Obstetric outcomes and key determinants in a South Indian state: Insights from a tertiary care hospital

Introduction: Electroconvulsive Therapy (ECT) originated as a form of biological/neuro modulatory treatment for psychiatric disorders. In recent decades, its use is declining despite evidence-based international guidelines, but on the contrary, there has been an increase in research on ECT. Aim: To explore the sociodemographic profile, clinical profile, ECT parameters, side-effects and outcomes of modified ECT among patients who received ECT over the past six years (2019-2025). Materials and Methods: This retrospective study was conducted in Department of Psychiatry, Aarupadai Veedu Medical College and Hospital (AVMCH), Vinayaka Mission’s Research Foundation (VMRF-DU), Puducherry, India in March 2025 to September 2025. The medical records were obtained for 71 patients who received ECT in the last six years (May 1st, 2019-May 31st, 2025). The data were collected using a semistructured proforma for sociodemographic details, clinical profile, ECT parameters and the clinical response. The data was entered in MS Excel 365 and statistical analysis was done using mean and standard deviation for continuous variables, percentage and frequency for categorical variables. Results: A total of 64 records were included out of 71. The most common ICD 10 diagnosis of subjects who received ECT was bipolar affective disorder- 21 (32.8%), followed by Schizophrenia- 19 (29.6%). The most common indication for ECT, irrespective of diagnosis was irritability/aggression/ violence- 19 (29.7%). The clinical response of the subjects who received ECT were improved in 43 (67.2%), partially improved in 15 (23.4%) and not improved in 6 (9.4%). Conclusion: In the present study, no major life-threatening complications was found with minimal and manageable sideeffects following modified ECT. ECT was indicated predominantly for mood disorders followed by psychotic disorders, especially, for those patients with irritability/aggression.

Vancomycin-resistant enterococci (VRE) and Vancomycin-variable enterococci (VVE) pose significant challenges in urinary tract infections (UTIs) due to limited treatment options and silent resistance genes. To determine the prevalence, resistance profiles, and clinical outcomes of VRE and VVE in UTIs at a Regional AMR Surveillance Centre in North India. A cross-sectional study was conducted among hospitalized UTI patients (≥18 years) at a tertiary care hospital. Enterococcus isolates were identified by MALDI-TOF MS and tested for antimicrobial susceptibility (CLSI 2023). PCR was used to detect vanA, vanB, and vanC genes. All vanA-positive but phenotypically susceptible isolates were subjected to reversion assays on vancomycin-supplemented agar to confirm VVE status. Clinical data were analyzed for risk factors and outcomes. Of 130 Enterococcus isolates, 88.5% were E. faecalis and 11.5% E. faecium. VRE prevalence was 16.2% (21/130), with 90.5% harboring vanA. VVE comprised 8.5% (11/130). All 11 vanA-positive but phenotypically susceptible isolates reverted to resistance on vancomycin-supplemented agar, confirming true VVE. VRE showed 100% resistance to ampicillin, with high resistance to nitrofurantoin (85.7%), while VVE exhibited 63.6% ampicillin resistance and 9.1% nitrofurantoin resistance. Both groups retained 100% susceptibility to linezolid and fosfomycin. Clinical risk factors associated with VRE/VVE included urinary catheterization, ICU admission, and prolonged hospitalization (>30 days). Mortality was higher in VRE (25%) and VVE (18.2%) compared to VSE (6.3%) (p=0.023). This study confirms the presence of VVE in India by demonstrating reversion of all vanA-positive, vancomycin-susceptible isolates to resistant phenotypes. The high prevalence of VRE/VVE, driven by vanA, highlights the inadequacy of phenotypic AST alone. Targeted molecular screening of high-risk isolates may be considered to prevent therapeutic failure. Linezolid and fosfomycin remain effective options, but urgent strengthening of stewardship and infection control measures is warranted.

