University College Of Medical Sciences Research Articles

Mortality in type 1 diabetes mellitus: A single centre experience from the ICMR – Youth onset diabetes registry in India

IntroductionThe prevalence of youth onset diabetes is rising globally along with a greater burden of complications and mortality in them. The current study was undertaken to examine the mortality and causes of death in patients with youth onset diabetesregistered in a tertiary care hospital in North India. MethodsWe analyzed mortality and causes of death in 1088 patients with youth onset diabetes registered from 2006 to 2019 at University College of Medical Sciences, Delhi. Information of death was obtained telephonically or by home visit or from hospital records wherever available. Verbal autopsy according to ICMR questionnaire was performed and cause of death determined as per WHO ICD-10/11. ResultsAmong 898 youth onset type 1 diabetes mellitus (T1D) patients who had a mean follow up of 6.4 years, 105 deaths (11.6 %) occurred. Forty three percent of deaths had diabetes onset at 15 years or below, and 75.6 % had HbA1C > 10 %. Deaths occurred in 24.2 % within 2 years and in 53.6 % within 3 years of diagnosis. Chronic Kidney disease, infections and ketoacidosis were the commonest causes. ConclusionWe found poor glycaemic control and high mortality in people with youth onset T1D being treated at a tertiary care hospital in north India.

Clinical and Bacteriological Profile of Necrotising Fasciitis at a Tertiary Care Hospital, New Delhi: An Observational Study

Introduction: Necrotising Soft Tissue Infection (NSTI) is a rapidly progressing infection characterised by extensive necrosis and widespread destruction of the soft tissues located anywhere from the superficial epidermis of the skin to the deep musculature. Aim: To explore the clinical characteristics and identify the bacterial agents responsible for Necrotising Fasciitis (NF). Materials and Methods: The present observational study was conducted in the Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur (GTB) Hospital, New Delhi, India, from November 2017 to April 2019, involving 77 NF patients. The clinical characteristics and identification of bacterial agents were achieved by analysing clinical specimens from cases clinically diagnosed with NF. The antibiotic resistance patterns of these bacterial isolates were also determined. Data was recorded in an Excel worksheet, and statistical analysis was conducted using Statistical Package for Social Sciences (SPSS) software version 21.0. Results: Total of 77 patients were included, among which 62 (80.5%) were males and 15 (19.4%) were females with the mean±Standard Deviation (SD) age 43.96±19.3 years. The most common bacteria isolated were Escherichia coli, 20 (25.3%). Staphylococcus aureus was isolated in nine patients, and of them, six were Methicillin-resistant Staphylococcus Aureus (MRSA). Conclusion: Early detection of NF, a severe infectious condition, can significantly reduce morbidity and mortality. The findings underscore the critical need for early diagnosis and treatment due to significant mortality rates.

Quality of Life of Developmentally Normal Children With Epilepsy and Their Siblings.

Quality of life (QOL) is a fundamental and multidimensional concept that should be considered with health problems, specifically chronic diseases, such as epilepsy. There have been limited studies on how pediatric epilepsy impacts the QOL of siblings of affected individuals. Hence, we studied the impact of epilepsy on the QOL of affected children and their siblings. This study aimed to assess the QOL of developmentally normal children with epilepsy and their siblings and the association of QOL scores with the clinicodemographic profile. This study was conducted at the University College of Medical Sciences and Guru Tegh Bahadur Hospital, New Delhi, India, a tertiary care hospital. The QOL of children (4-12 years) with epilepsy was assessed using epilepsy-specific questionnaires, i.e., Quality of Life in Childhood Epilepsy Questionnaire-55 (QOLCE-55), which covers the cognitive, emotional, social, and physical domains, and Pediatric Quality of Life Epilepsy Module (Peds QL EM), which covers the impact, cognitive, sleep,executive, and mood/ behavior domains. QOL in siblings was assessed using the Peds QL Inventory, which covers the following domains: physical, emotional, social, and school. The principal investigator administered these questionnaires to parents in Hindi/ English. Scoring was done as per standard instructions of the questionnaire. Clinical and demographic data were recorded in a pro forma. The median QOLCE-55 score was 81.12, with a range of 74.65-86.34, and the median Peds QL EM score was 89.31, with a range of 75.58-94.48. Overall, Cronbach's alpha of QOLCE-55 and Peds QL EM was >0.8. Breakthrough seizures (≥10) affected the overall QOL (p=0.001)and all domains of QOLCE-55 (except emotional function (p=0.44)) and Peds QL EM (except sleep/fatigue domain (p=0.59)). Age, sex, parental education, socioeconomic status, and type of epilepsy did not affect the overall QOL (p>0.05). The QOL of siblings was not affected as per the Peds QL Inventory score (median score 100) and self-made questionnaire. Our results suggest that the QOL of children with epilepsy was compromised, whereas the QOL of their siblings was not affected.

