South Indian Tertiary Hospital Research Articles

A prospective cohort study of hypoalbuminemia as risk factor of wound healing in diabetic foot: a study from tertiary hospital in south India

Background: Diabetic foot ulcers is a major complication of diabetes mellitus, and precedes >80% of all diabetes related lower leg amputations. One of the risk factors in non-healing diabetic ulcer is low serum albumin level. The objectives of this study were to study the effect of low serum albumin level in patients with diabetic foot ulcer and to study the factors affecting wound healing in diabetic ulcer.Methods: Prospective cohort study in a tertiary hospital.Results: The mean age among study was 57.8 out of which 68.3% were males and 31.7% were females. 55% patients presented with slough over ulcer, 29.2% patients presented with healthy granulation and 15.8% patients presented with extensive wound infection. Among study group 50% patients had good glycaemic control and 50% patients had poor glycaemic control.Conclusions: Low serum albumin level is one of the attributable risk factor of non-healing ulcers in diabetic foot. Poor glycaemic status is also a risk factor for non-healing ulcer.

Prevalence and factors associated with breastfeeding in a population with good literacy

Background: Recent studies in the scientific world show that countries with high income levels and high maternal education have poorer breast feeding rates. This study was done in a population with good literacy with an objective to assess the knowledge, beliefs, practices, prevalence of breast feeding and factors associated with it among women with children less than two years of age.Methods: This was a cross sectional study done among 183 women at a tertiary hospital of south India in a population with female literacy 77% and male literacy 90%. Knowledge, beliefs and practices were assessed by validated questionnaire. Data entry and analysis were done with Epidata 3.1 and SPSS18 software.Results: The prevalence of early initiation of breast milk was 56.3% (95% CI: 48.98 to 63.62), colostrum to newborn 84.2 % (95% CI: 78.82 to 89.58),exclusive breast feeding (EBF)10.6% (95% CI: 6.02 to 15.18), predominant breast feeding 80.6% (95% CI: 74.72 to 86.48) and delayed complimentary feeding was 8.8% (95% CI: 4.58 to 13.02).Only 51% (95% CI: 42.92 to 57.68) had health professional guidance and among them only 29.34% (95% CI: 19.84 to 38.83) had received it after delivery. Lower segment caesarean section (LSCS) had 3.9 times (95% CI: 1.95 to 8.05) risk of late initiation of breast milk. Breast feeding information from relatives had protective effect from late initiation of breast milk with odds ratio 0.33 (95% CI: 0.16 to 0.66). Women who had not received health professional guidance had 3.5 times (95%CI: 1.13 to 11.00) risk of not practicing exclusive breast feeding.Conclusions: The knowledge and beliefs about breast feeding were encouraging. Inspite of good literacy women need guidance from health personnel for EBF. Mothers who had delivered by LSCS have to be given help to initiate breast feeding earlier.

A prospective study to compare the effectiveness of saline dressing versus povidone iodine dressing in chronic diabetic wound healing: study from a tertiary hospital in south India

Background: Saline dressings and povidone iodine dressings have been traditionally used for the management of chronic diabetic wounds Methods: Subjects attending diabetic wound clinic and surgery outpatient department/ casualty of Government Medical College and Hospital, Kozhikode, Kerala, India were divided into two groups by consecutive sampling i.e., Povidone iodine and Saline dressing group. Regular occlusive dressing was done for 6 weeks of follow-up period.Results: 3 out of 20 subjects in Saline treated group achieved complete healing by 6 weeks as compared to 1 out of 20 subjects in Povidone iodine treated group. There was a significant decrease in the wound surface area at 6th week in Saline dressing group in comparison to the povidone iodine group at P = 0.03 (<0.05) level of significance.Conclusions: Saline dressing is more effective in achieving healing in chronic diabetic wounds as compared to Povidone iodine dressing.

