorders. State-of-the-art magnetic resonance imaging (MRI) and functional MRI (fMRI) were employed. Participants underwent clinical assessments, and neuroimaging data were analyzed for structural and functional abnormalities. Advanced techniques such as diffusion tensor imaging (DTI) were utilized to explore microstructural changes in white matter tracts. Results: Distinct neuroimaging patterns were observed in different neurodevelopmental disorders. Structural abnormalities were prominent in ASD and ID, with nuanced variations in gray and white matter volumes. Functional connectivity abnormalities in ADHD were highlighted, emphasizing the involvement of attention and executive function networks. DTI revealed microstructural changes in white matter tracts, particularly in the prefrontal-striatal circuitry in ADHD and disruptions in interhemispheric communication in ASD. Conclusion: Our study contributes valuable insights into the neurobiological underpinnings of paediatric neurodevelopmental disorders, emphasizing the importance of neuroimaging for tailored diagnostic and therapeutic approaches.

Risk factors for diabetic retinopathy: a case-control study

Purpose To emphasize the severity of the issue, it is crucial to recognize that diabetic retinopathy (DR) is not only the biggest contributor to blindness in India, but it is also becoming increasingly prevalent with each passing day. This study offers information from a matched case-control study conducted in an Indian tertiary care hospital on several risk factors for DR. The objective of the investigation is to identify the primary diabetes mellitus (DM) risk factors and the amount by which they influence diabetes pathogenesis. Methods The outpatient and inpatient departments participated in a matched research study. Diabetics with DR were included among the patients, while diabetics without DR were included in the controls. Before performing structured interviews, a total of 252 people (126 cases and 126 controls) were recruited and matched for age (±2 years) and sex. Results The average age in the DR and non-DR categories was 63.7 9.5 years and 63.3 10.4 years, respectively. Smoke (OR=1.92, P=0.02), alcoholism (OR=2.62, P=0.03), a poor diet (OR=2.72, P=0.0008), nonadherence to dietary advice (OR=4.41, P=0.0001), other microvascular disorders (OR=3.79, P=0.0001), dyslipidaemia (OR=1.85, P=0.0), and hypertension (OR=5.91, P=0.0001). Drug abnormalities (adjusted odds ratio (AOR)=7.89, P=0.0001) and hypertension (AOR=1.16, P=0.0001) were indicated as risk factors for the development of DR in multivariate regression research. Conclusion According to our findings, DM with inconsistent anti-diabetic drug use and hypertension are more likely to acquire DR. Modifiable risk factors for DR include insulin, physical inactivity, dyslipidemia, alcoholism, and smoking. With the increasing frequency of DR educating DM about lifestyle changes that may minimize their risk of developing DR is more critical than ever.

Beliefs, barriers, and promotion practices of Indian nurses' regarding healthy eating for cancer survivors in a tertiary care hospital-A cross sectional survey.

To describe the beliefs, barriers and promotion practices of Indian nurses' regarding healthy eating (HE) behaviours amongst cancer survivors, and to gain insights into whether their educational qualifications might affect the promotion of HE. Data was gathered using a validated questionnaire, 388 of the approached 400 nurses who worked at a tertiary care hospital in India gave informed consent to participate in the study. The Mann-Whitney U test and the Chi square analysis (for continuous and categorical variables respectively) were performed to carry out sub-group comparisons based on the qualification of the nurses i.e., Bachelor of Science in Nursing (BSc) and General Nursing and Midwifery (GNM). The nurses believed that dieticians/nutritionists were primarily responsible for educating the cancer survivors regarding HE. HE was promoted by nurses' relatively equally across multiple treatment stages ("during" treatment 24.4%, "post" treatment 23.1%; and "pre" treatment 22.3%). Nurses' believed HE practices had numerous benefits, with improved health-related quality of life (HRQoL) (75.7%), and mental health (73.9%) being the most frequent responses. The most frequently cited barriers by the nurses in promoting HE were lack of time (22.2%), and lack of adequate support structure (19.9%). Sub-group comparisons generally revealed no significant difference between the BSc and GNM nurses in their perceptions regarding HE promotion to cancer survivors. Exceptions were how the GNM group had significantly greater beliefs regarding whether HE can "reduce risk of cancer occurrence" (p=0.004) and "whether or not I promote HE is entirely up to me" (p=0.002). The nurses in India believe in the promotion of HE practices among cancer survivors across various stages of cancer treatments. However, they do face a range of barriers in their attempt to promote HE. Overcoming these barriers might facilitate effective promotion of HE among cancer survivors and help improve survivorship outcomes. Indian nurses employed in the two tertiary care hospitals wish to promote HE among cancer survivors, but require further knowledge and support services for more effective promotion of HE.

