Tertiary Care Research Articles

ENDOSCOPIC THIRD VENTRICULOSTOMY VS VENTRICULOPERITONEAL SHUNT IN OBSTRUCTIVE HYDROCEPHALUS IN TERMS OF POST-OPERATIVE COMPLICATIONS

: Obstructive Hydrocephalus is a condition characterized by increased cerebrospinal fluid (CSF) volume within the brain's ventricular system, leading to clinical deterioration and disability. Without treatment, it can be fatal. Two primary treatment modalities are Ventriculoperitoneal Shunting (VPS) and Endoscopic Third Ventriculostomy (ETV), with ongoing debate over the superiority of one approach over the other. Objective: To compare the complications associated with Ventriculoperitoneal Shunting (VPS) and Endoscopic Third Ventriculostomy (ETV) in patients with obstructive hydrocephalus. Methods: A randomized controlled trial was conducted at a tertiary care hospital from April 15, 2024, to September 15, 2024. A total of 100 patients diagnosed with obstructive hydrocephalus were randomly allocated into two groups: 50 patients received VPS treatment, and 50 received ETV. Complications, including surgical site infection, seizures, hematoma, and CSF leakage, were recorded and analyzed. Results: Complications were observed in 36% (n=18) of patients in the VPS group compared to 16% (n=8) in the ETV group, with a statistically significant difference (p=0.023). Surgical site infections occurred in 8% (n=4) of VPS patients, while no infections were reported in the ETV group. Seizures were significantly more common in the VPS group, affecting 26% (n=13) compared to 8% (n=4) in the ETV group (p=0.017). Hematoma formation was observed in 4% (n=2) of VPS patients and 6% (n=3) of ETV patients. CSF leakage occurred in 4% (n=2) of VPS patients and 2% (n=1) of ETV patients. Conclusion: Endoscopic Third Ventriculostomy (ETV) demonstrated a significantly lower complication rate compared to Ventriculoperitoneal Shunting (VPS) in the management of obstructive hydrocephalus. These findings support ETV as a safer alternative with fewer associated complications.

Use of fibrin sealant in vein anastomosis in renal transplantation and its effect in preventing blood loss and postoperative peri-graft collection.

This study is to assess efficacy of fibrin sealant in vein anastomosis in renal transplantation in preventing blood loss and postoperative peri-graft collection. This is a retrospective analytical case-control study of renal transplantations done in a tertiary care center in India in a 1-year period. Fibrin sealant was randomly used in vein anastomosis during the period. All the data were extracted and retrospectively analyzed. Those with fibrin sealant use were the study group and without sealant use were the control group. Primary objective was to assess effectiveness of fibrin sealant in preventing blood loss and postoperative peri-graft collection. Secondary objectives were to evaluate patients' demographic profile, hospital stay and other intraoperative and postoperative characteristics. During the study, 163 patients were enrolled, 82 study group and 81 control group. Warm ischemia, cold ischemia and operative times of study group were 2.57 ± 2.03, 44.23 ± 8.89 and 189.6 ± 51.6min, respectively, and that of control group were 2.67 ± 2.07, 42.37 ± 8.5 and 178.8 ± 54.6min, respectively. The mean intraoperative blood loss in study and control groups was 124.83 ± 110.89 and 155 ± 50.27ml, respectively, and the difference was statistically significant (p .027). The mean peri-graft collection in study group and control group were 72.33 ± 29.18ml and 134.67 ± 102.84ml, respectively, but the difference was not statistically significant (p .086). The study also demonstrated that the duration of hospital stays significantly differed between two groups (p < .043). In this study, fibrin sealant has demonstrated both safety and efficacy in effectively managing bleeding, sealing vascular anastomoses, and mitigating peri-graft collection.

