Tertiary Health Care Centre Research Articles

Do heavy metals have a role in extrahepatic portal vein obstruction in children: A pilot case-control study

ObjectiveExtrahepatic portal venous obstruction (EHPVO) is a common cause of portal hypertension in Southeast Asia as compared to the western world, where chronic liver disease is the most common cause. Pollution and inadvertent exposure to heavy metals in poor socio-economic status in this part of the world are quite common. Therefore, this study was proposed to determine the association between heavy metal levels and oxidative stress in children with EHPVO. MethodsThis pilot case-control study was conducted in the department of Pediatrics, of a tertiary health care centre from January 2020 to October 2021. Children between 1 and 14 years, diagnosed with EHPVO were included. Controls were the healthy volunteers from OPD and near discharge indoor pediatrics patients. Metal analysis for Copper, Lead, Zinc, and Manganese, & Antioxidant activity for superoxide dismutase (SOD), Glutathione reductase (GR) and Lipid peroxidase (LPO) in form of malondialdehyde (MDA) was measured in both the groups. ResultsA total of 80 subjects were enrolled (40 EHPVO cases and 40 controls) mean age for cases was 8.15 ± 3.53, and for control, was 7.69 ± 3.55 years (p = 0.560). Lead values were found to be significantly higher (p = 0.003) in EHPVO cases (5.39 ± 3.13) in comparison to controls (3.30 ± 2.91). Mean superoxide dismutase (SOD) and Glutathione reductase (GR) values were decreased (p = 0.035- GR) and the malondialdehyde (MDA) value was increased in the EHPVO cases as compared to controls. ConclusionChildren with high blood levels of lead might be at risk of portal vein thrombosis resulting in EHPVO, and lead-induced oxidative stress.

Epidemiology, clinical characteristics, and associated cost of acute poisoning: a retrospective study.

Poisoning is a major public health issue and a leading cause of admission to the emergency department (ED). There is a paucity of data describing the epidemiology and cost of acute poisoning. Therefore, this study investigated the epidemiology, patterns, and associated costs of acute poisoning in emergency department of the largest tertiary care healthcare centre in Qatar. This study was a retrospective review of the health records of patients admitted to the ED due to poisoning between January 2015 and December 2019. Incidence, clinical characteristics, and costs associated with acute poisoning were assessed. Frequency and percentages were calculated for categorical variables and mean and SD for continuous variables. The relationship between sociodemographic characteristics and poisoning profile was assessed using the chi-square test. A micro-costing approach using the cost of each resource was applied for cost calculations. The incidence of acute poisoning was 178 cases per 100,000 patients. Females (56%) and children below 14 years (44.3%) accounted for the largest proportion. Most of the exposures were accidental involving therapeutic agents (64.2%). The mean length of hospital stay was found to be 1.84 ± 0.81 days, and most patients (76.6%) were discharged within the first 8 h. A statistically significant difference was found between age groups and type of toxin (χ2 = 23.3, p < 0.001), cause and route of exposure (χ2 = 42.2, p < 0.001), and length of hospital stay (χ2 = 113.16, p < 0.001). Admission to intensive care units had the highest cost expenditure (USD 326,008), while general wards accounted for the least (USD 57,709). Unintentional poisoning by pharmacological agents is common in infants and children. This study will assist in the development of educational and preventive programmes to minimise exposure to toxic agents. Further studies are required to explore the impact of medical toxicology services, and post discharge monitoring of poisoning.

Safety and Efficacy of Biopsy in Patients with Diffuse Intrinsic Pontine Gliomas

Diffuse intrinsic pontine gliomas are aggressive tumors that carry a poor prognosis with a 2-year survival rate of <10%. The imaging appearance is often pathognomonic, and surgical biopsy is not mandatory to initiate treatment in children. Studies of biopsy samples provide insight into the disease's molecular pathobiology and open prospects for targeted therapy. This study was conducted to determine the diagnostic yield and safety of stereotactic biopsies. This is a prospective observational study from a single tertiary health care center. All patients with clinical and radiological features diagnostic of diffuse intrinsic pontine gliomas (DIPGs) who underwent biopsy from July 2018 to June 2023 were included. Biopsies were performed using either stereotactic frame-based, frameless, or endoscopic techniques. A total of 165 patients with DIPGs were evaluated in the study period. The option of biopsy with its associated risks and benefits was offered to all patients. A total of 76 biopsies were performed in 74 patients (40 children and 34 adults, including 2 repeat biopsies). The median age was 15 years. Diffuse midline gliomas, H3K27M altered, was the most common histopathological diagnosis (85% pediatric and 55.9% adults). The diagnostic efficacy of the procedure was 94.7%. The complication rate was 10.8%, with no permanent neurological deficits due to surgery. There was no procedure-related mortality. Establishing the safety of the procedure could be an important step toward popularizing the concept, which might offer a better understanding of the disease. Brainstem eloquence and a lack of direct benefit to patients are the primary obstacles to brainstem biopsy.

