Tertiary Care Institute In India Research Articles

Screening For Occult Heart Failure in Type 2 Diabetes Mellitus Using NT-proBNP: Real-World Evidence From a Tertiary Care Center in India.

Objective Heart failure (HF) is an important underrecognized complication of type 2 diabetes mellitus (T2DM). Recent literature and recommendations support screening for HF among T2DM people attending the outpatient department (OPD) in non-emergency settings using a biomarker. The present study is a retrospective cross-sectional study that assesses the prevalence of screen positivity (S+) for undiagnosed HF among T2DM people (with normal electrocardiogram (ECG) and no history of heart disease) attending the OPD at a tertiary care center in India using N-terminal pro-B-type natriuretic peptide (NT-proBNP). It also highlights the risk factors for S+ for HF. Methods This is a retrospective cross-sectional study of the practice of NT-proBNP screening in T2DM to diagnose stage B HF. A total of 1,049 consecutive people with T2DM (age range: 18-75 years) attending the OPD of a tertiary care institute in India were screened for HF using NT-proBNP (cut off S+ >125 pg/mL). Demographic variables, vitals, smoking status, family history, status of hypertension, medications for diabetes, and glycemic control were recorded and correlated with the risk of S+ for HF. Results Of the 1,049 people with T2DM, 336 (32.03%) had S+ for HF. Those with S+ had higher age (62.5+9.3 vs 54.2 +10.6 years), longer duration of T2DM (14.4 +7.8 vs 9.6 +6.1 years), positive history for smoking (94 [28%] vs 55 [7.7%]) and tobacco chewing (66 [19.6%] vs 24 [3.4%]), higher blood pressures (both systolic [152.1+19.9 vs 134.6 +15 mmHg] and diastolic [87.7+9.6 vs 83.9+7.8 mmHg]), higher glycated hemoglobin (HbA1c) (8.4+1.4 vs 7.6+1 years), higher BMI (28.3+2.8 vs 27.2+2.1 kg/m2), presence of chronic kidney disease (CKD) (210 [62.5 %] vs 118 [16.5%]), and a positive family history of cardiac ailments (185 [55.1%] vs 122 [17.1%]) (p<0.05 for all). The above factors also correlated with increased chances of S+ for HF on regression analysis. Conclusion S+ for HF is common in people with T2DM attending OPDs. The S+ was associated with increasing age, longer duration of T2DM, smoking and tobacco chewing, uncontrolled hypertension and T2DM, obesity, the presence of CKD, use of pioglitazone and insulin, and positive family history. It is the need of the hour to widely extend routine screening for HF in T2DM patients using NT-proBNP in the OPD setting so that benefits of guideline-based therapy can be extended.

Fetal Aortic Valvuloplasty—Successful First Attempt from Tertiary Care Institute in India

Fetal Aortic Valvuloplasty—Successful First Attempt from Tertiary Care Institute in India

Analysis of errors in medical certificates of cause of death (MCCD) at a tertiary care institute in 2022

AimMedical Certificates of Cause of Death (MCCD) play a pivotal role in shaping national health statistics and public health initiatives. This study investigates the quality of MCCD completion at a Tertiary Care Institute in India, focusing on certification errors made by physicians while issuing death certificates. MethodsUsing a retrospective, cross-sectional approach, 1603 MCCDs issued during the study period were analyzed for formal correctness and mistakes. The study employed predefined categories to assess the nature and impact of these errors. While this research did not verify the factual accuracy of the MCCDs against patients’ medical records, it categorized errors into major and minor, based on their potential to influence the accurate classification of the underlying cause of death.ResultsThe study showed the presence of errors in all 1603 death certificates examined, categorizing them as major, minor, or both. Notably, 99.2% of cases lacked the mention of the time interval between death and the morbid condition. Analysis of major errors indicated that in 64.6% of cases, competing causes of death were mentioned, while 77.4% featured multiple causes of death. Furthermore, improper sequencing of the cause of death was identified in 11.2%, whereas 7.9% had poorly defined conditions as the cause of death.ConclusionTo improve the quality of healthcare data and public health management, these findings highlight the necessity for precise MCCD reporting and the significance of comprehending mortality patterns. For informed decision-making and changes to the healthcare system, addressing the found errors and patterns is essential.