Aetiopathological and demographic profile of diabetic foot: a prospective cross sectional study from a tertiary hospital in South India

Background: Diabetes mellitus is a chronic disorder affecting large segment of population and is a major public health problem.Methods: A prospective cross sectional study of 150 patients conducted in the Department of Surgery at Government Medical College, Kozhikode, Kerala, IndiaResults: Maximum numbers of patients were in the age group of 60-69. Male to female ratio is 3.04:1.50% had duration of diabetes <10 years and 50% had duration ≥10. years. 81 (54%) patients had neuropathy, 53 (35.3%) had PVD, 41 (27.3%) had history of prior foot ulcer, 70 (46.7%) had poor glycemic control (RBS >200 mg/dl) at the time of admission and 44 (29.3%) had history of smoking.Conclusions: Most important risk factors for diabetic foot ulcers were neuropathy (54%), poor glycemic control (46.7%) and PVD (35.3%), diabetic foot requires a comprehensive management.

A study of clinical and laboratory profile of scrub typhus in children in a tertiary hospital in South India

Background: Scrub typhus is an acute febrile illness caused by infection with Orientia tsutsugamushi. The present study was conducted to study the clinical features, laboratory profile, complications and response to therapy among children suffering from scrub typhus in a tertiary health care institution of Tamil Nadu, India.Methods: The study was conducted at Saveetha Medical College Hospital, Tamil Nadu, India. Duration of the study was from August to December, 2015 in the Department of Pediatrics. Children with clinically suspected Scrub typhus were subjected to detailed clinical examination and investigation. Diagnosis of scrub typhus was confirmed by IgM ELISA. Results: 34 patients were diagnosed as suffering from scrub typhus. Common symptoms noted were fever, headache, cough and cold, chills, rigor, myalgia and vomiting. The common complications noted were thrombocytopenia in 16 children (47%) and features of meningoencephalitis and hepatitis were present in 2 children (5.8%). Eschar was identified in 24 (70.5%) patients. Mixed infection was seen in 4 (11.7%) children who had concurrent culture positive Urinary Tract Infection. Conclusions: Scrub typhus is an acute febrile illness which requires high index of suspicion for early diagnosis, monitoring of the clinical and laboratory parameters and prompt treatment which may help in complete cure without further complications and morbidity.

Associated Injuries in Maxillofacial Trauma: A Study in a Tertiary Hospital in South India.

Maxillofacial trauma when associated with concomitant injuries has a significant potential for increased morbidity. This study aims to identify the causes of trauma, evaluate the types of associated injuries and to highlight the significance of multi professional collaboration in sequencing of treatment. A total of 300 patients who reported to the casualty of a tertiary Hospital in Karnataka with facial fractures were enrolled. Associated injuries were sustained by 162 patients. The predominant aetiology was the Road Traffic Accident with maximum number of patients in the age group of 20-29 and a male to female ratio of 10.1:1. The mandible was the most frequently fractured bone. Head injury was the most common associated injury. The mortality rate was 0.66%. The mean ISS and GCS values among the patients who sustained associated injuries along with maxillofacial trauma were higher and lower respectively, as compared to those without associated injuries with a statistically significant difference (p<0.001). Implementation of strict road safety measures in the rural and interior regions of South India, to prevent morbidity and mortality due to road traffic accidents is essential. Injuries to the facial skeleton must be approached with the knowledge of probable associated injuries that could have been incurred.

Total serum calcium and corrected calcium as severity predictors in acute pancreatitis: a prospective study in a tertiary hospital in South India

Background: Acute pancreatitis still remains a disease of growing burden to mankind; it is an unpredictable, potentially lethal disease with a high mortality. The incidence of acute Pancreatitis appears to be increasing. Aim of the study was to evaluate total serum calcium and corrected calcium as prognostic severity factors in acute pancreatitis.Methods: This prospective study was conducted in a tertiary hospital from July2015 to June 2016. All the patients who were diagnosed to have acute pancreatitis by clinical examination, laboratory, radiological and biochemical investigations were considered as cases. Serum calcium and albumin corrected calcium measured within 24 hours of admission. Patients followed up for a maximum period of 4 weeks and outcome studied, in terms of whether patient had local or systemic complication, mortality. Significance of serum calcium and albumin corrected calcium in predicting outcome of acute pancreatitis is assessed and compared with BISAP score.Results: Acute pancreatitis most commonly occurs in the age group of 30-50. 80% of acute pancreatitis occurs in male and 20% in female. Alcoholism accounts for 58% cases of acute pancreatitis and gall stone account for 28% of acute pancreatitis.Conclusions: Hypocalcaemia and low ACC can predict severity of acute pancreatitis, as with BISAP score, but it is not superior to BISAP score.