An Evaluation of the Second Trimester Thyroid Function Test in Gestational Diabetes Mellitus: A Case-Control Study.

Gestational diabetes mellitus (GDM) is defined as glucose intolerance in a female with its onset or first recognition during pregnancy. Females with GDM are at higher risk of developing antenatal complications like preeclampsia during pregnancy and increased risk of type 2 diabetes as well as cardiovascular disorders later in their life. Maternal thyroid changes in the first and second trimesters of pregnancy have been widely related to the risk of GDM.Hypothyroidism during pregnancy is associated with early and late complications like abortions, anaemia, gestational hypertension, placental abruption and postpartum haemorrhage, impaired infant neurodevelopment, and low birth weight. This study aims to compare the thyroid function test (TFT) (serum fT3, fT4, TSH)and thyroid peroxidase antibody (anti TPO) between GDM and non GDM pregnant women in the second trimester and to correlate the adverse pregnancy outcomes with TFT in GDM and non GDM women. A nested case-control study was done in the Department of Obstetrics and Gynaecology, Department of Endocrinology, Department of Paediatrics, University College of Medical Sciences, and Guru Teg Bahadur (GTB) Hospital, Delhi. About 350 pregnant women from 13 weeks till 28 weeks period of gestation were screened out of which 40 GDM and 40 non GDM women were selected after performing an oral glucose tolerance test (OGTT). A TFT and anti TPO test were compared between GDM and non GDM participants. Furthermore, various parameters like sociodemographic profile, mode of delivery, pregnancy outcomes, and adverse maternal and adverse neonatal outcomes were compared. The mean age of GDM women is found to be more than non GDM women. The mean TFTvalues are significantly lower in women with GDM as compared to non GDM women. In addition, higher values of anti TPO antibody (thyroid autoantibody) were found in the GDM group which aidsin insulin resistance. Maternal complications like polyhydramnios, preterm labour, and pregnancy-induced hypertension were found to be more frequent in the GDM group compared to the non GDM group, but the results were statistically not significant. There was a higher incidence of caesarean delivery in the GDM group. Thus, we recommend the implementation of routine thyroid function profile testing in all antenatal females especially those who are at risk of developing GDM. Our study is one of the few Indian studies to evaluate the association of TFT in GDM, and we recommend similar research with a larger sample size and postnatal follow-up.

Association of predictive factors and neurosurgical postoperative infections: A retrospective analysis

ObjectiveTo identify the factors that predispose neurosurgical patients to surgical site infections (SSI) as well as assess the risk factors attached to infection by a specific microorganism. MethodologyA retrospective case-control study was conducted at University College of Medical Sciences and G.T.B. Hospital, Delhi. Adult patients (>18 years) undergoing a neurosurgical procedure with a diagnosis of SSI in the year 2021 having a minimum follow up of 30 days postoperatively or until death if they survived less than 30 days were included. Statistical analysis was performed using the SPSS 16 software with level of significance at 0.05. ResultsAn incidence of 3.15% was observed at our center. Mean age of the study population was 39.2 ± 13.07 years (range 22–70 years) with a male: female ratio of 3:1. Having an underlying infection (p = 0.024), ASA score> 2 (p = 0.041), duration of surgery> 4 h (p = 0.025), diabetes (p = 0.027) and preoperative stay at the hospital (p = 0.036) were found to be statistically significant risk factors in the prediction of SSI in neurosurgical patients which were utilised to create a regression model with an accuracy of 70% and AUC of 0.833. Deep infections were found to have a significant association with positive culture on the collected samples (p = 0.035). ConclusionsThis study is a starting point to identify which factors could predict the presence of a particular organism isolated from the site of infection in neurosurgical patients, thereby minimizing AMR.