This study aimed to investigate whether prebypass endogenous melatonin concentrations are associated with perioperative oxidative DNA injury, indexed by urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG), and to explore their relationship with postoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in children undergoing cardiac surgery with cardiopulmonary bypass (CPB). A prospective, observational study. A single-center study conducted in a tertiary care hospital. Eighty pediatric patients (neonates to 18 years) undergoing corrective cardiac surgery with CPB. No experimental intervention was performed; blood and urine samples were collected perioperatively for biochemical analysis. Serum prebypass and postbypass melatonin levels were measured by enzyme-linked immunosorbent assay; urinary 8-OHdG and NT-proBNP were quantified immediately and 24 hours postoperatively. Postbypass melatonin concentrations correlated positively with age (r = 0.288, p = 0.010) and negatively with surgical duration (r = -0.230, p = 0.040). Higher prebypass melatonin levels tended to be associated with lower postoperative urinary 8-OHdG (r = -0.300, p = 0.007). Postoperative 8-OHdG showed strong linear correlations with NT-proBNP both immediately and 24 hours after surgery (r = 0.516, p < 0.001; r = 0.451, p < 0.001). In multivariable analysis, 8-OHdG remained an independent predictor of NT-proBNP, whereas melatonin did not. Oxidative DNA injury is strongly associated with postoperative myocardial stress in pediatric patients undergoing CPB. Prebypass melatonin status showed an exploratory, nonindependent relationship with perioperative oxidative stress, while oxidative stress markers were robustly linked to NT-proBNP. These findings delineate a redox-cardiac stress axis in pediatric CPB and support further investigation into the role of endogenous antioxidant capacity in perioperative cardiac stress.

Timely end-of-life decision-making is critical for ensuring quality care in the pediatric intensive care unit (PICU). We evaluated the impact of intensivist-led care on the timing and structure of end-of-life (EOL) practices. We retrospectively reviewed 39 PICU deaths over a 3-year period at a tertiary care hospital. Patients were categorized into pre-intensivist (no intensivist), passive-intensivist (intensivist without authority), and active-intensivist (intensivists with full decision-making authority) periods. Physician Orders for Life-Sustaining Treatment (POLST) completion increased (pre: 50.0%, passive: 28.6%, active: 100%; P < .01), while DNR completion declined (pre: 30.0%, passive: 35.7%, active: 0%; P = .049). Time from decision to death increased to 5.0 days (P = .038). Cardiopulmonary resuscitation-related deaths decreased from 30.0% (pre) and 42.9% (passive) to 6.7% (active) and no escalation of support increased to 93.3% during the active-intensivist period (P = .044). Intensivist-led care significantly enhanced POLST documentation and reduced aggressive interventions, promoting structured EOL practices in the PICU.

Background: Leukocytosis as a marker of inflammation is commonly seen after left ventricular assist device (LVAD) placement. Differentiating reactive postoperative leukocytosis from infection can drive antimicrobial stewardship initiatives. Methods: We conducted a retrospective chart review of adults who underwent durable LVAD implantation between 2017 and 2019 at a tertiary care hospital. We described the white blood cell (WBC) count trends postoperatively after LVAD placement. Secondary outcomes included comparing the WBC trends between patients with and without bacteremia or clinical evidence of infection requiring antimicrobial therapy. Results: We included 115 LVAD patients with a median age of 61 years. We noted a peak in median WBC count to 14.3 (×10 3 /μL) (interquartile range: 11.3, 17.6) on day 2 postoperatively and another, slightly lower peak of 14.0 between days 10 and 12. After day 12, the median WBC count declined gradually to a normal range. There were 8 (6.9%) LVAD patients with clinical or microbiological evidence of infection; postoperative WBC trends were similar when these patients were excluded. Conclusions: Postoperative leukocytosis is common after cardiopulmonary bypass, especially in LVAD patients. This expected post-LVAD leukocytosis should not prompt antimicrobial therapy without other signs of infection.