A Cross-Sectional Study on Patient Preferences for Selecting Surgeons for Joint Replacement Surgery in India.

Introduction This study aims to investigate the complex decision-making process of patients in India when choosing surgeons for joint replacement surgery, with a focus on both clinical and non-clinical factors influencing their preferences. Methods This was a cross-sectional observational study conducted at the KIMS-Sunshine Hospitals, Hyderabad, a high-volume tertiary care institute in India, in which patients with end-stage osteoarthritis requiring primary total knee arthroplasty were evaluated using a self-administered questionnaire, which assessed both patient-related and surgeon-related factors in choosing their joint replacement surgeon. Results A total of 210 participants were surveyed among whom the majority were females with an average age of 60.2 years with the majority belonging to the upper-middle-class socioeconomic status (48.6%, N=102). Fifty-nine percent preferred surgeons with over 20 years of experience, and 63.8% were willing to travel out-of-state for recognized expertise. Family recommendations (33.8%) and surgeon reputation (24.3%) were primary factors in surgeon selection. A vast majority (73.3%) preferred surgeons who were skilled in robotic surgery and had foreign training (32.9%). However, the majority (67.6%) did not express any gender preference.The survey highlighted a broad range of informational sources affecting decisions, including financial consideration (63.8%), personal referrals, and online platforms (17.1%). Preferences were also shaped by hospital reputation and insurance options (10.5%), illustrating a nuanced interplay of quality, cost, and personal connections in the selection process. Conclusion The findings of this survey illuminate the intricate and diverse preferences exhibited by patients when selecting a surgeon for joint replacement surgery. A significant rise in patient expectations is evident, underscoring a demand for more personalized, contemporary, and high-quality healthcare services. Importantly, geographical proximity appears to be a diminishing concern in their decision-making process. This trend presents an opportunity for centers of excellence to extend their influence and attract patients on both a regional and national level.

Optic nerve sheath diameter as a non-invasive tool to detect clinically relevant raised intracranial pressure in children: an observational analytical study

BackgroundRaised intracranial pressure (ICP) contributes to approximately 20% of the admissions in the paediatric intensive care unit (PICU) in our setting. Timely identification and treatment of raised ICP is important...

Compliance to iron and folic acid supplementation and associated factors among antenatal mothers attending OPD in a tertiary care institute in India

Compliance to iron and folic acid supplementation and associated factors among antenatal mothers attending OPD in a tertiary care institute in India

Taste Dysfunction and its Relationship to HbA1C Level and Disease Duration in Type 2 Diabetes Mellitus Patients with Autonomic Neuropathy

Background and Aim: Type 2 diabetes mellitus (T2DM) effect quality of life very much and causes variouscomplications. Diabetic autonomic neuropathy (DAN) is one of the common complications in diabetes. Thuspresent study was aimed at determining taste dysfunction in a population of T2DM subjects and its correlation with HbA1c level.Material and Methods: This was an observational cross sectional study which was carried over a period of one year in the department of medicine, Tertiary care institute of India. The 100 patients of T2DM with autonomicneuropathy and 100 healthy controls were taken for the study. Autonomic neuropathy was assessed clinically.Chemical taste test using four solutions of basic tastes (sweet, sour, salty, bitter) were done.Results: There was a significant difference between the 2 groups in terms of HbA1c (%) (p≤0.05), with the median HbA1c (%) being highest in the chemical taste dysfunction: sweet: yes group. Strength of association (Point- Biserial correlation)=0.49. There was a significant difference between the various groups in terms of distribution of chemical taste dysfunction: Sweet (p≤0.05). There was no significant difference between the groups in terms of duration of T2DM (years) (p&gt;0.05).Conclusion: The study found a significant correlation between taste dysfunction and HbA1C level and bloodsugar fasting level in type 2 diabetes mellitus patients. Alteration in taste was mainly for sweet. Sour, and bitter did not show any difference in case groups compared to controls.