The Journey and Progress of the Department of Neurosurgery at the University College of Medical Sciences and Guru Teg Bahadur Hospital.

Guru Teg Bahadur Hospital (GTBH) associated with the University College of Medical Sciences (UCMS) is one of the largest hospitals associated with a medical college in the National Capital of Delhi, India. The Department of Neurosurgery was initially established here in 1997, but since its inception, has made rapid strides in terms of infrastructure and quality of patient care. The main objective of this article is to depict the history and path of progress of the Neurosurgery Department, from its inception to its present status, along with the inherent and existing challenges in running the department. A retrospective analysis from the time the department was established to its present status was done. The improvement of infrastructure, increase in patient inflow over the years, the number of procedures related to different subspecialties, and existing challenges along with the scope of further improvement were analyzed. There has been a significant upgradation of infrastructure more so in the last 5 years. Both indoor and outdoor patient attendance has increased over the years along with steady significant growth of the number of elective and emergency procedures. However, despite the progress, significant challenges hampering optimal patient care still remain to be overcome. The department right now is providing satisfactory patient care with absolutely no financial burden to the patients. Neurosurgery academic residency has recently resumed, and a wide range of neurosurgical conditions are being successfully treated. If the existing challenges are addressed in a timely manner, the coming years hold a bright future for the department.

Risk Factors of Incident Kidney Stones in Indian Adults: A Hospital-Based Cross-Sectional Study.

Background The diverse manifestations of urolithiasis providevery interesting epidemiological data. This has prompted various studiesto look into the etiopathogenesis of renal stones, which is believed to be multifactorial, both exogenous and endogenous. VDR Fok1 is a risk factor for renal stone formation and could cause the formation of renal stones through the mechanism of crystal induction and crystallization in the urine. While a few recent studies have shown the role of heavy metals like cadmium and lead in the formation of renal stones, the current knowledge is still insufficient. Methods This case-control prospective study was conducted in Guru Teg Bahadur (GTB) Hospital, a tertiary care facility in Delhi with 30 cases and 30 controls. Patients visiting the department of surgery between November 2011 and April 2013 were enrolled in the study. Cases were defined as patients with renal stones diagnosed on the basis of history and radiological investigations. Controls were selected from the patients admitted to the department of surgery for reasons other than renal stones. The study protocol was approved by the Institutional Ethical Committee of the University College of Medical Sciences, GTB Hospital, Delhi. Written informed consent was obtained from all patients.A structured questionnaire was used to collect data.Metal levels were analyzed by an atomic absorption spectrophotometer (Shimadzu Flame AA-680, Shimadzu Corp., Kyoto, Japan)at Delhi University. The vitamin D receptor gene was measured using genomic DNA.Horizontal agarose gel electrophoresis was used for the quantification of the genomic DNA. Results There were 30 cases and 30 controls in the study. Stress was more prevalent among cases (63%) compared to controls (36%). Nearly 83% of cases had the ff allele of the Vitamin D receptor gene compared to 46% of controls. The median arsenic and lead levels were higher among cases compared to controls.In the unadjusted model of logistic regression, we found stressed patients had three times higher odds of developing renal stones compared to non-stressed patients (OR (95% CI): 2.98 (1.04-8.52); p=0.04). Similarly, patients with higher blood concentrations of arsenic and lead had higher odds of developing renal stones compared to those with lower concentrations. Conclusions There was a definitive role of heavy metals, including lead, cadmium, and arsenic, seen with renal stones. A significant association was seen between the ff allele of VDR polymorphism (Fok1 enzymes) and patients with renal stones. Other parameters, including male and stress factors, seem to have an important role in renal stone formation.