Unplanned Readmissions After Surgical Repair of Congenital Heart Defects at a Tertiary Care Hospital.

Long-Term Outcomes Following Traumatic Injury in Older Adults in Pakistan: A Prospective Cohort Study.

Assessment of Communication and Handover of Clinical and Nursing Care Information in a Tertiary Care Hospital

Idiopathic inflammatory myopathies (IIM) are rare autoimmune disorders. Their clinical heterogeneity often leads to diagnostic delays, which have been associated with worse outcomes. In individuals with darker skin phototypes, cutaneous signs may be less apparent, further complicating recognition. We aimed to evaluate the association of diagnostic delay with disease activity and cumulative damage in patients with IIM. We conducted a cross-sectional, comparative study at a tertiary care hospital in Mexico from November 2024 to July 2025. Patients aged 18years or older diagnosed with IIM were included and classified according to established criteria and a treating rheumatologist's assessment. Data collected included demographics, comorbidities, skin phototype, and serology. Disease activity was measured using the myositis disease activity assessment tool which includes the Myositis Disease Activity Assessment Visual Analog Scale (MYOACT) and the Myositis Intention-to-Treat Activity Index (MITAX) and cumulative damage using the Myositis Damage Index (MDI). Patients were stratified by diagnostic delay, ≤ 5months, and > 5months. Statistical analysis included correlation tests and group comparisons. 53 patients were included, mean age of 45.3years; 84.6% women. Dermatomyositis was the most frequent subtype (62.2%). Patients with diagnostic delay > 5months were significantly younger (p = 0.02) and showed higher disease activity (MYOACT p < 0.001; MITAX p = 0.005) and damage (MDI extent p = 0.03). Fitzpatrick phototypes IV-V were more prevalent among patients with longer diagnostic delays (80.7% p = 0.002 vs. 51.8% p = 0.002). Longer diagnostic delays in IIM were associated with increased disease activity, functional impairment, and disproportionate impact on younger patients and those with darker skin tones. These findings highlight the need for earlier recognition and equitable diagnostic practices in diverse populations. Key Points •A diagnostic delay ≥ 5 months is associated with greater accumulated damage and disease activity. • A darker skin phototype and a younger age predispose to a longer diagnostic delay. • Delayed diagnosis was associated with worse physical function.

Isolated brachiocephalic artery-A multi-modality management in a tertiary care hospital in South India

Clinical differences between metformin-associated lactic acidosis and metformin-unrelated lactic acidosis: A descriptive study.

Background: Aging is the universal and biological process, with increase in life expectancy and reduction in fertility rates contributing to steep rise in the elderly population. This demographic transition has great implications for healthcare systems, as geriatric population are more susceptible to chronic diseases, reduced body function and medication related complications. Potentially Inappropriate Medications (PIMs) are a significant concern among geriatric patients due to age-related pharmacokinetic and pharmacodynamic changes. The Beers criteria, developed by the American Geriatric Society (AGS), serves as an essential tool to identify and reduce inappropriate prescribing. Objective: The objective of this study is to assess the appropriateness of prescribing medication among the geriatric patients using 2023 AGS Beers Criteria and to identify factors associated with PIM use. Methodology: A cross-sectional study was conducted among 310 geriatric inpatients (≥65 years) admitted at General Medicine Department of government tertiary care hospital in Mandya for period of 6 months. Medication appropriateness was evaluated using the 2023 AGS Beers Criteria. Data were analyzed using descriptive statistics, Chi-square tests, and binary logistic regression to assess associations between PIM use and predictors such as age, gender, number of diagnoses, and polypharmacy. Results: Among 310 patients included in the study 50.6% were female and 49.4% were male patients. The mean age of the population was 73.4 ±7.27 years, with median age of 72 years. Out of 310 patients 122 patients were prescribed with at least one PIM, out of 2,129 total number of medications with an average of 6.87 drugs per patients, 5.73% drugs were found to be PIMs. The frequently prescribed PIMs were found to be Antihistamine drug Chlorpheniramine, rapid acting insulin, and aspirin accounting up to 33.2%, 16.5%, and 15.7% respectively. The most frequently prescribed PIM category was Category 1, accounting for 75.8% of PIMs. Polypharmacy showed a statistically significant association with PIM use (p &lt; 0.001), while age group, gender, and number of diagnoses were not significantly associated. Binary logistic regression revealed that patients with polypharmacy had 12 times higher odds of receiving a PIM. Conclusion: PIM use among geriatric inpatients was high, with polypharmacy being a significant predictor. Implementing regular medication reviews using Beers Criteria could improve prescribing quality and reduce adverse outcomes in this population. Educating and training healthcare professionals on geriatric pharmacotherapy, and involvement of clinical pharmacists on routine patient care is necessary.

