Tertiary Health Care Centre Research Articles

Clinical and Hematological Manifestations of Systemic Lupus Erythematosus at Initial Presentation in a Tertiary Healthcare Center

Clinical and Hematological Manifestations of Systemic Lupus Erythematosus at Initial Presentation in a Tertiary Healthcare Center

Association of wide pulse pressure with coronary collateral flow in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention.

Coronary collateral flow (CCF) is crucial for myocardial viability in patients with obstructive coronary artery disease, specifically ST-elevation myocardial infarction (STEMI). However, hypertension can contribute to vascular dysfunction and hinder the formation of CCF. Wide pulse pressure (WPP), defined as ≥65 mmHg, may better reflect impaired cardiovascular health compared to classic blood pressure indices. The effect of WPP on CCF remains unclear. Therefore, we aimed to evaluate the impact of WPP on CCF. This retrospective study included 1180 STEMI patients that underwent primary percutaneous coronary intervention (PCI) between 2021 and 2023 at a tertiary healthcare center. Patients were classified into good and poor CCF groups based on the Rentrop classification. Out of these patients, 272 (23.1%) had good CCF, while 908 (76.9%) had poor CCF. Two distinct models were constructed using multivariable logistic regression analysis to identify independent predictors of good CCF, including pulse pressure (Model 1) and WPP (Model 2). Covariates such as age, gender, diabetes mellitus, smoking, pre-infarction angina, Killip Class 3/4, multivessel disease, peak troponin, pre-thrombolysis in myocardial infarction (TIMI) flow 0, and previous PCI were added to both models. WPP was identified as an independent predictor that negatively influences good CCF (OR: 0.511, 95% CI: 0.334-0.783, p = 0.002). Moreover, diabetes, pre-infarction angina, Killip class III/IV, multivessel disease, and pre-TIMI flow 0 were also found to be independent predictors of CCF. WPP, derived from blood pressure measurements, has been associated with poor CCF in STEMI patients undergoing primary PCI and may serve as a predictor of poor CCF.

Radiological assessment of pulmonary vascular changes and gastrointestinal changes in patients with COVID-19 referred to a tertiary health care center in Chennai, India: a prospective cross-sectional study

BACKGROUND: The coronavirus disease pandemic (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has led to significant morbidity and mortality worldwide since its emergence in 2019. Although primarily a respiratory illness, COVID-19 can also affect other organ systems, including the vascular and gastrointestinal systems. COVID-19 is linked to both venous and arterial thrombosis, and numerous studies have indicated a heightened risk of pulmonary embolism. Autopsies have revealed pulmonary vasculature thrombosis and bowel ischemia in patients with COVID-19. AIM: To assess radiological pulmonary vascular changes, specifically pulmonary embolism, and gastrointestinal changes in patients with COVID-19 referred to a tertiary healthcare center in Chennai, India. MATERIALS AND METHODS: Computed tomography pulmonary angiography and contrast-enhanced computed tomography of the abdomen were conducted in 100 patients with COVID-19 who met the selection criteria. A radiologist with 5 years of experience evaluated pulmonary vascular and bowel changes. Subsequently, statistical analysis was performed to determine the significance of the relationship between patients with COVID-19 and the occurrence of pulmonary vascular and bowel changes. RESULTS: In this study, 11 patients exhibited pulmonary thromboembolism, and 7 showed significant bowel changes such as bowel wall thickening, mesenteric ischemia, and omental infarction, indicative of potential gastrointestinal involvement of patients with COVID-19. A positive correlation was found between pulmonary embolism prevalence in patients with COVID-19. Pulmonary embolism was diagnosed at a mean of 11 days from disease onset. Of the 24 patients with severe acute respiratory illness, 7 showed pulmonary embolism, detected by computed tomography pulmonary angiography. In addition, of the 10 patients on mechanical ventilation, pulmonary embolism was found in 7. Among the seven patients with bowel changes, four had pulmonary embolism, as detected by computed tomography pulmonary angiography, indicating a significant association between the two concomitant complications. The observed bowel changes were attributed to intravascular thrombosis. CONCLUSIONS: Based on our findings, pulmonary emboli and bowel changes often occur in patients with COVID-19. Multivariate analyses also revealed a connection between invasive mechanical ventilation and pulmonary embolism. The results indicate that patients with severe COVID-19 may also experience concurrent acute pulmonary embolism. Thus, for these patients, the use of contrast-enhanced computed tomography instead of standard non-contrast computed tomography may aid in treatment decision-making.