Sensitivity and Predictive Value of the Frozen Section of Sentinel Lymph Node Biopsy in the Post-neoadjuvant Setting: Experience From a Tertiary Care Hospital in a Resource-Limited Country

Sensitivity and Predictive Value of the Frozen Section of Sentinel Lymph Node Biopsy in the Post-neoadjuvant Setting: Experience From a Tertiary Care Hospital in a Resource-Limited Country

Prevalence of Anemia in Patients With Rheumatoid Arthritis Presenting at Multi-organization Tertiary Care Hospitals

Prevalence of Anemia in Patients With Rheumatoid Arthritis Presenting at Multi-organization Tertiary Care Hospitals

Neuropsychiatric Disorders and Burn Trauma: Insights From a Tertiary Care Hospital

Neuropsychiatric Disorders and Burn Trauma: Insights From a Tertiary Care Hospital

Quantifying Health Utility of Age-related Vocal Atrophy.

Age-related vocal atrophy (ARVA) negatively impacts voice and quality of life (QOL). This study aims to determine utility-based QOL in ARVA patients, correlate findings with traditional patient-reported outcome measures (PROMs), and generate utility-based inferences. Forty ARVA patients were prospectively recruited from a tertiary care center. Health utility was measured using standard gamble, time trade-off, and visual analog scale, assessing participants' current health states relative to defined comparison states (blindness/death). Traditional PROMs (Voice Handicap Index-10 [VHI-10] and Voice-Related Quality of Life Scale [V-RQOL]) were also collected. Descriptive and paired statistics were performed to determine health utility, and Pearson correlation assessed the association between PROMs and health utilities. Mean health utility in ARVA was 0.84 ± 0.22, 0.88 ± 0.17, and 0.62 ± 0.25 using standard gamble, time trade-off, and visual analog scale, respectively. There were positive correlations between V-RQOL and time trade-off (r = 0.66; p < 0.0001) as well as with standard gamble (r = 0.47; p = 0.002). Participants with ARVA reported no difference in health utility impact between their voice impairment and monocular blindness (Mean dif 10.9; 95% CI -1.6, 23.5; p = 0.101). Patients with ARVA were willing to part with an average 4.6 ± 6.1 years of life to restore normal voice. ARVA patients view their voice impairment as a significant health decrement, comparable to monocular blindness. These findings underscore the substantial impact of ARVA on QOL and highlight the need for continued research and new therapies. 4 Laryngoscope, 2024.

Evaluating the Effectiveness of Ahmed Glaucoma Valve Implantation in Reducing Intraocular Pressure in Refractory Glaucoma in the Saudi Arabian Population at a Tertiary Care Centre

Objectives: To assess the efficacy of Ahmed glaucoma valve implantation (AGVI) in lowering intraocular pressure (IOP) in patients with refractory glaucoma. Methods: In this retrospective study, we analyzed the medical records of 60 patients who received AGVI for refractory glaucoma. Data collected included demographics, type of glaucoma, preoperative and postoperative IOP, number of glaucoma medications, and any surgical complications. Success was defined as achieving an IOP &lt;21 mmHg at the final follow-up visit. Results: At the final follow-up (mean duration of 11.6 months), AGVI achieved successful IOP control (IOP of &lt;21 mmHg) in 40 eyes (66.7%). The mean number of glaucoma medications decreased significantly from 2.95 preoperatively to 1.98 postoperatively (p &lt; 0.001). Neovascular glaucoma (NVG) had a lower success rate compared to other types of glaucoma. Prior glaucoma surgery was associated with a higher risk of failing to reach target IOP, although this trend was not statistically significant (p = 0.108). Conclusion: AGVI implantation effectively lowered IOP in patients with refractory glaucoma, especially in the short term. However, long-term success rates were lower, and NVG showed less favorable outcomes. AGVI is a valuable option for managing refractory glaucoma, but careful patient selection is essential. Further research is needed to evaluate long-term efficacy and refine treatment strategies.