Study of Prescription Pattern of Antimicrobial Agents in the Medical Intensive Care Unit (MICU) of a Tertiary Care Hospital

BACKGROUND Heart failure (HF) is prevalent worldwide; however, due to the absence of a dedicated monitoring system in India, an adequate assessment of epidemiological trends in HF remains unaccomplished. Determining the profile of patients with HF facilitates early detection and therapy, minimising the disease burden. AIM To describe the demographics, clinical characteristics, haematological and biochemical parameters, electrocardiogram and echocardiogram findings and recognise the various causes of HF in India. METHODS This was an observational study conducted between May 2019 and December 2020 at a tertiary-care institution in North India. Consecutive adult patients with clinically stable chronic HF were enrolled. Demographic characteristics, clinical features, laboratory parameters, electrocardiographic findings, echocardiographic data, and HF etiology were recorded using a standardised questionnaire. RESULTS This study enrolled a total of 407 chronic HF patients with a mean age of 58.8 years, 64.4% of whom were male. The mean left ventricular ejection fraction was 38.47%. Ischemic heart disease is the leading cause of HF, accounting for 53.6% of the population. Diabetes was the most prevalent linked co-morbidity (28.6%), followed by hypertension (21.5%). The majority of individuals had HF with reduced ejection fraction (58.5%), and the most frequent presenting symptom was exertional dyspnea. Complete guideline-directed medical therapy, defined as concurrent use of an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, beta blocker, and mineralocorticoid receptor antagonist (in any dose), was achieved in 64% of patients. Newer therapies like angiotensin receptor-neprilysin inhibitors were prescribed in only 6.6% of patients. Of 95.6% patients were in sinus rhythm (atrial fibrillation in 4.4%). The other findings included left bundle branch block (21.1%), left anterior hemiblock with right bundle branch block (10.2%), and right bundle branch block (7.6%). CONCLUSION HF in this cohort occurred at a younger age and was predominantly ischemic in etiology, with most patients having HF with reduced ejection fraction. Despite reasonable guideline-directed medical therapy prescription rates, suboptimal dosing and low uptake of newer therapies highlight the need for structured HF care and improved access to evidence-based treatment in India.

BackgroundNon-small cell lung cancer (NSCLC) patients who have mutations in their epidermal growth factor receptor (EGFR) gene respond more favorably to tyrosine kinase inhibitors (TKIs) than to standard chemotherapy. However, tissue biopsy-based EGFR testing is invasive, costly, and technically challenging. Plasma-derived circulating tumor DNA (ctDNA) offers a minimally invasive and cost-efficient alternative for mutation profiling. This study assessed the agreement between EGFR mutation status in plasma-derived ctDNA and tissue biopsy in NSCLC patients from tertiary care hospitals in Bangladesh.MethodsIn this cross-sectional analytical study, we recruited 32 patients with NSCLC before EGFR-TKI treatment. EGFR mutations in ctDNA samples were identified using the Amplification Refractory Mutation System (ARMS) polymerase chain reaction method. Tissue biopsy results were obtained from routine diagnostic procedures. Agreement between ctDNA and tissue biopsy results was assessed using kappa statistics, and diagnostic performance metrics were calculated.ResultsMost of our study participants were male (75%) and had stage IV lung adenocarcinoma (72%). We observed substantial agreement between plasma-derived ctDNA samples and tissue biopsies (kappa, κ = 0.683). This agreement was almost perfect (κ = 0.826) when calculated for patients with stage IV disease. The overall concordance was 84.4%. Compared with tissue biopsy, ctDNA testing yielded a sensitivity of 73.3% and a specificity of 94.1%.ConclusionPlasma-derived ctDNA demonstrates substantial agreement with tissue biopsy for EGFR mutation detection in patients with NSCLC, particularly those with advanced-stage disease. These findings support ctDNA as a viable alternative for molecular profiling in settings where tissue biopsy is limited or impractical.