Spectrum of Renal Involvement in Cancer Patients: A Cross-sectional Descriptive Study

Introduction: Cancer is associated with multiple renal manifestations like Acute Kidney Injury (AKI), Chronic Kidney Disease (CKD), proteinuria, and electrolyte imbalance. The reason behind renal dysfunction in cancer patients is multifactorial and can be attributed to underlying cancer and treatment modalities, in addition to co-morbidities surgical procedures and infections. Aim: To assess the spectrum of renal involvement in cancer patients presenting at a tertiary care hospital. Materials and Methods: The cross-sectional descriptive study, was conducted in the Department of Medicine of University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India. One hundred consecutive patients referred for nephrology consultation with diagnosed cancer, irrespective of cancer aetiology between the age group of 15-70 years with deranged kidney function test were recruited. Detailed medical and treatment history, including the type of cancer-solid or haematological, cancer status-cured or continuing, treatment given-chemotherapy, radiotherapy or surgery or a combination and associated co-morbidities like diabetes mellitus and hypertension were recorded. Routine investigations and special investigations, including assessment of estimated Glomerular Filtration Rate (eGFR) and estimation of Albumin-Creatinine Ration (ACR) was done. Patients were then segregated, based on their kidney function test into groups with AKI or CKD and underlying cause was valuated. Summary statistics was presented as mean, median or frequency and data analysed using Statistical Package of Social Sciences (SPSS) version 24.0. Results: The mean age of the study population was 53.73±12.20 years with 63% male and 37% female participants; 87% patients had solid cancers, while 13% had haematological cancers. The median duration, since the diagnosis was seven months and the patients were undergoing chemotherapy, radiotherapy or a combination of both; seven patients had surgery for underlying malignancy and an additional six had received chemotherapy or radiation therapy along with surgery. At the time of recruitment, 78% patients had AKI and 22% patients were diagnosed with CKD. Chemotherapy-induced nephropathy was the most common cause of AKI (n=46). In the CKD group diabetes (n=7) was the most common aetiology. Conclusion: The kidneys in cancer patients can be involved in a number of ways, as a consequence of the cancer itself, its treatment, superimposed infections or associated comorbidities. Chemotherapy-induced nephropathy is the most common cause of AKI, whereas, diabetes is the most common cause of CKD in cancer patients.

Evaluation of Serum Soluble Endoglin Levels in Pre-eclampsia: A Case-Control Study

Introduction: Soluble Endoglin (sEng) has an anti-angiogenic effect, by inhibiting of Transforming Growth Factor (TGF)-β1 bond at endoglin receptors and inhibiting vasodilatation. sEng levels increase in Pre-eclampsia (PE) due to hypoxic placenta and there have been possible role of it in the pathogenesis of PE and its therapeutic implications. Aim: To compare serum sEng levels in pre-eclamptic patients (cases) versus control. Materials and Methods: This case-control study was carried out November 2019 to October 2021, in the Department of Obstetrics and Gynecology, University College of Medical Sciences, Delhi. On 40 cases with a singleton pregnancy with diagnosis of PE enrolled as cases and 40 normal healthy pregnant women matched for age and gestational age as controls. sEng was estimated using commercially available Enzyme- Linked Immunosorbent Assay (ELISA) kit. Last uterine (Ut) and Umbilical Artery (UA) doppler findings were noted and sEng levels were compared with doppler studies. The analysis was done using student t-test and Chi-square test. Results: A total of 80 participants were included in the study, 40 in case group (mean age 26.53±4.93 years) and 40 in control group (mean age: 25.35±3.10 years). A total of 21 PE cases were Non Severe PE (NSPE) (52.5%) and 19 were Severe PE (SPE) (47.5%). Early-onset PE was observed in n=11 (28%) and the remaining n=29 (72%) had late-onset PE. sEng was significantly higher in pre-eclamptic women 55.08±21.42 ng/mL as compared to controls 44.15±12.02 ng/mL (p=0.006). Higher levels of sEng were seen in SPE 59.20±28.44 ng/mL vs NSPE 51.36±11.66 ng/mL (p 0.066). sEng levels between early onset PE (50.93±5.89 ng/mL) and late onset PE (56.66±24.84 ng/ ml) (p= 0.832). sEng levels were higher in cases with abnormal Resistance Index (RI) of Ut artery 54.23±6.68 ng/mL than in normal RI of Ut artery 54.23±6.68 ng/mL, though not significant. Abnormal Ut artery RI doppler was seen more in early-onset (n=2, 33%) than in late onset PE (n=1, 7%). Conclusion: PE cases had significantly higher levels of sEng compared to controls. Thus, it can be concluded that, there is a definitive role of sEng in pathogenesis of PE due to its antiangiogenic action.