Comparison of Surgical Outcomes between Endoscopeassisted Evacuation and Conventional Burr Hole Aspiration of Brain Abscess at a Tertiary Care Hospital

Background: Brain abscess is a major health problem with a reasonable morbidity and mortality rate. Objective: The objective of this study was to compare the efficacy between endoscope-assisted evacuations of brain abscess with burr hole aspiration method in a tertiary health care center. Methodology: This non-randomized clinical trial was conducted in the Department of Neurosurgery at Dhaka Medical College Hospital, Dhaka, Bangladesh during the period of July 2016 to December 2017. Patients with the age group of more than or equal to 18 years of both gender presented with brain abscess were enrolled in this study. The endoscope-assisted evacuation of abscess was done on group A patients and burr hole aspiration was done on group B patients. Outcome of the patients was assessed using GCS and MRC muscle power grading and by GOS. Patients were evaluated by contrast enhanced CT scan of head at pre-operative, 1st and 30th postoperative day. Both groups received best available medical treatment along with surgery. Results: The mean age of was 13.0 ± 6.3 years in burr hole group and is 13.1 ± 6.4 years in endoscope-assisted group. The patients presented with GCS was 66.7% in burr hole group and 93.3% in endoscope assisted group. The study showed e”75.0% evacuation of brain abscess at 1st post-operative day in 13(92.9%) patients in endoscope-assisted group and 5(33.3%) patients in burr hole group. The study showed mortality rate of 6.7% in both the groups. Mean residual volume at 30th post operative day was 0.75ml in endoscope-assisted group and 1.75ml in burr hole aspiration group. Conclusion: In conclusion endoscope-assisted procedure has better rate of abscess evacuation, less chance of residual and repeated surgeries than conventional burr hole. Bang. J Neurosurgery 2023; 13(1): 14-19

Spectrum of Patterns in Lymph Node Histopathology at A Tertiary Healthcare Centre in Hadoti Region

Spectrum of Patterns in Lymph Node Histopathology at A Tertiary Healthcare Centre in Hadoti Region

Stressful Life Events in Impulsive and Non-impulsive Suicide Attempters: A Cross-sectional Study

Background: Suicide is a significant public health issue, yet it can be avoided with prompt, evidence-based, and frequently inexpensive interventions. There are distinctions between the profiles of impulsive suicide attempters (ISA) and non-impulsive suicide attempters (NISA), and a significant number of suicide attempts are impulsive. A thorough multisectoral suicide prevention strategy is necessary for an effective national response. Methods: This observational cross-sectional study was conducted at a tertiary healthcare center in Karnataka. Sixty inpatients above the age of 18 years with an alleged history of suicide attempts were enrolled in the study. Their stressful life events in the past year were assessed using the Presumptive Stressful Life Events Scale (PSLES). Impulsive and non-impulsive attempters were considered based on the time gap between the suicidal ideation and the suicidal attempt with the presence or absence of plans regarding the act. They were compared using appropriate inferential statistical tests. Results: The majority of the suicide attempts were impulsive (63.3%). The ISA and NISA did not differ in socio-demographic characteristics except for age and family type, with impulsive attempters being more common at younger ages than the non-impulsive attempters ( p = .02). The majority of ISA were from joint families (44.7%), while 72.7% of NISA were from nuclear households ( p = .04). Compared to ISA, NISA recollected a higher number of stressors. Conclusion: The ISA and NISA differ in aspects of age, family type, and stressors. Characteristic distinctions between ISA and NISA should be recognized and understood in order to design policies for suicide prevention and minimize morbidity and mortality. Exploring and addressing the stressors and helping patients to overcome them through better coping skills helps in suicide prevention.