Diagnostic Accuracy of Endotoxin and Endotoxin Binding Protein in Late-Onset Neonatal Sepsis.

To evaluate the diagnostic utility of endotoxin and endotoxin binding protein (EBP) for the diagnosis of late-onset neonatal sepsis (LOS) and compare it with the diagnostic utility of C-reactive protein (CRP). This diagnostic study of neonates, both term and preterm, with clinical suspicion of LOS was conducted in a tertiary care institute in India between January 2021 and March 2023. Blood samples were collected for evaluating endotoxin and EBP along with culture. Endotoxin and EBP were measured with enzyme linked immunosorbent assay, CRP was measured by nephelometry method, and the results were compared with blood culture done with BACTEC (gold standard). Out of 160 samples, 73 showed culture positivity. Endotoxin was positive in 81 samples and showed sensitivity of 84%, specificity of 78% and diagnostic accuracy of 81% (AUC 0.837, P value <0.001). EBP was positive in 82 samples and showed sensitivity of 80.8%, specificity of 73% and diagnostic accuracy of 76% (AUC 0.824, P value <0.001). CRP was positive in 105 samples and had sensitivity of 86%, specificity of 51% and diagnostic accuracy of 67% (AUC 0.827, P value <0.001). The present study showed endotoxin and EBP have higher specificity for diagnosing neonatal sepsis. As culture takes minimum 48h, endotoxin and EBP can be utilized as biomarkers for diagnosis of sepsis.

Knowledge, attitude and practice towards Ayurveda among patients attending cardiology and neurology clinics at a tertiary care institute in India.

Background Ayurveda, the Indian system of medicine, has been practised in India since ages. We evaluated the overall awareness regarding Ayurveda among patients attending two specialty clinics at a tertiary care institute. Methods We did a cross-sectional study on patients attending the cardiology and neurology clinics at a tertiary care hospital in India. We conducted this paper-based survey using a standardized, validated questionnaire. Statistical analysis was performed using STATA version 14.2. Results Three hundred and ninety-seven patients agreed to participate in the study. Their mean (SD) age was 45.65 (15.02) years. Among them 68.5% were men and 56.9% were from urban areas. Participants perceived that Ayurveda comprised herbal drugs (77.6%), metallic/herbo-mineral preparations (44.3%), Panchakarma therapy (22.2%) and personalized medicine (37.8%). Principal sources of information were TV promotional programmes (34.7%) and newspaper advertisements (13.9%). Nearly two-thirds (63%) of participants opined that Ayurveda is effective in chronic disorders. Although only 9.1% of participants reported the use of Ayurvedic medicines, 89.2% believed it would be beneficial if the All India Institute of Medical Sciences (AIIMS), New Delhi had Ayurveda services. Three-fourths (75.8%) of respondents were interested to participate in research studies integrating Ayurveda with modern medicine. Conclusion Imprecise knowledge and awareness towards Ayurveda appears to prevail in addition to the low practice among the patients surveyed. We found imprecise knowledge of Ayurvedic therapies and its low usage among patients attending specialized OPDs in a tertiary care hospital. The major source of information reported was promotional advertisements in the print and electronic media. Our survey shows a need for awareness programmes for general public at various levels.

Improving Early Initiation of Breastfeeding in Healthy Late Preterm Neonates Through Reformed Lactation Support Program: A Before and After Study

Background Early Initiation of Breastfeeding (EIBF) reduces neonatal mortality up to three times, particularly in preterm and low-birth weight infants. Existing Lactation Support Program (LSP) of the institute tackles breastfeeding-related issues to achieve EIBF as early as possible for all delivered healthy infants. LSP was reformed by introducing new policy in February 2021 to achieve EIBF &lt;1 hour in all healthy delivered neonates. Aim The aim of the study was to study the efficacy of new lactation policy of LSP on rates of EIBF and time to attain the first breastfeeding in late preterm neonates of gestational age 35+0 weeks -36+6 weeks. Method A ‘before-and-after’ design was used to study the effect of the new policy on EIBF at a tertiary care institute in India from January 2018 to March 2023. Impact was assessed by comparing baseline data in pre-policy (group A) with that of new policy (group B). Result Among 417 babies included, 336 and 81 belonged to group A and B, respectively. EIBF rates were 42% and 99% in group A and group B, respectively ( p &lt; .0001). Median time to initiate EIBF was 100 min IQR [85–117] in group A compared to 26 minutes IQR [19–37] in group B ( p &lt; .0001). Conclusion Lactation support program is an invaluable key practice for attainment of EIBF. Through simple measures, significant improvement in EIBF was possible in healthy late preterm population. This LSP can be considered as ideal model to be adapted at national level to improvise EIBF.