Risk Factors for Urinary Tract Infections in Renal Allograft Recipients: Experience of a Tertiary Care Center in Hyderabad, South India.

Renal transplantation is an effective and commonly performed procedure for end-stage renal disease. Urinary tract infections are a major cause of morbidity and mortality in renal transplant patients. As data on postrenal transplant urinary tract infections from the Indian subcontinent are limited, the present study was conducted to estimate the burden of urinary tract infections in this vulnerable group of patients. This was a prospective study on patients undergoing renal transplantation in 2014 at our tertiary hospital in South India with a follow-up of 2 years to evaluate the risk factors for urinary tract infections. The prevalence of urinary tract infections was 41.9% with a male preponderance of 76.9%. Mean age of the 31 patients was 32.4 ± 10.2 years (range: 16–55 years). Gram-negative bacilli were the most common isolates with Escherichia coli being the predominant pathogen (53.3%). All the infections occurred within 1 year of transplantation with delayed graft function (P < 0.001; confidence interval [CI]: 29.0–96.3) and prolonged hospital stay (P = 0.0281; CI: 42.1–99.6) being the significant risk factors for acquiring urinary tract infections. Carbapenemase production was noted in 33.3% of isolates and all the Gram-negative organisms isolated in the 1st month of transplantation were carbapenem-resistant (CR) E. coli. The high rate of carbapenem-resistant organisms in the early posttransplant period is a point of concern, especially with cadaver transplants. Infection control practices and catheter care need to be strictly monitored to minimize the risk for UTI in the immediate posttransplant period.

Varicella Zoster Virus Infection of the Central Nervous System - 10 Year Experience from a Tertiary Hospital in South India.

Introduction:Varicella zoster virus is an exclusively human neurotrophic virus. The primary infection with the virus causes varicella. The virus remains latent in nervous tissue and upon secondary activation causes a variety of syndromes involving the central nervous system (CNS) including meningoencephalitis and cerebellitis.Materials and Methods:In this study, we looked at the epidemiology, clinical and laboratory features, and outcomes of patients who were admitted with varicella zoster of the CNS from 2005 to 2014.Results:There were 17 patients. Fever was present in 13 patients, seizures in 9 patients and headache and vomiting in 4 patients each. A generalized varicella rash was present in 8 out of 17 patients. A single dermatomal herpes zoster was present in seven patients. Two patients had no rash. Varicella zoster polymerase chain reaction (PCR) in cerebrospinal fluid (CSF) was done in 5 patients of which 4 were positive and 1 was negative. Nine patients had diabetes with an average glycated hemoglobin of 8.6%. Total number of deaths was five.Conclusions:Patients with diabetes who develop varicella or herpes zoster may be at risk for CNS complications. The diagnosis of varicella encephalitis has to rest on a combination of clinical findings and CSF PCR, as neither the rash nor the PCR is sensitive enough to diagnose all the cases with varicella encephalitis.

Prevalence of diabetic retinopathy in patients in a tertiary hospital in south India

Aims: To estimate the prevalence of Retinopathy in patients attending a diabetic clinic and to evaluate the risk factors underlying its development. Methods: 750 diabetic patients who reported for executive check up in a preventive clinic were evaluated for absence or presence of retinopathy. Diabetic Retinopathy (DR) present was graded as non proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). Risk factors were then evaluated in order to delineate those related to retinopathy. Investigations included complete blood count, blood sugar, serum lipids, ECG, Renal function tests and complete clinical examination. Results: DR was detected in 111 patients (14.8 %) with NPDR in 106 patients (14.1%) and PDR in 5 patients (0.7%). Factors related to the incidence of retinopathy were duration of diabetes, presence of hypertension, high blood sugar level and hyperlipidemia. It was found that duration of diabetes, level of glycemic control and high levels of cholesterol were statistically significant for the occurrence of retinopathy. Conclusion: In addition to glycemic control, lowering of serum lipids may be effective in lowering the incidence of retinopathy in diabetic patients .Hypertension was not related to the occurrence of retinopathy.