Prospective observational study on clinical profile of congenital anomalies of kidney and urinary tract (CAKUT) in children in central India: A study protocol

Background Congenital anomalies of the kidney and urinary tract (CAKUT) are a group of structural abnormalities affecting these vital organs, frequently leading to chronic kidney disease in children. This study aims to comprehensively understand the clinical profile of CAKUT in children in Central India, an area with unique socio-demographic characteristics and limited prior research on this topic. Methods A prospective observational study will be conducted over three years in the pediatric department of AVBRH, a tertiary healthcare center in Central India. Data were collected through interviews with parents or guardians of children up to 18 admitted to the hospital. Clinical symptoms, prenatal history, physical examinations, and diagnostic investigations were meticulously documented. Expected outcome The study is expected to reveal the prevalence and clinical profile of CAKUT in Central Indian children. Anticipated outcomes include insights into anomalies, clinical symptoms, and potential correlations with factors like prenatal care and consanguineous marriages. Diagnostic investigations will help assess the severity of renal impairment. The results may also uncover regional variations and have implications for public health initiatives aimed at early intervention and improved patient care. However, these are preliminary expectations that are subject to confirmation through the completion of the study.

Increased Postoperative Opioid Consumption in the Presence of Coadministration of 5-Hydroxytryptamine Type 3 Antagonists with Acetaminophen: A Hospital Registry Study.

Acetaminophen and 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists are administered as standard prophylaxes for postoperative pain, nausea, and vomiting. Preclinical studies, however, suggest that 5-HT3 antagonists may compromise acetaminophen's analgesic effect. This hospital registry study investigates whether 5-HT3 antagonists mitigate the analgesic effect of prophylactic acetaminophen in a perioperative setting. This study included 55,016 adult patients undergoing general anesthesia for ambulatory procedures at a tertiary healthcare center in Massachusetts from 2015 to 2022. Using binary exposure variables and a comprehensive selection of preplanned patient- and procedure-related covariates for confounder control, the authors investigated whether intraoperative 5-HT3 antagonists affected the association between pre- or intraoperative acetaminophen and postoperative opioid consumption, gauged by opioid dose in milligram oral morphine equivalents (OME) administered in the postanesthesia care unit. A multivariable, zero-inflated negative binomial regression model was applied. A total of 3,166 patients (5.8%) received only acetaminophen, 15,438 (28.1%) only 5-HT3 antagonists, 31,850 (57.9%) both drugs, and 4,562 (8.3%) neither drug. The median postanesthesia care unit opioid dose was 7.5 mg OME (interquartile range, 7.5 to 14.3 mg OME) among 16,640 of 55,016 (30.2%) patients who received opioids, and the mean opioid dose was 3.2 mg OME across all patients (maximum cumulative dose, 20.4 mg OME). Acetaminophen administration was associated with a -5.5% (95% CI, -9.6 to -1.4%; P = 0.009; adjusted absolute difference, -0.19 mg OME; 95% CI, -0.33 to -0.05; P = 0.009) reduction in opioid consumption among patients who did not receive a 5-HT3 antagonist, while there was no effect in patients who received a 5-HT3 antagonist (adjusted absolute difference, 0.00 mg OME; 95% CI, -0.06 to 0.05; P = 0.93; P for interaction = 0.013). A dose-dependent association of pre- or intraoperative acetaminophen with decreased postoperative opioid consumption was not observed when 5-HT3 antagonists were coadministered, suggesting that physicians might consider reserving 5-HT3 antagonists as rescue medication for postoperative nausea or vomiting when acetaminophen is administered for pain prophylaxis.

Tracheostomy - A Comparative Study of Decannulation with Gradual Blocking of the Tube vs. Reduction of the Size of Tube - A Prospective Study.