Oral Health Status among Postmenopausal Women Attending Tertiary Hospital of Bharatpur, Nepal

Introduction: Menopause is a biological process occurring in middle aged women causing changes in the level of circulating hormones. Changes in the oral flora, oral mucosa and decrease in bone mineral density leads to many menopauses related oral findings. Objective: This study was conducted with the objective to assess the oral health status of postmenopausal women visiting tertiary health care centre in Bharatpur, Chitwan. Methods: Analytical cross-sectional study was conducted among 224 postmenopausal women attending dental OPD in a tertiary health care centre. Comprehensive oral examination was done where CPITN index was used to record periodontal health and DMFT index was used to record caries experience of the patient. Data entry was done in Microsoft Excel and statistical analysis was done using SPSS version 20. Results: Total 224 patients were examined with age range of 45 to 78 years and the mean age of 56.71 years. 113 study participants comprising 50.4%, showed supra or subgingival calculus followed by gingival bleeding in 54 (24.1%). Mean decayed score among study participants was found to be 2.71±2.85, mean missing score was found to be 4.29±7.83. Conclusion: Mean score for missing teeth suggestive of sequel of dental caries and periodontitis was found higher among the post-menopausal women followed by mean decayed score. Dental caries score was high probably due to dryness of mouth and other predisposing factors.

Prevalence of food-related misbeliefs among postoperative patients at a tertiary care health center: a pilot survey and future directions

Background: Effective postoperative recovery is significantly influenced by nutrition, yet pervasive food-related misbeliefs can impede this process. This is particularly prevalent in regions with high rates of medical misinformation and cultural dietary restrictions. Methods: A survey was conducted with 917 postoperative patients at a tertiary care center in India from July 2019 to December 2019. A structured questionnaire was used to identify prevalent dietary misconceptions and their potential impact on wound healing. Results: The survey revealed that 18.9% of patients harboured detrimental food-related misbeliefs, with the majority avoiding high-protein foods such as meat and dairy due to unfounded fears of adverse effects on wound healing. Conclusions: The findings highlight a critical need for targeted educational interventions to correct these misbeliefs and promote nutritional practices that support recovery. Given the scope of this issue, further research is recommended to explore the broader implications of dietary misconceptions on post-surgical outcomes across different regions and cultures.

Prevalence of Pregnancy-Induced Hypertension in Teenage Pregnancies at a Tertiary Care Hospital

The aim of this study was the evaluation of the prevalence of pregnancy-induced hypertension among teenage pregnancies in a tertiary care setup. This descriptive case series was conducted at the Gynaecology &amp; Obstetrics Department from December 2023 to June 2024. A total of 163 pregnant women in the age range of 10-19 years with a gestation age of more than 20 weeks were enrolled in the study. PIH was diagnosed if blood pressure was ≥140/90 mmHg on at least two occasions. The participants were followed at different stages of pregnancy. Data analysis was done using SPSS-17 and Chi-square tests, where a p-value ≤0.05 was considered significant. PIH was present in 14.7% of cases. No significant association was noted between maternal age, gravidity, parity, and gestational age with PIH. Younger maternal age is the other important risk factor for PIH.

Exploring factors associated with domestic violence among pregnant women in Pakistan and its implications for maternal and perinatal health

ABSTRACT Domestic violence during pregnancy is a critical health issue due to its significant implications for both maternal and fetal well-being. Women in South Asian countries are particularly at a higher risk of experiencing domestic violence. The objective of this study was to identify factors associated with domestic violence among pregnant women attending tertiary care antenatal services in Pakistan. The secondary aim was to evaluate the impact of domestic violence on maternal and perinatal outcomes. The study participants were 681 pregnant women registered for antenatal care and delivery at a tertiary care hospital in Islamabad, Pakistan. Data were collected through in-person surveys and medical chart reviews. Associations between domestic violence and study variables were examined by logistic regression analysis. Among the study participants, 31.4%experienced some form of domestic violence during pregnancy, with psychological abuse (16.4%) being the most prevalent followed by sexual abuse (9.5%) and physical violence (1.8%). Women whose husbands were unemployed were three times more likely to experience domestic violence (aOR; 3.3, 95%CI: 1.6, 7.0). Similarly, husband’s substance abuse was significantly associated with domestic violence during pregnancy (aOR: 120.8, 95%CI: 57.9, 252.2). Domestic violence was a significant predictor of adverse maternal outcomes, including anemia, preterm labor, and recurrent abdominal pain. Similarly, domestic violence was a significant predictor of NICU admission (aOR: 20.6, 95%CI: 12.6, 33.8) and low birthweight (aOR: 24.4, 95%CI: 10.2, 58.4). The study findings emphasize the urgent need for comprehensive interventions targeting domestic violence among women and preventing its cascading effects on pregnancies.