Thrombus aspiration in primary percutaneous coronary intervention in acute ST-elevation myocardial infarction patients with high thrombus burden: one-year outcomes in a tertiary healthcare center in Ho Chi Minh City

Abstract Background Primary percutaneous coronary intervention (PCI) can dislodge atherosclerotic debris, risking microvascular embolism. Thrombus aspiration (TA) before stenting in ST-segment elevation myocardial infarction (STEMI) patients has been linked to reduced mortality, lower recurrence of heart attacks, and improved cardiac function. However, limited research exists on the effectiveness of TA in Vietnam, underscoring the need for further studies to enhance cardiovascular care. This prospective observational study was conducted to evaluate the role of TA in STEMI patients admitted with a substantial thrombus burden at Nguyen Tri Phuong Hospital. Results Out of 92 participants, 68 underwent TA treatment. Post-treatment, the TA group exhibited better TIMI and TMP flow grades and a higher rate of ST-segment normalization, with no significant difference in major adverse cardiac events (MACEs) at 30-day and 12-month follow-ups compared to those untreated. Conclusions TA during PCI enhances ST-segment normalization and TIMI and TMP scores in STEMI patients, improving myocardial perfusion. No difference in MACE occurrence was noted between groups after 30 days and 12 months, suggesting TA’s potential benefits without increasing adverse outcomes.

Pattern and Clinical Reasons for Dental Extractions in Patients Visiting a Tertiary Health Care Centre in Southern District- Nuh of Haryana, India: A Retrospective Observational Study

Introduction: The causes of tooth extraction exhibit significant geographical and cultural variations between regions within a country and across different countries. To date, no study has been conducted on the pattern of tooth loss in a comparatively socially and economically disadvantaged population in Nuh, Haryana, India. Aim: To analyse the pattern and clinical reasons for tooth extraction in relation to factors such as age and gender among patients visiting the Dental Department of a tertiary care centre in India. Materials and Methods: A retrospective observational study was carried out in the Department of Dentistry, Shaheed Hasan Khan Mewati (SHKM) Government Medical College Nalhar, Nuh, Haryana, India, from January 2017 to December 2019. Data were collected from the available records of patients across different age groups during the period from January 2017 to December 2019. Data on age, gender, reasons for extraction, jaw type and tooth number were recorded. The total number of extracted teeth was used for statistical analysis using Microsoft Excel software. Results: During the study period, 2643 patients underwent tooth extraction, with 1304 (49.33%) being males and 1339 (50.66%) females. A total of 3358 teeth were extracted, with 1382 in males and 1976 in females. The number of teeth extracted was higher in females (58.84%, n=1976) compared to males (41.15%, n=1382). The majority of extractions occurred in the 21-30 years age group, 750 (21.73%) followed by the 31-40 years age group, 663 (19.71%). The most common reason for extraction was dental caries and its sequelae, 2462 (73.34%). The most frequently extracted tooth was the first molar in the fourth quadrant (9.26%) followed by the first molar in the third quadrant (8.72%). Conclusion: Given the paramount importance of first permanent molars, it is concerning to see many young patients losing this tooth in the present study. Therefore, it is crucial to raise awareness among the general population about maintaining oral hygiene, regular dental check-ups and treatment. The role of pit and fissure sealants in caries prevention for first permanent molars cannot be overstated.