Tracheostomy is one of the most common procedures done in intensive care unit (ICU) patients. Decannulation is the weaning off from tracheostomy to maintain spontaneous respiration and/or airway protection. However, this step needs a near perfect coordination of brain, swallowing, coughing, phonation, and respiratory muscles. However, despite its perceived importance, there is no universally accepted protocol for this vital transition. In this systematic review of decannulation we focus attention to this important aspect of tracheostomy care. To compare the two methods of decannulation, with gradual blocking of the tube and reducing the size of the tube and also study and compare the incidental complications associated with both methods. This longitudinal, open label, randomized, observational study of 50 patients who were tracheostomized for more than 7 days was carried out in a tertiary health care Centre in central India. Over the course of 2 years demographic data, clinical information was collected and patients divided into 2 groups according to the method of decannulation done by a simple randomization method. The outcomes and the complications associated with the two techniques in the study groups were also be noted down and then compared. Maximum number of patients in both the study groups were males (56% in group with tube blocking, and 52% in group with tube size reduction). 48% cases in group with tube blocking, and 60% in group with tube size reduction were noted to be between 51 and 70 years' age group. The mean duration between tracheostomy and decannulation in group with tube blocking was 16.63 + 8.44 days, and while it was 16.71 + 8.79 days in group with tube size reduction. 36% patients in group with tube blocking had tracheostomy tube number 7.5, while 32% had tube number 8. 36% in group with tube size reduction had tube number 7.5 while 32% had tube size 7. 4 patients in group with tube blocking, and 3 patients in group with tube size reduction required reinsertion of tube. 40% patients in group with tube blocking, and 44% in group with tube size reduction underwent tracheostomy following prolonged intubation. 4 patients in group with tube blocking, and 3 patients in group with tube size reduction required reinsertion of tube. 1 patient in group with tube blocking had trachea-esophageal fistula as post decannulation complication. 1 patient each in group with tube size reduction had granule formation over stoma and tracheal stenosis as complications. The two decannulation methods, viz., gradual blocking of tube and reduction of tube size, showed comparable outcomes in terms of tube reinsertion rate, mechanical ventilation rate after decannulation, successful decannulation, and complications.

Abstract PO5-05-13: Clinical utility of whole body low dose computed tomography for detecting bone metastasis in breast cancer patients: A cross sectional study

Abstract Clinical utility of Whole Body Low Dose CT scan for detecting bone metastasis in Breast cancer patients: A cross sectional study Background: Skeletal scintigraphy (Bone scan) is the imaging of choice to detect bone metastasis in locally advanced and metastatic breast cancer patients. Nuclear medicine facilities are however limited in their availability. As an alternative diagnostic modality to bone scan, we studied the diagnostic capability of Whole-Body Low Dose CT (WBLDCT) scan for detection of bone metastasis in these patients. Materials and Method: This cross-sectional study was conducted from November 2021 to May 2023 at a tertiary healthcare center in India with an aim to study the clinical applicability of whole-body low dose computed tomography scan for detecting bone metastasis in patients with breast cancer. Breast cancer patients with primary tumor measuring 5cm or more, pathologically proven axillary lymph node metastasis, Stage III/IV disease, symptoms attributable to metastasis and suspected disease recurrence were included. All patients underwent WBLDCT and Bone scan within a period of about 2 weeks. WBLDCT was done during the same time as conventional dose CT scan was being done as part of metastatic workup. WBLDCT acquisition protocol was set in CT scan machine by modulating the technical parameters like Care dose 4D-automated, Care kV semi, rotation time &amp; noise index. The image analysis was performed by Radiologist and Nuclear medicine experts in a blinded fashion. Data was recorded in MS Excel sheet. Sensitivity, specificity, positive and negative predicative value, and concordance rates were calculated using SPSS software ver 25.0. Agreement amongst WBLDCT and Bone scan was calculated using Inter-rater agreement. p value &amp;lt; 0.05 was taken as significant. Results: 110 patients were enrolled in this study. The mean age of participants was 48.5 years and three fourth had stage III disease at presentation. Estrogen receptor positive disease was seen in 43.64% participants while 30% were triple negative. Her2neu positive disease was seen in 27.27% patients. Bone scan couldn’t be done in 03 patients who deferred treatment (these had no bone metastasis on WBLDCT). Both bone scan and WBLDCT detected bone metastasis in 19 patients. Bone scan picked up additional metastasis in three patients which were missed on WBLDCT. WBLDCT detected bone metastasis additionally in three patients which were not detected on Bone scan. Multiple lesions were most seen in vertebrae in 38.5% and 28.6% on bone scan and WBLDCT respectively. The sensitivity and specificity of WBLDCT for detection of bone metastasis was 86.36% and 96.47% respectively. The concordance rate between Bone scan and WBLDCT scan was 94.39% with an Inter-rater Kappa(k) quotient for agreement of 0.828 (p&amp;lt; 0.0001). Conclusion: WBLDCT scan has comparable diagnostic capability to skeletal scintigraphy in detecting bone metastasis in breast cancer and may be a useful alternative specially in resource limited settings. Table 1: Sensitivity, specificity, positive predictive value and negative predictive value of WBLDCT for detection of metastasis Variables Values Sensitivity (95% CI) 86.36% Specificity (95% CI) 96.47% AUC (95% CI) 0.91 Positive Predictive Value (95% CI) 86.36% Negative Predictive Value (95% CI) 96.47% Diagnostic accuracy 94.39% Inter-rater agreement (kappa) 0.828 Citation Format: Lipton Mitra, Suhani Suhani, Ankur Goyal, Rakesh Kumar, Mohit Joshi, Hemanga Bhattacharjee, Haresh KP, Raju Sharma, Rajinder Parshad. Clinical utility of whole body low dose computed tomography for detecting bone metastasis in breast cancer patients: A cross sectional study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-05-13.