Study protocol for supplementation of single high dose Vitamin D in deficient critically ill children and assessment of their short-term outcome: An open label randomized control trial

Vitamin D, traditionally linked to bone metabolism, plays pleotropic roles in cellular regulation. In critically ill children, Vitamin D deficiency is associated with adverse outcomes, motivating our open-label Randomized Control Trial. Our aim is to assess short-term outcomes in Vitamin D-deficient critically ill children following a single high oral dose. Conducted at a central Indian tertiary care hospital with a sample size of 100, participants aged 1 month to 18 years will be randomized. Group A receives standard treatment with customary cholecalciferol dosing, while Group B receives standard treatment with a single high oral/nasogastric tube dose (10,000 IU/kg to 400,000 IU) of Vitamin D. Outcomes include PICU stay duration, mechanical ventilation period, occurrences of Ventilator-Associated Pneumonia and Central Line-Associated Blood Stream Infection, instances of Acute Kidney Injury, presence of Multiorgan dysfunction, maximum Vasoactive-Inotrope Score, and mortality rates. Results and interpretation will be guided by study observations. Trial registration: CTRI/2022/10/046556.

Quality of Transition of Care in a Tertiary Care Hospital: Patients’ Perspective

Background: Persons with continuous complex care frequently require care in multiple settings. During transitions between settings, there is evidence that the quality of care is jeopardized for these patients. Objectives: The present study aims to measure the quality of transitional care at a tertiary care hospital in India using the Care Transition Measure (CTM) and to explore the association between the quality of care transition and patients’ characteristics. Materials and Methods: The CTM was administered to 314 People Living with HIV (PLHIV) in four different wards. The measure included the following sections: (a) demographic and medico-administrative characteristics of the patients age, sex, education, the number of comorbid conditions, the type of admission, length of stay (LOS), the discharge diagnosis, and hospital admissions for the same condition as for the index hospitalization in the past 3 months. (b) The CTM is composed of 15 questions administered to patients after discharge from the hospital. The measure comprises four subdimensions: critical understanding, importance of preferences, management preparation, and the existence of a written and understandable care plan. The score in the CTM ranges from 0 to 100, with lower scores indicating a lower quality of transitional care. Results: The total mean score was 42.2, with a wide range (from 0.0 to 100.0). The highest scores were attributed to the factor “Critical Understanding”, whereas lowest scores were attributed to the factor “Care plan” (52.1 vs. 20.9). The factors “Level of communication” with the medical staff, “Management Preparation”, and “Importance of preferences” had an average score of about 39.0 (38.5, 41.4, and 33.5, respectively). Patients admitted from the emergency department had significantly higher CTM scores than those admitted from the outpatient department (P=0.023). Patients with an LOS of more than 6 days had significantly higher CTM scores compared with patients with an LOS of less than 6 days (P=0.006). Patients admitted for the same diagnoses as for the index hospitalization more than three times within the previous 3 months had a significantly higher CTM score than those admitted less than three times (P=0.017). Conclusion: The quality of transitional care at study hospital is suboptimal. An adequate plan for preparing patient discharge and follow-up after discharge should be designed.