Scleral buckling in retinal detachment due to retinal dialysis - A vitreoretina fellow's perspective.

To analyze the efficacy of scleral buckling in the hands of vitreo-retina (VR) fellows under training in eyes with retinal detachment associated with retinal dialysis and analyze the patient and retinal characteristics in these eyes. We carried out a retrospective consecutive case review at a tertiary eye care center in North India. Records of all the patients who had undergone scleral buckling (SB) for retinal dialysis-associated rhegmatogenous retinal detachment by VR fellows (with less than 2 years' experience) between January 2017 and January 2020 were reviewed. Fifty-three eyes of 53 patients with a mean age of 20.77 years were analyzed. Of the patients, 73.58% were males. History of eye trauma was present in 71.69% patients. A total of 21 residents operated these 53 eyes. SB was able to achieve retinal attachment in a single surgery in 84.9% (45/53) eyes. Mean preoperative best corrected visual acuity was 1.9 ± 1.05 log of minimum angle of resolution (logMAR), which improved postoperatively to 1.07 ± 0.72 logMAR (P < 0.001). Surgical success rate was 85.71% (24/28) in eyes with no proliferative vitreoretinopathy (PVR), 66.66% (2/3) in eyes with PVR-A, 91.66% (11/12) in eyes with PVR-B, and 80% (8/10) in eyes with PVR-C1. Fifty-two eyes had a single dialysis and one eye had two separate dialysis. Six eyes had giant retinal dialysis (dialysis greater than 3 clock hours) and all were due to trauma. Five patients had retinal dialysis in the fellow eye and were diagnosed with bilateral idiopathic retinal dialysis. Scleral buckling is a safe and effective management for retinal dialysis retinal detachment even in the hands of VR fellows under training.

Point-of-care procalcitonin trends in suspected neonatal late-onset infection: a prospective observational study.

Procalcitonin-guided antimicrobial decision-making has been shown to be safe in adult intensive care settings. Most antimicrobial exposure in neonatal units is in culture-negative conditions. We hypothesise that Procalcitonin aids antimicrobial stewardship efforts in suspected Late-Onset Neonatal Sepsis. Neonates were enrolled if they were aged over 72 h and were placed on antibiotics for a suspected infection. Procalcitonin levels were taken at set timepoints for the duration of antimicrobial exposure. Three subgroups were created: non-infectious episodes, blood culture-negative infectious episodes, and bloodstream infections. Eighty-five suspected infectious episodes were recruited across two tertiary neonatal and paediatric intensive care units. There was a significant difference between the median PCT in bloodstream infections (BSI) compared to non-infectious episodes (2.13 versus 0.26 µg/L, p < 0.001). A cut-off of 0.5 µg/L had sensitivity 92.9% and specificity 68% for bloodstream infections at 24 h. The difference between median PCT values at 24 h was significant (0.27 vs 7.08; p < 0.001) for feed intolerance vs. NEC Grade IIIa-IIIb subgroups. Procalcitonin levels taken 24 h following evaluation for late-onset neonatal infection are useful in out ruling BSI or severe Necrotising Enterocolitis. Up to 30% of antimicrobial exposure could be avoided with the use of Procalcitonin levels in low-risk neonates. This study demonstrates the utility of serial Procalcitonin measurements in antimicrobial stewardship efforts in the Neonatal Unit. Procalcitonin can be used to aid in antimicrobial decision making in suspected Late-Onset neonatal infection. Procalcitonin testing at twenty-four hours in episodes of Gastrointestinal deterioration can out rule Bells Grade III Necrotising Enterocolitis.

Association Between the Use of Proton Pump Inhibitors and Severe Clinical Outcomes in COVID-19 Patients: A Retrospective Observational Study.