A Study on Nature of Violence Against Doctors in Tertiary Care Centers in Karnataka, India: A Cross-Sectional Study.

Over the previous decades, violence against physicians has risen. To comprehend the issue connected with it, we need to know the nature of violence and doctor's views on the current state of safety at their disposal. The purpose of the study was to assess the incidence and nature of violence against doctors in tertiary health care centers in Karnataka, India. The objectives were to collect data from three tertiary care centers, evaluate the incidence of violence against doctors in tertiary care centers, and evaluate the nature of violence against doctors in tertiary care centers. From the list of all tertiary care centers in Dakshina Kannada, three tertiary care hospitals were randomly chosen. Approval of the Ethical Committee from the Institutional Ethics Committee (IEC) of KVG Dental College and permission from chosen hospitals were obtained. A pre-validated questionnaire was handed over to the available physicians and surgeons in these hospitals to be filled. The total number of participants in the study was 330. Nearly half (48.02% of physicians) reported experiencing violence during working hours. The Department of Obstetrics and Gynaecology recorded 43.2% of instances, while surgery, medicine, and other departments reported 23.6%, 22.8%, and 10.4%, respectively. Violence against physicians continues to be a huge issue that must be addressed through decisive measures by the police and hospitals. This impacts the healthcare system in the nation and often cripples it owing to the loss of human resources and working hours.

ASSOCIATION OF VITAMIN B12 DEFICIENCY AND MUCO-CUTANEOUS FINDINGS IN DERMATOLOGY: A CASE-CONTROL STUDY

Background:Vitamin b12 deficiency is considera common nutritional deficiency in Indian population.Vitamin B12 deficiency related to hair and cutaneous features like hair-fall, and cutaneous pigmentation are not well described in literature. Aim:To study serum vitamin b12 level in relation to diffuse hair-fall and muco-cutaneouspigmentation. Study design: Case-control observational study Materials and methods:Total 240 patients presented with diffuse hair-fall or muco-cutaneous pigmentation were taken as cases and screened for serum vitamin b12 level at tertiary health care centre. Other 240 patients of same age group presented with other dermatological conditions were taken as control. Also associated symptoms like weakness, malaise, numbness, tingling, paresthesia, burning sole, glossitis, angular cheilitis, angular stomatitis, aphthous stomatitis, graying of hair, mild memory impairment, irritability, psychosis, delusion of paresthesia, dementia and depression were noted in each patient. Results:Out of 240 patient females: male ratio was 3.52:1. Vegetarian:non-vegetarian ratio was 3.36:1. Out of 240 patients 42% patient presented with hair fall, 33% with hyperpigmentation and 25% had both complain. Facial pigmentationin 20%, extra-facial in 15%, both (facial &amp; extra-facial) in 45% of patients were noted. Mucosal pigmentation was present in 20%. Serum vitamin b12 level was low in 198 cases and 87 control. Hemoglobin level was low (&lt;10 gm/dl) in 196 0f cases and 127 of control. Amongst 240 cases weakness in 58, malaise in 22, numbness in 5, tingling in 15, paresthesia in 2, burning sole in 108, glossitis in 76, angular stomatitis in 13, aphthous ulcer in 31, graying of hair in 92, memory impairment in 18, irritation in 64, psychosis and delusion of paresthesia in 1, dementia in 8 patients were noted. Conclusions:Vitamin B12 deficiency is not rare, but data are insufficient regarding its prevalence. In our study, 240 patients with diffuse hair fall and muco-cutaneous pigmentation as case group and 240 patients as control group were included. Among groups, vitamin b12 deficiency was found in 198 cases and 87 control. We found that there was significant association with vitamin b12 deficiency, diffuse hair fall and muco-cutaneous pigmentation as clinical markers for dermatologists.