Are low birth weight neonates at risk for suboptimal renal growth and function during infancy?

BackgroundTo assess the renal growth and function of neonates during infancy in relation to birth weight and gestational age.MethodsA longitudinal study was conducted at a tertiary hospital in South India from June 2010 to August 2014. Low birth weight neonates (LBW) were further sub-classified based on gestational age and compared with normal birth weight (NBW) full term neonates at birth, 6 months and 18-24months of age. The renal volume was measured by ultrasound and renal function by Cystatin C- derived glomerular filtration rate (CysGFR) at the three time points during the dynamic phase of renal maturation in infancy.ResultsWe recruited 100 LBW and 66 NBW term neonates. Thirty five percent of the LBW neonates were SGA. Among the AGA neonates, 39 % were LBW neonates. The mean height and weight of the LBW neonates were significantly lower compared to NBW neonates throughout infancy. The increment in kidney volume was in accordance with the change in body size, being lower in LBW compared to NBW infants. The combined kidney volume was significantly lower in LBW and SGA neonates across all three time points (p < 0.001). CysGFR in the LBW and SGA infants, despite having low kidney volumes, were comparable to the GFRs of NBW and AGA neonates at the end of infancy.ConclusionThis study highlights the fact that both birth weight and gestational age influence kidney growth and function in infancy. At the end of infancy, despite a significant difference in kidney volumes and age at last follow up, the glomerular filtration rate was comparable between LBW and NBW infants. Though not statistically significant, there was a trend towards higher urine microalbumin in LBW compared to NBW in infancy.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0314-7) contains supplementary material, which is available to authorized users.

High Tobacco Use among Presumptive Tuberculosis Patients, South India: Time to Integrate Control of Two Epidemics

ObjectivesTobacco is an important risk factor for tuberculosis (TB) infection and TB disease. Identifying tobacco users and providing tobacco cessation services is expected to reduce the burden of TB. We assessed tobacco use among presumptive TB patients attending a tertiary hospital and their willingness to attend tobacco cessation services. MethodsA cross-sectional study was conducted among presumptive TB patients attending a designated microscopy center of a tertiary hospital in South India. All presumptive TB patients aged≥18 years attending the designated microscopy center were interviewed using a semistructured interview schedule. Data on presumptive TB patient's age, sex, tobacco use and forms of tobacco, attempts to quit tobacco since 1 year, and willingness to attend a smoking cessation clinic in tertiary hospital were captured. History of use of tobacco in the past 1 month was considered as “tobacco use.”. ResultsA total of 424 presumptive TB patients aged≥18 years were interviewed. Tobacco use in the past 1 month was reported by 176 (41.5%, 95% confidence interval: 36.9–46.3%) presumptive TB patients. In total, 78 (18%) presumptive TB patients were eventually diagnosed with smear-positive pulmonary TB, of them 63 (80%) were tobacco users. Presumptive TB patients aged≥30 years, male sex, and < 10 years of education were significantly associated with tobacco use. Of 176, a majority of 132 (75%) used some form of smoking. Of a total of 132 smokers, 70 (53%) were willing to avail of tobacco cessation services. ConclusionTobacco use among presumptive TB patients was high. Considering the high willingness to quit among smokers, proven brief interventions to help quit smoking can be tried.

CometQ: An automated tool for the detection and quantification of DNA damage using comet assay image analysis