A Retrospective Analysis of Demographics, Clinical Features, and Treatment Patterns in Sickle Cell Disease Patients at a Tertiary Healthcare Centre of North East India

A Retrospective Analysis of Demographics, Clinical Features, and Treatment Patterns in Sickle Cell Disease Patients at a Tertiary Healthcare Centre of North East India

Preoperative Multivariable Model for Risk Stratification of Hypoxemia During One-Lung Ventilation

BACKGROUND: Hypoxemia occurs with relative frequency during one-lung ventilation (OLV) despite advances in airway management. Lung perfusion scans are thought to be one of the most accurate methods to predict hypoxemia during OLV, but their complexity and costs are well-known limitations. There is a lack of preoperative stratification models to estimate the risk of intraoperative hypoxemia among patients undergoing thoracic surgery. Our primary objective was to develop a risk stratification model for hypoxemia during OLV based on preoperative clinical variables. METHODS: This is a single-center, retrospective cohort study including 3228 patients who underwent lung resections with OLV from 2017 to 2022, at a tertiary academic health care center in the United States. Vital signs and ventilator settings were retrieved minute by minute. Intraoperative hypoxemia was defined as an episode of oxygen desaturation (Spo 2 <90%) for at least 5 minutes. Demographic and clinical characteristics were included in a stepwise logistic regression, which was used for the selection of predictors of the risk score model. All patients included in this cohort underwent elective lung surgery in lateral decubitus position, with double lumen tube and placement confirmation with fiberoptic bronchoscopy. Our model was validated internally using area under the receiver operating curves (AUC) with bootstrapping correction. RESULTS: The incidence of hypoxemia during OLV was 8.9% (95% confidence interval [CI], 8.0–10.0). Multivariable logistic regression identified 9 risk factors with their corresponding scoring: preoperative Spo 2 <92% (15 points), hemoglobin <10 g/dL (6 points), age >60 years old (4 points), male sex (4 points), body mass index >30 kg/m2 (8 points), diabetes mellitus (4 points), congestive heart failure (7 points), hypertension (3 points), and right-sided surgery (3 points). The AUC of the model after bootstrap correction was 0.708 (95% CI, 0.676–0.74). Based on the highest Youden index, the optimal score for predicting intraoperative hypoxemia was 13. The risk of hypoxemia increased from 4.7% in the first quartile of scores (0–13 points), to 32% in the third quartile (27–39 points), and 83.3% in the fourth quartile (>39 points). At scores of 20 or greater, the specificity of the model exceeded 90% and reached a positive predictive value of 80%. CONCLUSIONS: The risk of hypoxemia during OLV can be stratified preoperatively using accessible clinical variables. Our risk model is well calibrated but showed moderate discrimination for predicting intraoperative hypoxemia. The accuracy of preoperative models for risk stratification of hypoxemia during OLV should be explored in prospective studies.

Histopathological evaluation of the placenta: Clues of intra-uterine fetal demise

Intrauterine fetal demise (IUFD) is a distressful event with lasting impact and risk of recurrence. However, in majority of cases, the cause remains unexplained. The aim of the present study is to evaluate the histomorphological features of placenta, the findings associated with commonly known etiologies of IUFD and other clues provided by it in establishing the cause of IUFD.: A prospective, observational study was conducted at a tertiary healthcare center in North India for a period of 3.5 years. A total of 104 placental specimen from IUFD cases were received and evaluated microscopically by 3 histopathologists. Data was tabulated and analyzed.: Majority cases of IUFD were seen in multigravida women (52.8%) in the age group of 25 to 30 years. We found that inflammatory lesions in 46.1% cases, maternal vascular malformation (MVM) in 25% cases, fetal vascular malformation in (FVM) in 16.3%, combined MVM and FVM in 2.9% while 9.7% cases were idiopathic. Presence of fibrotic villi, intervillous fibrin deposition, chorioamnionitis and calcification were the most common findings. Pregnancy induced hypertension was the most common maternal cause of IUFD identified (20.3%), while congenital anomalies were the most common fetal (72.1%) and placenta previa was the most common placental cause (33.3%). A comprehensive placental histopathological evaluation can provide clues regarding the causation and progression of IUFD, allowing clinicians to initiate early management and prevent recurrence. Patient education regarding the same may also motivate the patient to seek early and proper antenatal care in subsequent pregnancies.