Concordance of breast cancer services in an urban tertiary care institute in India to EUSOMA guidelines: An audit of Indian breast cancer practices.

The provision of breast cancer care tends to vary substantially from one breast unit to another. To provide state-of-the-art patient-centered care to women diagnosed with breast cancer, adoption and adherence to structured treatment algorithms, protocols, and international guidelines are essential. In this review, we endeavor to audit breast cancer care at our tertiary cancer center against published EUSOMA guidelines. This was a retrospective study with an observational design. All patients who completed recommended treatment for breast diseases at our institute from January 1, 2018 to December 31, 2018 were included and evaluated. Data were retrieved from patient e-prescriptions and medical records. Analysis was performed using Microsoft Office 2010 to measure how our practices compared to EUSOMA quality indicators (QIs). Clinical assessments, imaging, and preoperative work-up of breast cancer patients met EUSOMA standards. Prognostic and predictive characterization of tumors was performed in all cases. Surgical management of invasive cancer and ductal carcinoma in situ (DCIS) was in accordance with the guidelines. Adherence to postoperative radiation and adjuvant endocrine therapy was adequate. More mastectomies were performed in patients with invasive cancers measuring <3 cm. Overtreatment was avoided in every other subgroup. Adjuvant and neoadjuvant chemotherapy and targeted adjuvant therapy were adequately utilized unlike neoadjuvant targeted therapy. Minimal attrition was noted in patient follow-up. This extensive audit has set a benchmark for future annual audits and helped highlight areas where improvement of service delivery is needed.

Clinicodemographic Parameters and Outcomes in Patients with Coronavirus Disease 2019 Infection during the Third Wave in India: Is it the End of the Pandemic?

Introduction: The patient data from the third wave of coronavirus disease 2019 (COVID-19) pandemic in New Delhi caused by the Omicron variant in terms of severity of disease, incidental diagnosis, outcome, and effect of vaccination are relatively lacking. We set out to investigate the demographic and clinical parameters and outcomes of patients hospitalized with COVID-19, the differences between incidentally and symptomatically diagnosed patients, and the impact of vaccination on clinical manifestations and outcomes. Methods: The study was conducted at a non-COVID-19 dedicated tertiary care institute in India. The data with regard to presentation, vaccination, and outcome were collected prospectively. Results: A total of 101 patients were analyzed for the study. The mean age was 50.63 years with 46.53% women. No patient was of pediatric age. Respiratory failure was present in 26.73%. COVID-19 pneumonia was present in only 13.86%. There were 17 deaths. Only 4 deaths were caused by COVID-19 pneumonia. 60.4% of the patients were incidentally detected and 39.6% were symptomatically diagnosed. No incidentally detected patient had respiratory failure or COVID-19 pneumonia. Out of 101 patients, 66.34% were vaccinated and 33.66% were unvaccinated. Death occurred in 8.96% of vaccinated and 32.5% of unvaccinated patients. No vaccinated patient died due to COVID-19 pneumonia compared to 11.76% of unvaccinated patients. Conclusion: The Omicron wave had more patients admitted with incidentally detected COVID-19 than symptomatic individuals. These patients required in-hospital management of coexisting illnesses rather than for COVID-19. There were more deaths with non-COVID-19 causes. Vaccination appeared to be protective against severe COVID-19. Mortality was found to be lower in vaccinated individuals.

Endoscopic Tympanoplasty as an Alternative to Microscopic Tympanoplasty: A Comparative Study on Surgical Outcomes and patient satisfaction.