Background Proton pump inhibitors (PPIs) increase the risk of pneumonia secondary to PPI-induced hypochlorhydria. We aim to investigate the association between PPI and disease severity in coronavirus disease 2019 (COVID-19)-positive patients and the risk of hospitalizations in Muscat, Oman. Methodology COVID-19-positive patients aged 18 years and above at the time of diagnosis were included in this retrospective observational study. The details of the patients were retrieved from the electronic health records of the Al Shifa Hospital Information Management System and Tarassud. The composite primary endpoint was COVID-19 admission to a government tertiary hospital ward or intensive care within 14 days of diagnosis. Results A total of 506 COVID-19-positive patients were identified during the specified period. The mean age was 44 ± 15 years. The majority of the patients were Omani, and a female preponderance was observed. Overall, 104 (20.4%) patients were current PPI users. Admission due to COVID-19 was significantly associated with the presence of comorbid conditions such as diabetes mellitus (p = 0.001), hypertension (p = 0.001), and chronic kidney disease (p < 0.001). However, current PPI use (p = 0.140) was not significantly associated with an increased risk of hospitalization. Conclusions This data suggests that the use of PPIs during COVID-19 infection did not increase the risk of severe COVID-19 infection and poor outcomes leading to hospitalization in Muscat, Oman. However, the presence of other medical comorbidities, such as diabetes and hypertension, was associated with a higher risk of adverse clinical symptoms that resulted in hospitalization.

Prevalence of Edentulousness among Patient visiting a Tertiary Care Centre

Introduction: Absence of teeth i.e., edentulism is a common oral health issue worldwide and is an under evaluated disability. It is a preventable oral disability which brings major impact on overall health of individuals affecting the function, aesthetics, comfort and psychology. So, it should be identified and awareness for its management should be done so as to improve the quality of life of an individual. Objective: The purpose of this study was to collect baseline data on edentulism in the Nepalese population so that community-level awareness and educational programs could explain the importance of replacement lost teeth with prosthesis. Methods: The study was conducted in the College of Medical Sciences in the department of Oral medicine and Radiology and in the department of Prosthodontics from the patient visiting in these OPD for five months duration. Data were recorded in proforma and classified as complete / partial edentulous and further classified into Kennedy’s classification. The data were recorded and analyzed in SPSS 20. Result: Out of 301 patients, 24 (8%) had total edentulism, while 277 (92% had partial edentulism). Of the partially edentulous individuals, 90 showed just maxillary edentulism, 148 showed only mandibular edentulism, and 39 showed both maxillary and mandibular edentulism. Conclusion: Females were more likely than males to exhibit partial edentulism. Females showed more Kennedy's Class III classification than males. Both had equal complete edentulism. The mandibular arch showed more partial edentulism than the maxillary arch.

Bacteriological Profiles and Antimicrobial Susceptibility Patterns Among Isolates in Tonsillitis Patients Attending a Tertiary Care Hospital

Bacteriological Profiles and Antimicrobial Susceptibility Patterns Among Isolates in Tonsillitis Patients Attending a Tertiary Care Hospital

Effect of Nd:YAG laser posterior capsulotomy on higher order aberrations in different types of posterior capsule opacification: A prospective study.