Understanding the connection and relation between sleep and depression in a tertiary health-care center: Insights from a cross-sectional study

Abstract Background: There is a bidirectional relationship between sleep disturbance and depression, with which a new hypothesis could be generated, that is, sleep disturbance can be a prodromal event rather than a symptom of depression. Many long-term studies have identified insomnia as a risk factor for the onset or recurrence of depression in young, middle-aged, and older people and it can also increase the risk of self-harm and suicide, which can also exacerbate the medical comorbidity conditions and also increase the substance intake. Materials and Methods: Those patients attending the psychiatry outpatient department of tertiary Health-care center for 6 months were considered. Those patients who were diagnosed with depression as per the International Classification of Diseases-11 depression criteria were taken after getting proper informed consent from them. Then, those patients who satisfied the inclusion criteria were taken into the study and evaluated with self-structured pro forma including details regarding the sociodemographic profile, Hamilton Depression Rating Scale, and Insomnia Severity Index Scale to assess the severity of depression and sleep disturbance. Results: The prevalence of sleep disturbance in depressive individuals was found to be 78% (140). The significance was established between the severity of depression and the severity of insomnia (P<0.001), along with sleep duration (P<0.001), insomnia type (P=0.002), benzodiazepine usage (P<0.001) and self-harm ideas/attempts (P<0.001). Conclusion: Sleep is considered a major aspect of holistic care, as it may have an impact on the severity, frequency and duration of depression and its remission along with quality of life and mortality rate.

Proton pump inhibitors in inpatients: Are we getting it right? A retrospective analysis.

Proton pump inhibitors (PPIs) are commonly prescribed to hospitalized patients, but many of these prescriptions may not be based on evidence-based indications. It's important to understand that inappropriate prescribing of PPIs can lead to unnecessary medications and financial burdens. Unfortunately, there are not many recent studies exploring how often PPIs are prescribed and if they are being prescribed appropriately. The study aimed to assess the appropriateness of PPIs use among hospitalized patients. It evaluated the indications for PPIs use and determined whether the use of PPIs in hospitalized patients is justified or not. The study was conducted at Hamad General Hospital, a tertiary academic healthcare center in the state of Qatar. A retrospective observational study with 201 subjects, was conducted in general internal medicine wards at a tertiary hospital. Physician documentation and inpatient and outpatient medication prescriptions were analyzed for PPIs exposure. The appropriateness of exposure to PPIs is determined based on international recommendations. Of 533 hospitalized patients who were not critically ill, 201 (37.7%) were prescribed PPIs. The study found that 65.2% of the patients had no valid indication for PPIs exposure. Furthermore, 18% of patients were inappropriately prescribed stress ulcer prophylaxis with PPIs even though they had a low risk for the development of ulcer disease. After discharge, 82.6% of patients were prescribed PPIs, with the most common indication (43%) being gastrointestinal ulcer prophylaxis. This study sheds light on the issue of overutilization of PPIs, specifically in non-critically ill hospitalized patients. It highlights the unnecessary continuation of PPI prescriptions at discharge and emphasizes the importance of physicians reevaluating PPI prescriptions periodically to ensure they are still necessary and discontinuing them when possible to avoid unwanted consequences.

To Assess the Effect of Dyslipidemia on Treatment Outcome of Drug Sensitive TB Patients at a Tertiary Health Care Centre of North India

To Assess the Effect of Dyslipidemia on Treatment Outcome of Drug Sensitive TB Patients at a Tertiary Health Care Centre of North India

‘Effectiveness of various sulbactam-based combination antibiotic therapy in the management of ventilator-associated pneumonia caused by carbapenem-resistant Acinetobacter baumannii in a tertiary care Health centre’