Chronic otitis media treatment has evolved, with microscopic surgeries as the gold standard and endoscopic surgeries as a newer addition. This retrospective study includes 209 patients who underwent type 1 tympanoplasty, utilizing both endoscopic and microscopic techniques, between January 2019 and December 2022 at a tertiary care institute in India. The study aims to compare hearing outcomes, graft uptake, hospital stay, postoperative pain, and cosmesis between the two groups. Mean AB gap closure was 17.09 + 5.98 dB in the endoscopic group and 16.74 + 5.05 dB in the microscopic group (P = 0.687). The duration of surgery was 79.26 ± 17.37min in the Endoscopic group and 91.92 ± 15.35min in the Microscopic group. (P = < 0.00001). The Endoscopic group experienced less post-operative pain, shorter hospital stay (P = < 0.00001, P = 0.0008), and exhibited better cosmetic outcomes (P = 0.00001) compared to the microscopic group. Endoscopic tympanoplasty is a better alternative to microscopic tympanoplasty, delivering comparable hearing outcomes, shorter surgical duration, improved pain scores, and better cosmesis. The online version contains supplementary material available at 10.1007/s12070-023-04184-4.

A Retrospective Study to Evaluate the Perioperative Clinical Characteristics and Outcomes of Rhino-Orbital Cerebral Mucormycosis in COVID-19 Patients at a Tertiary Care Hospital in India.

Background and aims A descriptive analysis of patients who underwent surgical debridement for coronavirus disease 2019 (COVID-19) related mucormycosis was described, which aimed at the evaluation of perioperative clinical characteristics, perioperative complications, and outcomes. Methods We conducted a retrospective study on patients who underwent surgical intervention for mucormycosis during the COVID-19 pandemic at a tertiary care institute in India from March 1, 2021, to June 30, 2021. The medical records of 92 patients were reviewed and analyzed. Results There was a male predominance with a mean age of 50.86 years. The most common comorbidity was diabetes mellitus (DM) (98.9%). Intra-operative complications included hypotension, hyperglycemia, and hypokalemia. Most of the patients (88%) were extubated inside the operation theater, and 48% of patients had mortality. Serum ferritin levels, computed tomography severity score (CTSS), and D-dimers were significantly high in the patient who had mortality. Conclusion The perioperative mortality in patients with COVID-19 associated mucormycosis was very high. DM was the most common comorbidity followed by hypertension. Pre-operative elevated serum ferritin, D-dimer, and high CTSS were associated with higher mortality; hypokalemia, followed by hypocalcemia, was the most common perioperative and post-operative electrolyte imbalance. Thorough pre-operative optimization, multidisciplinary involvement, and perioperative care are of the utmost importance to decrease mortality and improve outcomes.

Early outcome analysis of Gastroschisis from a high-volume tertiary care institute in India: A prospective observational study

Background: Gastroschisis is one of the common congenital anterior abdominal wall defects with uncovered abdominal contents (usually intestines) protruding through it. Immediate reduction of the abdominal contents is crucial after birth because of the grave consequences of delayed management. The aim of our study was to evaluate the early outcomes of Gastroschisis at a tertiary care institute in India. Methods: This prospective observational study was undertaken over a one-year duration extending from January to December 2021 at our pediatric tertiary care teaching institute. Results: There were 30 male and 28 female patients, out of which 37 were preterm neonates. The mean birth weight was 2019±357g. Seven patients (12.07%) had major associated malformations. Fifty (86.21%) patients underwent primary skin flap closure. Staged reduction with silo was accomplished in five (8.62%) patients; three patients died during resuscitation before any therapeutic procedure could be undertaken. Among 55 (94.83%) patients with surgical procedures, only 26 (47.27%) could be salvaged with overall favorable (survival) outcomes in 44.83% of patients. Mortality was high (92.59%, 25/27) in the patients presenting with markedly edematous bowel with leathery peel. Seventeen (29.31%, 17/58) neonates died in the first 72 hours (postoperatively) due to complications of abdominal compartment syndrome, eight (13.79%) patients died due to postoperative sepsis with thrombocytopenia, and two (3.44%) had intestinal perforation. The duration of hospital stay in neonates who survived ranged from one to four weeks. Conclusion: Overall survival rates in our study were 44.83% markedly in contrast to the series published in the recent literature. The outcome of preterm (premature) patients, associated intestinal atresia, presence of edematous bowel with leathery peel, patients requiring silo due to viscero-abdominal disproportion, necrotizing enterocolitis, and associated malformations, was dismal.