Background and objectiveDNA damage analysis plays an important role in determining the approaches for treatment and prevention of various diseases like cancer, schizophrenia and other heritable diseases. Comet assay is a sensitive and versatile method for DNA damage analysis. The main objective of this work is to implement a fully automated tool for the detection and quantification of DNA damage by analysing comet assay images. MethodsThe comet assay image analysis consists of four stages: (1) classifier (2) comet segmentation (3) comet partitioning and (4) comet quantification. Main features of the proposed software are the design and development of four comet segmentation methods, and the automatic routing of the input comet assay image to the most suitable one among these methods depending on the type of the image (silver stained or fluorescent stained) as well as the level of DNA damage (heavily damaged or lightly/moderately damaged). A classifier stage, based on support vector machine (SVM) is designed and implemented at the front end, to categorise the input image into one of the above four groups to ensure proper routing. Comet segmentation is followed by comet partitioning which is implemented using a novel technique coined as modified fuzzy clustering. Comet parameters are calculated in the comet quantification stage and are saved in an excel file. ResultsOur dataset consists of 600 silver stained images obtained from 40 Schizophrenia patients with different levels of severity, admitted to a tertiary hospital in South India and 56 fluorescent stained images obtained from different internet sources. The performance of “CometQ”, the proposed standalone application for automated analysis of comet assay images, is evaluated by a clinical expert and is also compared with that of a most recent and related software—OpenComet. CometQ gave 90.26% positive predictive value (PPV) and 93.34% sensitivity which are much higher than those of OpenComet, especially in the case of silver stained images. The results are validated using confusion matrix and Jaccard index (JI). Comet assay images obtained after DNA damage repair by incubation in the nutrient medium were also analysed, and CometQ showed a significant change in all the comet parameters in most of the cases. ConclusionsResults show that CometQ is an accurate and efficient tool with good sensitivity and PPV for DNA damage analysis using comet assay images.

Clinical profile and serological epidemiology of scrub typhus and spotted fever among hospitalized children at a tertiary hospital in South India

Clinical profile and serological epidemiology of scrub typhus and spotted fever among hospitalized children at a tertiary hospital in South India

Clinical profile and serological epidemiology of scrub typhus and spotted fever among hospitalized children at a tertiary hospital in South India

Clinical profile and serological epidemiology of scrub typhus and spotted fever among hospitalized children at a tertiary hospital in South India

Correlation of carbapenem resistance and hypermucoviscosity in K.pneumoniae isolated from blood culture at a tertiary hospital in South India

Correlation of carbapenem resistance and hypermucoviscosity in K.pneumoniae isolated from blood culture at a tertiary hospital in South India

Predictors, outcome, profile of anti-tubercular drug induced hepatitis – A prospective nested case - control study in a South Indian tertiary hospital

Predictors, outcome, profile of anti-tubercular drug induced hepatitis – A prospective nested case - control study in a South Indian tertiary hospital

Clinicopathological study of cutaneous adnexal tumors in a tertiary hospital of South India

Introduction: Tumors of the cutaneous appendages are uncommon. They are categorized into sweat gland tumors, hair follicle tumors and sebaceous gland tumors. Benign adnexal neoplasm’s are more common than the malignant tumors. Aim: To study the spectrum of adnexal tumors of skin with respect to age, sex, site and histopathological pattern. Methodology: We conducted a retrospective analysis of 40 histopathologically confirmed cases of cutaneous adnexal tumors in a tertiary hospital of South India during three years. All the specimens of cutaneous adnexal tumors received during this period were analysed and lesions were categorized according to WHO classification system for Skin Adnexal Tumors. Result: 40 cases of Skin adnexal tumors were diagnosed during the study period. 21 cases (55%) were benign, while 19 cases (45%) were malignant. Skin adnexal tumors were most common in the age group of 31-50 years (35%), with equal sex distribution. The head and neck region was the most common site affected (37.5%) with 45% located on the face. The sweat gland tumors formed the largest group involving 55% cases followed by the hair follicle tumors (25%), followed by 10% each of apocrine gland and sebaceous gland tumors. Pilomatricoma was the most common benign tumor and malignant nodular hidradenoma was the most frequent malignant adnexal tumor in our study. Conclusion: Histopathological examination is the gold standard in the diagnosis of cutaneous adnexal tumors due to their wide spectrum and frequency of differentiation along two different lines within the same lesion. Keywords: Adnexal tumors, Histopathology, Skin, Pilomatricoma, syringocystadenoma