Genetic Polymorphism in Patients with Diabetic Nephropathy and Retinopathy: A Cross-sectional Study

Introduction: The chronic persistence of diabetes leads to microvascular complications, such as Diabetic Nephropathy (DN) and Diabetic Retinopathy (DR). Both of these are progressive disorders involving pathological changes in capillaries. A few biochemical pathways have been suggested to link hyperglycaemia and microvascular complications. The probability of developing and progressing DN and DR is associated with the duration of diabetes. These complex disorders are strongly influenced by both genetics and environmental factors. Several candidate genes have been reported to be associated with DN and DR in different populations. Aim: To determine the co-existence of DN and DR in relation to gene polymorphisms of Angiotensin-Converting Enzyme (ACE), Angiotensinogen (AGT), Receptor for Advanced Glycation End-products (RAGE), Aldose reductase (ALR2), and Vascular Endothelial Growth Factor (VEGF). Materials and Methods: The present DN and DR cross-sectional study was conducted at the Department of Endocrinology, University College of Medical Sciences, University of Delhi and GTB, New Delhi, India, and the Discipline of Biochemistry, Indira Gandhi National Open University, New Delhi, India. The study was conducted from October 2019 to August 2022. All the participants under uniform diabetes management were divided into two groups (100 in each group): Group 1 included Type-II diabetic patients with DN and DR, and Group 2 comprised Type-II diabetic patients with DN only. Polymorphisms in all genes were determined using Polymerase Chain Reaction (PCR), followed by digestion with restriction enzymes and visualisation through an ultraviolet transilluminator. The analysis of biochemical parameters and association of gene polymorphisms was performed using Statistical Package for Social Sciences (SPSS) version 26.0 software. Results: There were 57 males and 43 females in the DN+DR group, and 51 males and 49 females in the DN-DR group. The mean age of study subjects in the DN+DR group was 52.60±9.08 years, compared to the DN-DR group (47.33±10.68 years). The DN+DR group had a significantly higher mean duration of diabetes (11.78±6.86 vs. 5.13±4.78, p≤0.001) and a significantly lower mean waist circumference (91.30±13.99 vs. 95.11±9.95 cm, p≤0.02). The DN+DR group also had significantly higher urea (34.34±16.32 vs. 26.43±12.34 cm, p≤0.001), creatinine (1.34±0.90 vs. 0.89±0.25 cm, p≤0.03) and significantly lower estimated Glomerular Filtration Rate (eGFR) levels compared to the DN-DR group. The distribution of genotypes of ALR2 (p≤0.04) and VEGF genes (p≤0.001) showed a significant difference between both DN+DR and DN-DR groups. The frequency of the D allele of the VEGF gene (p≤0.02) (OR=1.94, 95% Confidence Interval (CI)=1.10-3.40) was higher in the DN+DR group. The DN+DR group also had a significantly lower frequency of the CT+TT dominant model of the ALR2 gene (p≤0.04) as well as an increased frequency of the ID+DD dominant model of the VEGF gene (p≤0.002). No significant differences were found in genotypic as well as allelic frequencies of ACE, AGT, and RAGE gene polymorphisms between the two groups. Conclusion: The D allele of the VEGF (I/D) gene polymorphism is significantly associated with DR in patients with DN. It can be concluded that the VEGF gene plays an important role in the development of retinopathy in DN patients.