Introduction: Kidney damage refers to pathologic abnormalities suggested by imaging studies or renal biopsy, abnormalities in urinary sediment, or increased urinary albumin excretion rates. The true incidence and prevalence of CKD are challenging to determine due to the asymptomatic nature of early to moderate stages. Methodology: The prospective observational study was carried out for a period of 6 months. The study was conducted in Nephrology department in a tertiary care hospital. A written and informed consent was obtained from the recruited patients. A Total of 200 patients were enrolled in the study. Aim: The study aimed to assess the renal dosing practices, stages, treatment profile and outcomes in kidney disease patients in a tertiary care hospital. Results &amp; Discussion: In our study 36-45 years age patients were 59(29.5%) as compared to other ages. Stages of renal failure includes 5 stage patients were more 66(33%) as compared to other renal failure stages. Clinical manifestations of renal failure Patients Dysuria patients were more 63 (31.5%), as compared to other clinical symptoms. Drug prescribing pattern for renal failure management includes ACE inhibitors prescribed drugs patients were more 56 (28%) as compared to ARB prescribed drugs patients were 52 (26%), Calcitriol prescribed drugs patients were 33 (16.5%), Vitamin D prescribed drugs patients were 25 (12.5%), Atorvastatin prescribed drugs patients were 34 (17%). Conclusion: To combat the rising burden of CKD, comprehensive strategies must be implemented, including early detection, management of underlying conditions, lifestyle modifications, and public health interventions to address environmental and genetic factors at the clinical level.

Background and objective: Non-ionic iodinated contrast media (NICM) are widely used in computed tomography (CT) to enhance imaging of internal structures. Although NICMs reduce hypersensitivity reactions (HSRs) compared with conventional ionic formulations, adverse events including rash, urticaria, and rarely anaphylaxis remain clinically important. This study aimed to evaluate the incidence, clinical characteristics, and severity of HSRs associated with various NICMs. Methods: A retrospective cohort study included patients undergoing contrast-enhanced CT between January 1, 2021, and December 31, 2023. Immediate HSRs were assessed using the Naranjo algorithm. Descriptive statistics summarized demographics and HSR features, and Fisher’s exact test evaluated differences in severity between contrast agents. Results: Among 412 patients (42.5% male; median age 60 years, IQR 52–67), most had normal or mildly impaired renal function. Seven NICMs were used. HSRs were predominantly mild-to-moderate cutaneous reactions, mainly rash with itching and urticaria. While anaphylaxis and angioedema were observed in only eight patients. Highest HSR incidences were observed with iomeprol (100.00%), iohexol (88.60%), and iobitridol (88.00%) which severity distribution did not differ significantly among NICMs (p &gt; 0.05). In addition, most reactions were classified as “probable” or “possible” by the Naranjo algorithm. Conclusion: HSR to NICMs were predominantly mild and largely limited to cutaneous manifestations, while moderate and severe reactions are rare but clinically significant. Although numerical differences in reaction rates were observed among individual contrast agents, no statistically significant association was identified between type of contrast media and severity.