ObjectiveCarbapenem-resistant Acinetobacter baumannii (CRAB) is a common cause of ventilator-associated pneumonia (VAP). Some in vitro data favour various combination antibiotic therapy. However, there is a need for more in vivo studies for the management of VAP caused by CRAB. This retrospective study was done to evaluate the effectiveness of various combination antibiotic therapy including sulbactam on outcomes of VAP caused by CRAB. MethodsAdult patients (age ≥18 years) diagnosed with VAP caused by CRAB were included. Patients with polymicrobial infections were excluded from the study. Patients with CRAB associated VAP who were given sulbactam based antibiotic combinations were observed for outcomes. The primary outcome was 28-day mortality after diagnosis of VAP caused by CRAB. Reduction in serum HsCRP (High sensitivity C-reactive protein) during treatment and requirement of inotropes were the secondary outcomes. Outcomes were compared between various sulbactam based antibiotic combination therapies. ResultsA total of 103 patients were included. A total of 44 (42.7 %) patients received sulbactam and minocycline or sulbactam and polymyxin B dual antibiotic combination, and 59 (57.3 %) patients received sulbactam, polymyxin B and minocycline triple antibiotic combination. The percentage difference in 28 days mortality was 27.51 % (95 % CI 8.03 %–44.06 %; p = 0.005) in dual vs triple sulbactam based antibiotic combination therapy. The percentage difference in requirement of inotropes during therapy and HsCRP reduction after 7 days of therapy was 23.65 % (95 % CI 6.43 %–38.3 %; p = 0.007) and 25.1 % (95%CI 10.1 %–38.2 %; p < 0.001) respectively when compared between dual vs triple sulbactam based antibiotic combination therapy. ConclusionTreatment with sulbactam, polymyxin B and minocycline combination antibiotic therapy was associated with significantly lower 28-day mortality. Moreover, the lower requirement of inotropes during treatment and a significant reduction in HsCRP level favours this combination antibiotic therapy in VAP caused by CRAB.

Correlation between serum vitamin B12, vitamin D, and suboptimal semen parameters in male infertility: A hospital-based cross-sectional study

ABSTRACT Background: Micronutrients such as vitamin B12 and D have recently gained attention for their potential roles in male reproductive health. Despite their significance, there’s a critical gap in understanding their association with male infertility, particularly concerning suboptimal semen parameters. This study aimed to address this knowledge gap by examining serum vitamin B12 and D levels in infertile males, providing insights that could inform targeted interventions for couples facing male infertility challenges. Methods: This cross-sectional study, conducted at Tertiary Health care centre in north India for 2 years, enrolled 73 infertile males aged 20–40 years from the fertility clinic (participants exhibited suboptimal semen parameters). Clinical and demographic data were collected through interviews and record reviews, while semen samples underwent meticulous processing for the analysis of various parameters. Blood samples were collected after overnight fasting for serum vitamin B12 (ELISA) and vitamin D (CLIA) assessment. Statistical analyses, performed using SPSS, included t-tests, Chi-square tests, and Pearson’s correlation analyses to explore associations between serum vitamin levels and semen parameters, with a significance level set at P &lt; 0.05. Results: The study comprised 73 infertile males with suboptimal semen parameters. Serum vitamin B12 levels (mean ± SD: 243.4 ± 69.3 pg/mL) and vitamin D levels (22.5 ± 13.2 ng/mL) were measured. Low vitamin B12 (&lt;200 pg/mL) was observed in 29 participants (39.7%), while low vitamin D (&lt;20 ng/mL) was noted in 51 participants (69.9%). Semen parameters revealed significant differences in sperm count, motility, and morphology between low and normal vitamin B12 groups. Similar patterns were observed with vitamin D levels, emphasizing potential associations between vitamin status and semen quality. Conclusion: Our findings suggest a potential link between low serum vitamin B12 and D levels and suboptimal semen parameters in infertile males. Addressing these nutritional deficiencies may hold promise for improving male fertility outcomes. Further research is warranted to elucidate the mechanisms involved and explore targeted interventions.