Epidemiological and Time Series Analysis of Tuberculosis with Prediction during COVID-19 Pandemic using ARIMA Model: A Study from Churu District of Rajasthan.

As Tuberculosis (TB) is a major public health problem in India and to achieve the goal of TB elimination, it is important to assess the trend of TB cases and the impact of lockdowns and other restrictions imposed for control of COVID-19 in India on the National TB Elimination Programme. Hence, the present study aims to study the temporal trend of TB cases and assess the impact of lockdown on TB detection. A retrospective record-based study was conducted in a tertiary care institute of India. A time series analysis of TB cases from April 2018 to May 2020 was carried out. An Auto-Regressive Integrated Moving Averages (ARIMA) model was used to forecast TB cases during the lockdown period and the result was compared with actual cases detected. The statistical analysis was accomplished with R software. The time series analysis showed that the projected TB cases in April and May 2020 were 67 and 86, respectively, while the observed cases in these months were 35 and 76. The trend of TB cases during the study period showed no steady increase or decrease and the detection of TB has declined during the COVID-19 lockdown period. The TB cases peaked from April to June and males constitute the majority of TB cases.

Body Mass Index as a Predictor of Quality of life of Patients with Chronic Obstructive Pulmonary Disease

Background and Aim: Studies have reported that excessive weight and obesity are common in the early stages ofCOPD, and malnutrition is common in moderate and severe COPD. COPD is known to show “obesity paradox”i.e., obese and overweight COPD patients have better outcome of disease as compared to underweights. The aimof the study was to assess the BMI of COPD patients, its distribution and relationship with various factors.Material and Methods: Present study was conducted at tertiary care institute of India for the duration of oneyear. Total 400 COPD patients were selected to assess their body mass index (BMI) using Quetelet’s formula.Study subjects were selected using a systematic random sampling method. Study subjects were categorized as perWHO’s classification of BMI for Asian populations.Results: Out of a total of 400 subjects enrolled in the study, majority (49%) were obese followed by 35% overweightsand 7% underweights. Health-related quality of life of undernourished patients was most affected. A statisticallysignificant relation was seen across all the components of SGRQ.Conclusion: Present research established that, the disease related malnutrition is common in COPD patients,therefore, BMI might be a useful indicator to predict the prognosis of disease. This calls for an urgent need by ourprimary care physicians to provide simultaneous weight management interventions in COPD patients so as toimprove their nutritional status, enhance the strength of respiratory muscles and reduce the inflammation whichwill be effective in long-term management of the disease.

Predisposing Factors of Diabetic Foot Amputation among the Diabetic Patients in a Tertiary Care Hospital

Background and Aim: Diabetic patients have a 15 to 20 time’s higher risk of amputation than non-diabetic patients.In literature, many factors have been mentioned which affect diabetic foot prevalence and its treatment amongdiabetic patients. Present study was directed to recognize those factors. Identification of those factors would helpto bring down the financial burden over patients and healthcare centers.Material and Methods: Present cross-sectional study was conducted among the diabetic (diabetes type Ⅱ) patients whocame with problems relevant with diabetic foot in the surgical outpatient department of tertiary care institute of India for theduration of 6 months. Three hundred Patients were categorized into two categories based on the treatment advised to them.One category of patients was treated through amputation whereas, other category of patients was treated with antibiotics andwound dressings. A self-structured questionnaire was built to collect the required data from patients. Chi-square was appliedto identify any association.Results: From the total of 300 patients 78 (26%) were advised amputation, whereas, 22 (74%) patients weremanaged conservatively. The correlation between diabetic foot amputation and various factors which includedgender, socioeconomic status, diet modification, blood sugar monitoring, life style, therapy type, smoking(p=0.02), ischemic heart disease, peripheral neuropathy and peripheral arterial disease (p=0.001) was statisticallysignificant.Conclusion: The incidence of foot amputation was high among the patients who had male gender, lowereducational status, lower socioeconomic status, longer duration of diabetes, no diet change, no proper blood sugarmonitoring, sedentary type of life style, inadequate therapy, poor compliance with treatment, history of smoking,hypertension, ischemic heart disease, stroke, peripheral neuropathy, and peripheral arterial disease and thesefactors were correlated with incidence of diabetic foot amputation significantly except duration of diabetes.