To evaluate higher order aberrations (HOA) in different types of posterior capsule opacification (PCO) and analyze its changes fosllowing Nd:YAG laser posterior capsulotomy (LPC). Tertiary care ophthalmic hospital. Prospective, comparative, observational study. One hundred ninety-three pseudophakic eyes with PCO were evaluated over 3 months. PCO was classified into pearly, fibrous, and mixed types. Their uncorrected visual acuity (UCVA), corrected distance visual acuity (CDVA), intraocular pressure (IOP), evaluation of posterior capsule opacification (EPCO) scoring and root mean square values of HOA (total, coma, spherical, and trefoil) were measured using a wavefront aberrometer before and after LPC. Pearly, fibrous, and mixed PCO were observed in 89 (46.1%), 47 (24.4%), and 57 (29.5%) eyes respectively. The UCVA and CDVA showed improvement in all types of PCO post-procedure. The total HOA was 0.48 ± 0.47, 0.43 ± 0.42, 0.37 ± 0.34, and 0.76 ± 0.53, the coma aberrations were 0.18 ± 0.15, 0.18 ± 0.14, and 0.19 ± 0.19, spherical aberrations were 0.07 ± 0.12, 0.09 ± 0.12, and 0.05 ± 0.06, whereas the trefoil aberrations were 0.35 ± 0.44, 0.24 ± 0.26, and 0.21 ± 0.20, 15-day post-Nd:YAG LPC in pearly, fibrous, and mixed PCO respectively, all of which showed a significant reduction. The EPCO score showed no significant difference between different subtypes of PCO and had no correlation with the HOA. Post Nd:YAG LPC showed improvement in visual acuity with significant reduction in HOA in all types of PCO.

Impact of universal masking in reducing the risk of nosocomial respiratory viruses among people with cancer.

Universal masking within healthcare settings was adopted to combat the spread of coronavirus disease 2019 (COVID-19). In addition to mitigating the risk for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, it also had an added benefit of preventing the nosocomial transmission of other respiratory viral diseases. This study examines the impact of the masking intervention on nosocomial respiratory viral infections (RVI) in vulnerable sub-populations of people with cancer at a tertiary care hospital. Interrupted time series analysis. We reviewed non-SARS-CoV-2 nosocomial RVI between January 1, 2017 and December 31, 2023 and compared its quarterly trends before (January 2017 to March 2020) and after (April 2020 to December 2023) the universal masking intervention was implemented. Prior to the masking policy, there was no significant change in the quarterly rate of non-SARS-CoV-2 nosocomial RVI (baseline trend: P = 0.662). Crude infection rates decreased from 5.6% preintervention to 4.3% after the masking policy was implemented (P < 0.001). Quarterly trends continued to steadily decline post-intervention (β = -0.10, SE = 0.04, P < 0.007). Our results suggest that universal face masking is associated with reduced non-SARS-CoV-2 nosocomial RVI, providing further evidence to support the continued use of face masks in healthcare settings to protect the health of immunocompromised patients.

Low energy availability surrogates are associated with Relative Energy Deficiency in Sport outcomes in male athletes

ObjectivesTo determine the association between surrogates of low energy availability (EA) and proposed health and performance outcomes of Relative Energy Deficiency in Sport (REDs) in a clinical sample of adolescent...

Evaluating Biomarker Dynamics in Breast Cancer Post-Neoadjuvant Chemotherapy: A Retrospective Cross-sectional Study

Background: Neoadjuvant chemotherapy (NACT) is integral to breast cancer management, yet its influence on biomarkers, notably androgen receptor (AR), remains underexplored. This study examines post-NACT alterations in receptor status, including ER, PR AR, HER2 and Ki67 index in breast cancer patients. Methods: A cross-sectional study, spanning three years at a tertiary care center, enrolled patients with invasive breast cancer undergoing mastectomy post-NACT. Pre- and post-NACT specimens underwent histological grading and immunohistochemistry for hormone status, HER2 status, and Ki67 index. Discordance between pre- and post-NACT receptor statuses and expression levels of biomarkers was assessed using McNemar’s and Wilcoxon signed rank tests respectively. Results: Among 100 patients, 35 were assessed. Mean age was 43.83 years, with prevalent T1 tumors (34.3%) and N1 nodal involvement (37.1%). Post-NACT, 54.2% showed no histological grade change. Notable alterations included changes in ER (14.2%), PR (14.2%), and HER2 status (8.57%). AR expression showed a significant change following NACT (p=0.03), while ER expression exhibited a trend towards significance (p=0.06). Ki67 index decreased in only 5.7% of cases. Conclusion: This study unveils intricate biomarker dynamics following NACT in breast cancer, with particular emphasis on AR, hitherto not evaluated. Larger investigations are imperative to elucidate clinical implications and tailor treatment strategies for breast cancer patients undergoing NACT.