User awareness about marketing of library products and services: A study of University College of Medical Sciences and Vallabhbhai Patel Chest Institute, University of Delhi, Delhi

User awareness about marketing of library products and services: A study of University College of Medical Sciences and Vallabhbhai Patel Chest Institute, University of Delhi, Delhi

Role of Aspergillus Specific IgG Titres as a Therapeutic Target for Chronic Pulmonary Aspergillosis: A Longitudinal Study

Introduction: Chronic Pulmonary Aspergillosis (CPA) continues to be an enigma to clinicians in regions with a high prevalence of pulmonary tuberculosis and is often misdiagnosed as the latter, attributable to the significant overlap in symptoms and radiology. Moreover, although the diagnostic criteria for CPA have been standardised, the role of serological markers in monitoring disease activity and response to therapy is still not well characterised. Aim: To understand the characteristics, risk factors and treatment outcomes in patients developing CPA and to determine the role of serological markers as indicators of disease activity. Materials and Methods: The present longitudinal study was conducted in the Department of Respiratory Medicine, University College of Medical Sciences and its associated Guru Teg Bahadur Hospital, Delhi, India from February 2021 to June 2022. Study included 46 patients suspected of harbouring CPA attributable to their clinico-radiological presentation. The diagnosis of CPA was made using the established criteria. Patients with a confirmed diagnosis of CPA received oral azole antifungals for 6 months and were monitored at 3-monthly intervals for reduction in baseline parameters to determine treatment success/failure. Paired and unpaired parametric variables were compared using the t-test and non parametric methods were compared using the Chisquare test. Results: The diagnosis of CPA was established in 31 (67.4%) patients of whom 77.6% were males and the mean age was 47.3±2.2 years. These patients had been symptomatic for 5.8±1.2 years. Underlying risk factors (such as the history of tuberculosis, chronic obstructive pulmonary disease, diabetes mellitus, history of long-term glucocorticoid use etc.) had been present for 6.9±1.3 years. Patients harboured an average of two risk factors with tuberculosis and diabetes mellitus being the most common local and systemic affliction, respectively. Patients with tuberculosis (p-value=0.001) and chronic steroid use (p-value=0.029) were significantly at higher risk of developing CPA. 6 months of azole therapy led to significant reduction in specific IgG titres (p-value=0.001), and serum precipitins (p-value=0.004). Two patients on itraconazole relapsed within 12 months but were successfully treated with voriconazole. Conclusion: Tuberculosis was the most significant local risk factor leading to the development of CPA, which developed soon after diagnosis of another systemic risk factor. Six months of azole therapy was adequate to induce remission of the disease, activity of which can be monitored though the measurement of serum IgG antibody titres.

Dietary Supplementation of Vitamin D to Curb Rickets in Children under Five Years in India

Purpose: Rickets is a common disorder among children under five years mostly in the developing countries. It negatively affect normal growth and development of children thereby reducing their genetic potential. The purpose of this study was to analyze the cause of rickets in children under five years and solutions available.
 Methodology: This study employed a descriptive cross-sectional approach and was conducted in the pediatric outpatients department of the Guru Tegh Bahadur (GTB) Hospital & University College of Medical Sciences (UCMS) Delhi. The study period was one year from September 2021 to September 2022 on 130 diagnosed cases of the rickets. Patients were enrolled via non- probability convenient sampling technique and a set developed inclusion and exclusion criteria. Data was collected through self-structured questionnaire after taking informed consent. Data analysis was done using SPSS version 26.
 Findings: The study found out that giving getting enough of both vitamin D and calcium is crucial to maintaining bone health and protecting against disorders like osteoporosis, a condition that is characterized by weak, brittle bones. While the daily value (DV) of vitamin D is 800 IU per day, the recommended dietary allowance (RDA) differs slightly depending on your age. Children and adults ages 1–70 need approximately 600 IU of vitamin D per day. This can come from a combination of food sources and sunlight. Adults over 70 should aim for at least 800 IU (20 mcg) of vitamin D per day. The RDA for calcium also varies by age. Children ages 4–8 need about 1,000 mg of calcium daily. Children ages 9–18 need approximately 1,300 mg daily. Adults ages 19–50 need about 1,000 mg daily. Over the age of 50, most people need 1,200 mg per day.
 Conclusion: The study conclude that children aged between one and three years are more susceptible to rickets than children between four and five years. The study also conclude that lower socioeconomic background, male gender, exclusive breastfeeding, unbalanced nutrition and mother’s poor nutritional status all contribute to high incidences of rickets in children under five years. Vitamin D is necessary for calcium absorption in your body. This plays a key role in maintaining bone strength and skeletal integrity.
 Recommendations: Supplements should be added in the diet of children during breastfeeding. Also, there should be adequate sunlight exposure of children. Finally, malnutrition of both children and mothers should be treated.