Clinical comparison of acute stroke cases with and without COVID-19

Background We aimed to assess acute stroke cases with and without coronavirus disease 2019 (COVID-19) positivity concerning clinical features and the number of hospitalizations acute stroke cases compared to the previous year. Methods Acute stroke patients with and without COVID-19 positivity, including those who were hospitalized in the neurology service and intensive care unit of tertiary healthcare center between 17 December 2020 and 31 January 2021 due to acute stroke, were included in this cross-sectional study. Results Mortality (p=0.042) and mechanical ventilation use (p=0.041) were more frequent in COVID-19-positive stroke patients compared to those without COVID-19. The most common type of stroke in COVID-19-positive acute stroke patients was ischemic stroke (69.23%). Additionally, stroke patients with COVID-19 had a significantly higher percentage of kidney disease compared to those without COVID-19 (p=0.009). We also observed that the number of acute stroke cases hospitalized in our hospital during the pandemic decreased significantly compared to the previous year (p=0.036). Conclusion Since the majority of our patients were diagnosed with COVID-19 after admission to the hospital due to stroke, it should be kept in mind that patients who apply to the hospital with stroke symptoms may also have COVID-19, even if they are asymptomatic.

Step-Up Management in Acute Pancreatitis: A Tertiary Care Center's Experience From Southern India.

Background The clinical spectrum of acute pancreatitis (AP) ranges from mild disease to severe form associated with multiorgan failure, prolonged hospital stay, high morbidity, and mortality. Acute necrotizing pancreatitis (ANP) is a severe form of AP. This study evaluates AP's outcomes after applying principles of the step-upapproach in a tertiary healthcare center in south India. Methodology This prospective observational study was carried out from January 2021 to December 2022. The study population includes patients admitted to our department with AP. Results Ninetypatients were included in the study, most of them were middle-aged males with ethanol ingestion as the common etiology. Thirty-seven (41.1%) patients had mild AP, 25 (27.7%)had moderately severe AP, and 28 (31.1%)had severe AP. Organ failure at admission was noted in 36 (40%) patients. Twenty-three (25.5%) patients developed ANP. Infected necrosis was noted in 3 (3.33%) patients. Eighteen (20%) patients needed image-guided percutaneous drainage. Seven (38.8%) needed necrosectomy following percutaneous drainage. Mortality was observed in 8 (8.8%) patients. Specifically, mortality was noted in 6 (6.6%) patients who presented later in their disease course. Conclusions Percutaneous catheter drainage is a safe and effective therapy to tide over the initial phase of AP. It also serves as a bridging therapy till the patient is clinically fit for a necrosectomy. Severe AP cases presenting late in their course are associated with significant mortality even after step-upmanagement. Standardized protocols for referral and management are essential to obtain a good clinical outcome.

Association of COVID-19 symptoms and functional status of the COVID-19 survivors in a tertiary health care center in a developing country

Background The COVID-19 pandemic has affected people globally, causing widespread illness and functional limitations. Methods This cross-sectional study aimed to investigate the association between COVID-19 symptoms and the functional status of COVID-19 survivors at Bangabandhu Sheikh Mujib Medical University (BSMMU) in Bangladesh. A total of 244 COVID-19 survivors were enrolled in the study, and their symptoms and functional status were assessed using standardized questionnaires. The post-COVID-19 functional status scale (PCFS) was used to assess the entire range of functional outcomes. Results Among the participants 57.4% were male and 42.6% were female. The mean (SD) age of the patients was 44.6 ±14.7 years where 37.7% were from the 20-35 years age group. The mean duration of suffering from COVID-19 was 15.9 ±6.1 days where 61.5 % of the patients had a duration of suffering of 11-20 days. Out of the 244 patients, 40 patients had no functional limitation (grade 0 functional status in the PCFS scale) while 100 had negligible functional limitation and 14 had severe functional limitation. We found patients who were suffering from multi-symptoms were statistically significant with PCFS scale grade 4, whereas grade 1 was found to be statistically significant with only respiratory distress. There was a significant association between the duration of COVID-19 symptoms and post-COVID-19 functional status for patients who experienced symptoms for 14 days or more (p&lt;0.05). Conclusions Considering the negative impact of COVID-19 symptoms on functional status, comprehensive care and support are required for COVID-19 survivors.