P254 Clinical and microbiological spectrum of invasive trichosporonosis from a tertiary care institute in India

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMIntroductionTrichosporonosis has emerged as an opportunistic pathogen causing invasive infections in immunocompromised patients. Invasive trichosporonosis can involve most organs of the human body. Trichosporon species can colonize many parts of our body and hence it is important to differentiate between colonization and infection for appropriate management of the patients.ObjectiveTo understand the clinical and epidemiological features of infections caused by Trichosporon spp.MethodsAll patients with clinically significant isolation of Trichosporon spp from various samples during a period of one year from January 2019-December 2019 were included in the study.In the present retrospective study demographic data, risk factors, clinical features, microbiological data, treatment, and the outcome of patients with invasive trichosporonosis were analyzed.All the specimens were processed by standard mycological procedures. Identification and susceptibility were done by VITEK 2. The isolates were sent to NCCPF, PGIMER Chandigarh for identification by MALDI-TOF. As no clinical breakpoints for Trichosporon spp. have been established by CLSI and EUCAST, antifungal susceptibility results were interpreted as suggested by Lemes et al.ResultsThere were 14 cases of trichosporonosis during the study period. The predominant age group was 60-70 years and the male: female ratio is 6.5:1.The underlying condition of the patient at admission was accidental trauma in 4/14 (28.7%) chronic kidney disease in 2/14 (14.2%), hematological malignancy in 2/14 (14.2%), pneumonia in 1/14 (7.1%), retroviral disease in 1/14 (7.1%), acute febrile illness in 1/14 (7.1%). The risk factors for acquisition of infections with Trichosporon species in the 14 patients were administration of broad-spectrum antibiotics in 13 (92.8%), urinary catheterization in 11 (78.5%), central venous catheterization, and prolonged ICU stay in 8 (57.1%) each, previous antifungal therapy in 6 (42.8%). The other risk factors were chemotherapy, steroid usage, and neutropenia.The clinical presentations were urinary tract infections in 10/14 (71.4%) patients (9 were catheter-associated UTIs), fungemia in 2/14 (14.2%), and wound infections in 2/14 (14.2%) patients. Trichosporon asahii is the predominant species isolated in 12/14 (85.7%) patients. Other Trichosporon spp. isolated include T. inkin and T. dohaense. All the isolates were correctly identified by VITEK 2 except one which was identified as T. inkin in VITEK 2 and T. dohaense by MALDI-TOF.All the isolates were susceptible to voriconazole and amphotericin B. 9/14 (64.2%) of the isolates were susceptible to fluconazole. Trichosporon spp. is inherently resistant to echinocandins.A total of 7 patients (50%) were successfully treated with voriconazole for a period of 14 days with advice to follow up and discharged. In all, 5 patients (35.7%) died due to underlying diseases before treatment could be started.ConclusionUrinary tract infection, mostly CA-UTI was the commonest clinical presentation of Trichosporonosis in our study followed by bloodstream infection and wound infection. The commonest risk factor was prolonged broad-spectrum antibiotic therapy followed by urinary catheterization. The growth of Trichosporon spp. from various samples has to be interpreted with caution as the organism can also exist as a colonizer in different body sites. Voriconazole was effective in the treatment of trichosporonosis.

TH-235. Cervical flexion induced myelopathy: Clinical, electrophysiological, and radiologic profile of 35 patients from a tertiary care institute in India

TH-235. Cervical flexion induced myelopathy: Clinical, electrophysiological, and radiologic profile of 35 patients from a tertiary care institute in India