Analyzing Causes of Rickets in Children under Five Years and Solutions Available in India

Purpose: Rickets is a common disorder among children under five years mostly in the developing countries. It negatively affect normal growth and development of children thereby reducing their genetic potential. The purpose of this study was to analyze the cause of rickets in children under five years and solutions available.
 Methodology: This study employed a descriptive cross-sectional approach and was conducted in the pediatric outpatients department of the Guru Tegh Bahadur (GTB) Hospital & University College of Medical Sciences (UCMS) Delhi. The study period was one year from September 2021 to September 2022 on 130 diagnosed cases of the rickets. Patients were enrolled via non- probability convenient sampling technique and a set developed inclusion and exclusion criteria. Data was collected through self-structured questionnaire after taking informed consent. Data analysis was done using SPSS version 26.
 Findings: Nutritional rickets was prevalent among children aged between one and three years with males being 61.74% and females being 38.26%. Children from lower socioeconomic background comprised 59% while children under exclusive breastfeeding comprised about 62%. Additionally, children supplemented cow’s milk but had rickets were 38% while children exposed to less sunlight comprised 57%. The study also found out that children that were exposed to sunlight when fully clothed had incidence of rickets at rate of 48% while children who were not oil-massaged during sunlight exposure comprised 31%. Finally, children who were subjected to unbalanced nutrition comprised about 78.34% while children whose mothers were under poor nutritional status comprised about 67%.
 Conclusion: The study conclude that children aged between one and three years are more susceptible to rickets than children between four and five years. The study also conclude that lower socioeconomic background, male gender, exclusive breastfeeding, unbalanced nutrition and mother’s poor nutritional status all contribute to high incidences of rickets in children under five years. Vitamin D is necessary for calcium absorption in your body. This plays a key role in maintaining bone strength and skeletal integrity.
 Recommendations: Supplements should be added in the diet of children during breastfeeding. Also, there should be adequate sunlight exposure of children. Finally, malnutrition of both children and mothers should be treated.

P374 Fungal coinfection in patients with SARS-CoV-2: Atertiary care hospital study

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PMBackgroundThere is a high risk of developing fungal co-infections in patients infected with SARS-CoV-2, few studies have been conducted on the incidence and risk of these secondary infections. The incidence of Candida infection due to different Candida species is increasing in COVID patients.MethodsThis retrospective study comprised a total of 23 patients with upper respiratory infection investigated in the Department of Microbiology of University College of Medical Sciences (UCMS) and Guru Teg Bahadur Hospital (GTBH), Delhi from April 2021 to June 2021. Identification was done using DNA sequencing.ResultsOf the 23 cases, identification by DNA sequencing, C. albicans was present in 34.78%, C. tropicalis in 30.43%, Pichia kudriavzevii in 26.08%, C. parapsilosis in 4.3%%, and C. auris in 4.3%.Conclusion C. albicans is the leading pathogen in our patients, along with the rise in the incidence of P. kudriavzevii which is usually an environmental contaminant. Regular surveillance and infection control practices are future ventures to reduce the burden of infection.