Diagnosis of Paediatric Extrapulmonary Tuberculosis by the MPT64 Antigen at a Tertiary Care Hospital.

Background Tuberculosis (TB) remains a global health concern, with India bearing a substantial burden. Paediatric TB, especially extrapulmonary TB (EPTB), presents unique diagnostic challenges due to its paucibacillary nature and the difficulty in obtaining suitable samples in children. Accurate and timely diagnosis is crucial to initiate appropriate treatment and mitigate disease spread. The MPT64 antigen test has shown promise in diagnosing TB, but its performance in paediatric EPTB remains underexplored. This study aimed to evaluate the diagnostic utility of the MPT64 antigen test in paediatric EPTB cases at a tertiary care hospital in India. Methods We conducted a prospective cross-sectional study at the Indira Gandhi Institute of Medical Sciences (IGIMS), a tertiary care hospital in India. A total of 250 paediatric participants, aged 0-18 years, with clinical suspicion of extrapulmonary tuberculosis (EPTB) were included. Diagnostic samples (e.g., tissue biopsies, pus, cerebrospinal fluid (CSF), and lymph node aspirates) were obtained, and tests including microscopy for acid-fast bacilli (AFB), mycobacterial cultures, GeneXpert MTB/RIF assay, and the TB Antigen MPT64 Rapid ICT Kit were performed. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of the MPT64 antigen test were calculated using culture and GeneXpert as reference standards. Results Among the 250 participants, 34 (13.6%) were confirmed to have EPTB. The MPT64 antigen test demonstrated a sensitivity of 70.6% and specificity of 92.1% in detecting EPTB cases. Mycobacterial cultures had the highest sensitivity (91.2%) and specificity (97.7%). GeneXpert showed a sensitivity of 70.6% and specificity of 93.9%. Overall diagnostic accuracy ranged from 88.7% for acid-fast bacteria (AFB) staining to 96.9% for mycobacterial cultures. The MPT64 antigen test had an area under the curve (AUC) of 0.814, indicating a good diagnostic accuracy. Conclusion The MPT64 antigen test demonstrates promising sensitivity and specificity for diagnosing paediatric EPTB, making it a valuable diagnostic tool, especially in resource-limited settings. However, mycobacterial cultures maintain the highest accuracy. Combining the MPT64 antigen test with other methods may enhance diagnostic capabilities.

Does organophosphorus poisoning increase the risk of staphylococcal ventilator associated pneumonia? - a retrospective study.

The aim of this study was to determine the clinical predictors of staphylococcal ventilator-associated pneumonia (VAP) and to compare the outcomes of staphylococcal VAP with non-staphylococcal VAP. A retrospective observational study was conducted among adult patients admitted to the medical intensive care unit (MICU) in a tertiary care hospital in India from January 2017 to December 2019. The patients were grouped based on their diagnosis into staphylococcal and non-staphylococcal VAP, and the baseline characteristics, clinical parameters, co-morbidities, and outcome parameters were compared. Out of 2129 MICU admissions, 456 patients with microbiologically confirmed VAP were included, of which 69 (15.1%) had staphylococcal VAP, and the remaining 387 (84.9%) had non-staphylococcal VAP. Organophosphorus (OP) poisoning was identified as an independent predictor of staphylococcal VAP (odds ratio: 2.57; 95% CI: 1.4 to 4.73). The median duration of mechanical ventilation before VAP diagnosis was less in the staphylococcal VAP group (4 vs. 5 days; p = 0.004). The staphylococcal group also showed a better in-hospital outcome. OP poisoning was an independent predictor of staphylococcal VAP. Staphylococcal VAP was diagnosed earlier in patients than non-staphylococcal VAP. Screening for nasal carriage for Staphylococcus, especially in patients with OP poisoning at the time of MICU admission, may help guide antibiotic therapy.