Clinical characteristics, imaging findings, management, and outcomes of patients with scimitar syndrome at a tertiary referral healthcare center in Colombia

Scimitar Syndrome is part of a complex spectrum of congenital cardiovascular anomalies related to anomalous pulmonary venous return. Depending on the extent of involvement, treatment can be either expectant or surgical. Prognosis and survival have been controversial, with some results supporting early surgical management. This research aims to disclose the outcomes and describe the management, clinical and imaging characteristics of patients diagnosed with Scimitar Syndrome treated in a tertiary referral healthcare center. Longitudinal descriptive observational study. The study included all patients diagnosed with scimitar syndrome in our institution between January/2011 and December/2022. A description of the sociodemographic and clinical characteristics, diagnostic tools used, treatment features, and patient outcomes is provided. Eleven patients were included, with a mean age at diagnosis of five years (CI 0–17), six of which were female (54.55%). Nine (81.82%) patients had evidence of a scimitar vein on the chest radiograph, six (54.55%) cardiac dextroposition, six (54.55%) pulmonary hypoplasia, five (45.45%) right pulmonary artery hypoplasia, and three (27.27%) had aortopulmonary collaterals. Four (36.36%) patients had horseshoe lungs, and four (36.36%) had bronchopulmonary sequestration. In the associations, two (18.18%) patients were found to have an atrial septal defect, three (27.27%) ventricular septal defect, and one (9%) had Tetralogy of Fallot. Pulmonary hypertension was demonstrated in two (18.18%) patients. Seven (63.64%) required surgical management to correct the scimitar vein, and two patients died due to unrelated complications. Scimitar syndrome presents diagnostic and treatment challenges, necessitating a multidisciplinary approach for timely care. Chest radiography and CT scans are primary diagnostic tools, with surgical intervention often warranted alongside other heart defects or significant hemodynamic repercussions. Medical management is effective for mild to moderate cases. Long-term patient outcomes remain uncertain due to study limitations, but improved life expectancy is anticipated with ongoing care.

Demographics and Pathomorphology of Ameloblastoma: A 9 Year Retrospective Review at a Tertiary Health Care Centre in North-Central Nigeria

Ameloblastoma is a benign but locally invasive neoplasm that arises from odontogenic epithelium of the dental lamina. It is classified into the conventional, unicystic, extraosseous/peripheral and metastasizing variants. It is the most common odontogenic tumour in Nigeria and other developing countries. It affects individuals of all ages, has a peak of occurrence in the fourth and fifth decades with no sex predilection. The Mandible is the most commonly affected site and the conventional variant is predominant. The aim of this study is to document the demographics and Pathomorphology of ameloblastoma diagnosed at the Jos University Teaching Hospital over the past nine years. There is no previous documentation of the pattern of this tumour in the North-central region of Nigeria making this study relevant. This is a retrospective observational review of all cases of ameloblastoma diagnosed histologically at the Jos University Teaching Hospital between January 1st 2015 to December 31st 2023. Materials utilized consisted of patient clinical case files, electronic histopathology result records, histopathology glass slides and formalin fixed paraffin embedded tissue blocks. The patient age, sex, anatomic location of tumour in the Jaw/face and pathomorphological features were recorded for all cases. The data obtained was analysed using Epi-info 7 (version 3.5.4) and Microsoft-Excel. Results were presented in tables and charts. Fifty one cases of ameloblastoma were diagnosed during the 9 years of review. Their ages ranged between 6 and 65 years with a mean age of 30.9±13.8 years and a peak of occurrence in the third decade. There were 29 males and 22 females with a male to female ratio (M:F) of 1.3:1. Ninety-two percent of cases occurred in the mandible and 8% in the maxilla. The conventional variant accounted for 72.5% of cases and the unicystic variant 27.5%. The follicular type accounted for 64.8% of cases of conventional ameloblastoma. Ameloblastoma occurred more commonly in males with a peak in the third decade. A vast majority of cases involved the mandible and the conventional type was predominant. This demographic pattern supports existing evidence that ameloblastoma occurs more commonly in males and in relatively younger patients in Africa.

Correlation of HbA1c with Various Hematological Parameters in Patients of Type 2 Diabetes Mellitus in a Tertiary Health Care Centre in North India: A Comparative Cross-Sectional Study