Feasibility, safety, and outcome of fetoscopic endoluminal tracheal occlusion for severe congenital diaphragmatic hernia at a low case-load center: one center's experience.

Antenatal fetoscopic endoluminal tracheal occlusion (FETO) has been introduced as an effective intervention to improve the outcome of severe congenital diaphragmatic hernia (CDH). We report our early experience with FETO. A retrospective chart review of case series. Tertiary health care center. 18-45 years old, with single fetuses diagnosed with left severe CDH (lung-head ratio <1 measured between 27-29 weeks of gestational age (GA) and liver up or observed/expected lung-to-head ratio <25%, normal echocardiogram and karyotype were included. FETO was performed between 28-30 weeks of gestation and removed after 4-6 weeks or at birth during an ex utero intrapartum treatment (EXIT) procedure. FETO represents a viable option for severe type of CDH fetuses with reasonable outcomes. FETO performance in low volume centers may be feasible with reasonable outcomes. Good outcome of postnatal care with no potential antenatal complications may affect FETO adoption in some societies. 5. 14 pregnant women were referred for assessment and only 7 met the inclusion criteria. Two were excluded initially (late referral and spouse refusal) and a 3rd excluded later due to failure of FETO due to faulty balloons. The median age of the mothers was 28 years and the gestational age was 29 weeks. Median observed/expected lung-to-head ratio was 23%. Among patients who had successful FETO, one had the balloon removed fetoscopically 4 weeks after insertion and one was removed 8 weeks after insertion during an elective EXIT procedure and both have survived. The other two had premature labor after 1 and 5 weeks after FETO and balloon removed during an emergency EXIT procedures, and both died within 24 hours of birth. FETO represents a viable option for severe type of CDH fetuses with reasonable outcome. FETO performance in a low volume centers may be feasible with reasonable outcomes. Good outcome of postnatal care with no potential antenatal complications may affect FETO adoption in some societies. Retrospective nature of the study may imply inaccuracy, but we believe data from electronic medical records is highly accurate.

PD-L1 Expression Varies in Thyroid Cancer Types and Is Associated with Decreased Progression Free Survival (PFS) in Patients with Anaplastic Thyroid Cancer.

Thyroid cancer (TC) remains a significant clinical challenge worldwide, with a subset of patients facing aggressive disease progression and therapeutic resistance. Immune checkpoint inhibitors targeting programmed death-ligand 1 (PD-L1) have emerged as promising therapeutic approaches for various malignancies, yet their efficacy in TC remains uncertain. The objective of this study was to investigate PD-L1 expression in aggressive TC and its association with histological subtypes, molecular mutation, and progression-free survival. This is a retrospective study of patients with advanced TC seen in two tertiary health care centers. Included in this study were patients with advanced TC with recurrence or progression on therapy for whom tumor molecular profiling and PD-L1 status were available. Kaplan-Meier estimators were utilized to analyze the progression-free survival (PFS) between patients with PD-L1 positive and negative status in Anaplastic TC (ATC) subgroup. A total of 176 patients with advanced thyroid cancer were included (48.9% female). Of the patients, 13 had ATC, 11 Medullary TC (MTC), 81 Papillary TC Classic Variant (PTCCV), 20 Follicular TC (FTC), 8 Oncocytic TC (OTC), 10 Poorly Differentiated TC (PDTC), and 30 had the Papillary TC Follicular Variant (PTCFV). BRAF mutation was present in 41%, TERT in 30%, RAS in 19%, TP53 in 10%, and RET in 8.6% of patients. PD-L1 positivity was significantly different across different TC types and histological subtypes (p < 0.01): Patients with OTC had the highest frequency of PD-L1 positivity (71%), followed by ATC (69%), PTCCV (28.5%), and FTC (11%). Patients with MTC and PTCFV did not exhibit any PD-L1 positivity. TP53 mutation was positively associated with PD-L1 expression (21.6% vs. 7.5%, p = 0.03), and RAS mutation was negatively associated with PD-L1 expression (8.1% vs. 24.2% p = 0.04). Among patients with ATC, positive PD-L1 expression was associated with lower PFS (p = 0.002). PD-L1 expression varies across different TC types and histological subtypes and may be modulated by the mutational landscape. PD-L1 expression in ATC is associated with shorter PFS. Follow up studies are warranted to elucidate the molecular mechanism driving the observed differences in immune pathways, potentially paving the way for the development of more effective and personalized immune therapies for patients with aggressive TC.