Next-day Parathyroid Hormone as a Predictor of Post-thyroidectomy Hypocalcemia

ABSTRACT Aims Total thyroidectomy is significantly complicated by parathyroid dysfunction and hypocalcemia. These aspects impact the decision regarding the timing of discharge and quantum of calcium supplementation required. Therefore, we aimed at evaluating the accuracy of next-day parathyroid hormone (PTH) level as a predictor of post-thyroidectomy hypocalcemia. Secondly, we aimed at establishing our institution's postoperative PTH level, which can accurately predict the development of post-thyroidectomy hypocalcemia to help us ensure the safe and early discharge of patients. Materials and methods A prospective observational study of 50 continuous patients undergoing thyroidectomy was conducted at a tertiary hospital in South India. Postoperative blood samples were collected for estimation of PTH, calcium, albumin, and phosphorous. The data were collated and results analyzed using Stata I/C 10.1. Results A total of 30% (15/50) of the patients had postoperative hypocalcemia (serum calcium &lt;8 mg/dL). Postoperative PTH was low (&lt;8 pg/mL) in 40% (20/50) of patients. There was a significant association between PTH &lt; 8 pg/mL and the presence of postoperative hypocalcemia (p = 0.029). The area under the receiver operating characteristic (ROC) curve was 0.7, and a next-day PTH of &lt;6 pg/mL showed the highest sensitivity and specificity (83 and 60% respectively) for the development of postoperative hypocalcemia, with a positive predictive value (PPV) and negative predictive value (NPV) of 83 and 60 respectively. Conclusion The PTH assessment performed the day after surgery is an acceptable test to predict post-thyroidectomy hypocalcemia; PTH &lt;6 pg/mL can be used as our institution's cutoff value. Department protocols for calcium and vitamin D supplementation following total thyroidectomy may be formulated based on the appropriately timed local postoperative PTH value to assist safe and early discharge of patients. Clinical significance Discharge protocols for patients undergoing thyroidectomy may be formulated based on the postoperative PTH values, thus enabling safe and early discharge of patients. How to cite this article Cherian AJ, Ramakant P, Paul TV, Abraham DT, Paul MJ. Next-day Parathyroid Hormone as a Predictor of Post-thyroidectomy Hypocalcemia. World J Endoc Surg 2016;8(3):203-207.

Acute undifferentiated febrile illness in patients presenting to a Tertiary Care Hospital in South India: clinical spectrum and outcome

Background:Acute undifferentiated febrile illness (AUFI) may have similar clinical presentation, and the etiology is varied and region specific.Materials and Methods:This prospective observational study was conducted in a tertiary hospital in South India. All adult patients presenting with AUFI of 3–14 days duration were evaluated for etiology, and the differences in presentation and outcome were analyzed.Results:The study cohort included 1258 patients. A microbiological cause was identified in 82.5% of our patients. Scrub typhus was the most common cause of AUFI (35.9%) followed by dengue (30.6%), malaria (10.4%), enteric fever (3.7%), and leptospirosis (0.6%). Both scrub typhus and dengue fever peaked during the monsoon season and the cooler months, whereas no seasonality was observed with enteric fever and malaria. The mean time to presentation was longer in enteric fever (9.9 [4.7] days) and scrub typhus (8.2 [3.2] days). Bleeding manifestations were seen in 7.7% of patients, mostly associated with dengue (14%), scrub typhus (4.2%), and malaria (4.6%). The requirement of supplemental oxygen, invasive ventilation, and inotropes was higher in scrub typhus, leptospirosis, and malaria. The overall mortality rate was 3.3% and was highest with scrub typhus (4.6%) followed by dengue fever (2.3%). Significant clinical predictors of scrub typhus were breathlessness (odds ratio [OR]: 4.96; 95% confidence interval [CI]: 3.38–7.3), total whole blood cell count >10,000 cells/mm3 (OR: 2.31; 95% CI: 1.64–3.24), serum albumin <3.5 g % (OR: 2.32; 95% CI: 1.68–3.2). Overt bleeding manifestations (OR: 2.98; 95% CI: 1.84–4.84), and a platelet count of <150,000 cells/mm3 (OR: 2.09; 95% CI: 1.47–2.98) were independent predictors of dengue fever.Conclusion:The similarity in clinical presentation and diversity of etiological agents demonstrates the complexity of diagnosis and treatment of AUFI in South India. The etiological profile will be of use in the development of rational guidelines for control and treatment of AUFI.