Intramedullary spinal cord tumors (IMSCTs) are typically treated with maximal safe resection, during which neurosurgeons often monitor for neurological injury using muscle motor evoked potential (mMEP) and direct wave (D-wave) neuromonitoring. The predictive value of changes in D-waves for identifying motor outcomes is underexplored. This study evaluated the utility of D-waves for predicting postoperative motor deficits. Patients who underwent resection of a primary IMSCT with mMEP neuromonitoring from 2003 to 2023 at a tertiary care hospital were identified. Patients who underwent D-wave monitoring in addition to mMEP monitoring were compared to those who underwent mMEP monitoring alone using the Mann-Whitney U-test, chi-square test, and Fisher's exact test. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of D-wave and mMEP monitoring for identifying new neurological deficits immediately postoperatively and at 1 month, 6 months, and last follow-up were calculated. After matching, 125 patients were included (median age 42.0 years; 57.6% male; median follow-up 34.0 months), of whom 88 had both mMEP and D-wave data. The most common pathologies were ependymoma (64.0%) and astrocytoma (17.6%). Patients who did and did not undergo D-wave neuromonitoring had similar preoperative neurological function, primary pathology, tumor grade, and tumor location. D-wave use was associated with increased gross-total resection (88.6% vs 64.9%, p = 0.002) and reduced mortality (5.7% vs 24.3%, p = 0.007), length of stay (5.0 vs 6.0 days, p = 0.033), and 30-day readmission (2.3% vs 13.5%, p = 0.013) and reoperation (1.1% vs 10.8%, p = 0.012). At the 6-month follow-up, D-wave monitoring alone was superior to mMEP and combination monitoring for detecting new motor deficits. D-wave monitoring had peak sensitivity (77.8%) and NPV (96.5%) at 6 months and peak specificity (95.8%) and PPV (76.9%) in the immediate postoperative period. D-wave monitoring was associated with reduced mortality and was more accurate than mMEP monitoring alone or combination monitoring for detecting new postoperative neurological deficits. Further prospective studies are needed to validate these results.

Antifungal stewardship programs are increasingly implemented to optimize antifungal use. Pharmacists are frequently involved in these programs; however, their specific contributions and impact have not been systematically characterized. The aim of this systematic review was to synthesize the available evidence regarding the role and impact of pharmacists in antifungal stewardship programs, specifically focusing on clinical, utilization, and economic outcomes, using a narrative synthesis approach. A systematic review was conducted. PubMed/MEDLINE and Scopus databases were searched for studies published from database inception to January 2026. Two reviewers independently screened titles, abstracts, and full texts according to predefined eligibility criteria. Data extraction was performed independently using a standardized form. Due to heterogeneity in study designs and outcomes, a narrative synthesis approach was applied. The review was reported in accordance with the PRISMA reporting guidelines. Risk of bias was assessed using the ROBINS-I tool for non-randomized studies. Fifteen studies met the inclusion criteria, the majority of which were quasi-experimental pre-post intervention studies conducted in tertiary care hospitals. Key pharmacist-driven interventions included antifungal dose optimization, de-escalation or discontinuation of therapy, facilitation of early appropriate antifungal treatment, therapeutic drug monitoring, and education or protocol development. Across studies, pharmacist involvement was associated with improvements in antifungal prescribing quality and stewardship process outcomes, including potential improvements in duration of antifungal therapy, antifungal consumption (measured by defined-daily-doses or days-of-therapy), time to appropriate therapy, and antifungal-related costs. Effects on clinical outcomes such as mortality and length of hospital stay were variable and generally not statistically significant. The overall certainty of the evidence is low to very low by the observational nature and the moderate-to-serious risk of bias of the included studies. Pharmacist participation in multidisciplinary antifungal stewardship teams may be associated with improved antifungal utilization and adherence to guidelines in hospitalized adults. The findings support that pharmacists are important members of multidisciplinary teams in antifungal stewardship.