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.

Management of Disseminated Rhinosporidiosis: Experience From a Single Tertiary Institution.

This study aims to present a series of patients with disseminated rhinosporidosis with diagnostic and therapeutic features. A retrospective study was conducted in a tertiary health care centre in South India from 2007 to 2020 with disseminated rhinosporidiosis. Twelve patients with multiple sites of involvement like the nose, nasopharynx, oropharynx, larynx, lacrimal sac and skin were included in the study. All patients underwent surgical excision, followed by peroral dapsone for one year. The age group was around 30-55 years, with male predominance (11:1). Pond bathing history was present in 50% (n=6). The most common site of lesion was the nose (100%), oropharynx (83.3%), skin (75%), larynx (50%) and less commonly, nasopharynx (41.6%) and lacrimal sac (25%). One patient underwent surgery four times (8.3%), followed by thrice and twice by five (41.6%) and six (50%) patients, respectively. On two years of follow-up, two patients (16.6%) had a recurrence in the nose and larynx whereas eight patients (66.6%) had no recurrence and two patients (16.6%) were lost to follow-up. This original article highlights the rare occurrence of disseminated rhinosporidiosis, the possibility of which should be kept in mind, mainly when two or more sites are involved. The most significant number of disseminated rhinosporidiosis cases in the literature is reported here. Dissemination with the cutaneous and multisite disease is rarely reported and poses difficulty in management. Early diagnosis and intervention prevent the dissemination of spores into various parts of the body.

Profile Of Opportunistic Infections Among HIV Patients On ART Attending At Tertiary Health Care Center

Profile Of Opportunistic Infections Among HIV Patients On ART Attending At Tertiary Health Care Center

Prevalence of Needle Stick Injuries Among Healthcare Workers at a Tertiary Care Centre in Kochi, India.

Background Needle stick injuries (NSIs) are a prevalent occupational hazard among healthcare workers (HCWs) globally. Strict adherence to standard work precautions by all HCWs at all times and the implementation of post-exposure prophylaxis (PEP) are measures for reducing the occurrence of NSIs. However, NSIs are poorly documented in the literature and may be a cause of morbidity in the long run. Objectives Our study aims to determine the prevalence of NSIs among HCWs and its associated factors in a tertiary healthcare centre in Kerala, India. Methods A cross-sectional study was conducted among 210 consenting HCWs who worked in different blocks of a tertiary care hospital in the Ernakulam district, Kerala, India. Data was collected using a semi-structured questionnaire through personal interviews.The questionnaire gathered sociodemographic information, details regarding NSI occurrences over the past one year, the devices involved and PEP. Data analysis was performed using StatisticalPackage for the Social Sciences (IBM SPSS Statistics for Windows, IBMCorp., Version 20.0, Armonk,NY), and categorical variables were expressed as frequencies and percentages. The chi-square test and binomial logistic regression were employed to identify factors associated with NSIs. Results The prevalence of NSIs among HCWs in the past 12 months was 31% (65 out of 210), with an average of 1.34 NSIs per HCW per year. The most commonly involved device was the intravenous (IV) cannula, and 22 out of 65 (33.8%)injuries occurred during injection procedures. A majority (45 out of 65; 69.23%) of HCWs reported NSI and 51 of them (78.4%) received PEP. Logistic regression analysis showed that HCWs aged over 31 years (adjusted odds ratio (AOR): 3.39; 95% confidence interval (CI): 1.29-8.42) were independently associated with a higher occurrence of NSIs. Conclusion Our findings underscore the importance of implementing comprehensive safety measures, including strict adherence to standard work precautions and timely administration of PEP.