Introduction: Diabetes has become one of the leading Global health Emergencies and is ranked among the top 10 causes of mortality worldwide. Diabetes mellitus causes a wide range of complications including micro and macrovascular complications like microangiopathy, retinopathy, nephropathy, neuropathy and diabetic foot. HbA1c is considered as the Standard of Care for monitoring type 2 Diabetes Mellitus. We aim to evaluate the common hematological parameters along with inflammatory parameters like neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in patients of type 2 diabetes mellitus. Methods: This was an observational laboratory based cross sectional study in which cases were included from 1st November 2023 to 31st December 2023. Two hundred and thirteen cases were divided into two groups (Diabetic and Non-Diabetic group) based on HbA1c levels and exclusion criteria. All cases were assessed for RBC count, TLC, DLC, Hb, RDW, Hct, NLR and PLR. Data was analysed using IBM SPSS v 29.0.2.0 (20) software and Microsoft Excel. A p value of less than 0.05 was considered statistically significant. Results: The mean age of diabetic and non-diabetic groups were 52.9 years and 50.6 years respectively (p &gt; 0.05) with sex ratio of 1:2.1 and 1:1.7 respectively. There were significant differences in the means of the two groups for hematocrit levels, WBC count, neutrophil count, and NLR with p values of 0.001, 0.018, &lt; 0.001 and &lt; 0.001 respectively. There was no significant difference in the means for other parameters. Conclusion: The study results are consistent with the significant role of inflammation in etiopathogenesis of type 2 diabetes with significant increase in the levels of hematocrit, WBC count, neutrophils and NLR in patients with poor glycemic control. Furthermore, NLR being an easy and cost-effective tool along with its high association with microangiopathic complications, it needs to evaluated meticulously for assessing the prognosis in patients of type 2 diabetes mellitus.

Health Status of Working Women in a Tertiary Care Center, North Kerala, India: During the COVID-19 Pandemic

Introduction: Women constitute about one-half of the workforces in most countries and spend a significant proportion of their time at the workplace, contributing to a lot of physical and mental stress. The health-care professional in the workforce was the most affected during the COVID-19 pandemic. COVID-19 and noncommunicable diseases (NCDs) and associated risk factors have a substantial correlation. According to numerous studies from around the world, people who already have established risk factors such as diabetes, hypertension, obesity, or other vascular risk factors, are more likely to contract COVID-19 and experience complications or even pass away from it. Objectives: The objective is to assess the health status of working women in a tertiary health-care center in Kerala during the COVID-19 pandemic. Methodology: The study was done in a tertiary health-care center in Kozhikode district, Kerala, South India. This center comprises medical, paramedical and nursing institutes. A total of 262 women were included in the study, and data were collected using a semi-structured questionnaire. Results: This study demonstrated that working women’s stress was prevalent. It reveals that 94 (99.4%) women experience stress, 60.7% experience depression, 72.5% do not engage in daily physical activity and 80.8% of women were at risk of having NCDs. Conclusion: This study was an attempt to explore the health status of the women’s working health status during COVID-19 time. It found that some women are hypertensive, depressed and have stress-related disorders such as anxiety and worries. Mental health is directly linked with physical activity. The stress levels were controlled for those who were involved in physical activity on regular basis. Hence, we should work on this area to help improve these conditions.

Assessment of oral manifestations of systemic health related knowledge of medical students pursuing internship programme at a tertiary health care centre

AimClinicians across the entire medical profession are responsible for detection, prevention and imparting importance of oral health to the patients. However, many studies conducted so far show lack of knowledge of medical students regarding dental conditions. The present observational study was undertaken to evaluate the knowledge of oral manifestations of systemic diseases amongst medical students undergoing Internship program at a tertiary centre. Materials & methodA self-structured Questionnaire comprising of 20 questions was used as a survey tool to assess the understanding of 100 medical students undergoing internship program. They were explained about the purpose of the study. The questionnaire consisted of an objective part Yes/No (7 questions) and subjective part designed on likert scale(13 questions). There were questions on their view on current curriculum for dentistry in medical undergraduate training and possible enhancement in teaching modalities. The subjective part had five options to choose from, Strongly agree, Agree, Neutral, Disagree And Strongly Disagree. Statistical analysisThe responses of objective questions was recorded and percentage calculated for both options. The total score was obtained for each participant based on their reponses to the subjective questions based on the Likert scale. Student t-test was applied to calculate means between male and female students. ResultsFor all objective questions, percentage was calculated for affirmative and negative responses. The responses were calculated on scale5-1 for the subjective questions. Reverse scoring was done for questions 10,11,12 i. e scale 1–5. The maximum achievable score in this category was 65 which was further divided into three category as Excellent score range 55–65, Good score range 45–54, Unsatisfactory score range 35–44. The number of students in excellent category were 11, Good 66, unsatisfactory 23. The average score obtained was 48.175. The mean scores for males was 48.0161 and for females it was 48.142. The scores were slightly better for females but the difference was statistically insignificant as (p-value = 0.455056). ConclusionThe present study showed good level of Knowledge on oral manifestations of systemic diseases among medical students as compared to other studies which forms an integral part of medical curriculum. The students responses on enhancing dental curriculum and teaching aids for improved education tools can help the faculty provide a better teaching learning experience.