P127 Cytokine gene Polymorphism in superficial Malassezia associated skin diseases

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM Objectivesü To isolate and characterize Malassezia species from patients of Pityriasis Versicolor (PV), Atopic Dermatitis (AD), Seborrhoeic Dermatitis (SD), and healthy controls.ü To study single nucleotide polymorphism in IL-10 and IFN- γ genes of the host and its relation with susceptibility to Malassezia infection.MethodsIt was a prospective observational study done in University College of Medical Sciences and GTB Hospital, Delhi. Sample size comprised of 38 cases each of AD. Skin scrapings were used for fungal culture on Sabouraud Dextrose Agar (SDA) and Modified Dixon Agar (MDA) and isolates were identified as per conventional phenotypic methods. Genomic DNA was extracted from blood samples and Cytokine genotyping was carried out by Amplification Refractory Mutations System-Polymerase Chain Reaction (ARMS-PCR) with sequence-specific primers. Three SNPs (IL10-1082A/G; IL10-819/592C/T; IFN-g +874A/T) in two cytokine genes were assessed in all the patients and healthy controls. Chi-squared Test or Fisher's-Exact Test and Bonferroni's correction were used for statistical analysisResults Malassezia yeast was isolated in 94.7%, 63.1% each and 52.6% in PV, AD, SD, and healthy controls respectively. Malassezia globosa was the most commonly isolated species from both patient and healthy control. Malassezia sympodialis was the second most common followed by M. furfur and M. restricta. Association between specific cytokine gene polymorphism and clinical outcome was found to be significant in PV, AD, and SD group. IFN-γ +874 T allele and IFN-γ +874 A allele were significantly associated with PV and AD respectively. IFN-γ +874 AA genotype frequency was found to be higher in PV and AD patients than in controls. This finding suggests that PV and AD patients may produce a lower IFN-γ. IL10-819/592 C/T alleles were also significantly associated with PV. IL10-819/592 CT genotype frequency was found to be lower, and CC genotype frequency was found to be higher in PV patients as compared to healthy controls, suggesting that IL10 production may be higher in PV patients. AD patients were more likely to carry the IL10–1082 G allele and, it was significantly associated with this disease. Moreover, IL10-1082 AG genotype was significantly associated with AD and SD, which corresponds to high production of IL10.ConclusionThe identification of Malassezia yeast to a species level is of a great importance to determine which species are implicated in certain skin diseases.The use of phenotypic methods for identification of Malassezia species is a reliable, easily executed method, that is also inexpensive. Molecular methods are necessary to decrease the turnaround time, especially for slow-growing Malassezia species.Cytokine gene polymorphism studies in IL10 and IFN γ genes demonstrated susceptibility of host to Malassezia infections. Comparison with the serum cytokine levels will help in understanding the evolution of Malassezia infections in susceptible host.Population genetics studies require inclusion of a larger number of subjects to evaluate the probability or the frequency of occurrence of the genotype.

P367 Candida sepsis in neonates a neglected pathogen: study from neonatal intensive care unit tertiary care hospital

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM IntroductionSignificance of Candida species in neonatal intensive care units (NICU) is increasingly being recognized. It is the third most common cause of late-onset sepsis in NICU patients and accounts for 9 to 13% of bloodstream infections (BSI) in neonates. Although Candida albicans has historically been the most frequently isolated species, recently non-albicans Candida (NAC) have emerged as an important opportunistic pathogen, notably Candida tropicalis, C. parapsilosis, C. krusei, C. glabrata, and C auris. This changing trend and the increasing use of azoles agents is now a matter of concern due to the emerging resistance of the non-albicans species to azoles.AimTo evaluate the Candida sepsis in neonates from neonatal intensive care units from a tertiary care hospital.Material and MethodsA cross-sectional study was conducted in the Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, East Delhi, India, during the period of July 2021 to December 2021. Overall, 30 suspected Candida sepsis patients from neonatal intensive care units were enrolled in the present study. The Candida spp. Isolated was identified as per standard mycological techniques. Preliminary identification was done by colony morphology on SDA, chromogenic media (Hichrome, Himedia Pvt. Ltd.), grown at 45°C, germ tube test, chlamydospore formation, and was confirmed by carbohydrate fermentation and assimilation tests. Antifungal susceptibility testing (AFST) was performed for Fluconazole (25 μg), and amphotericin B (AMB, 100 units) using the disc diffusion method on Muller-Hinton agar supplemented with 2% glucose and methylene blue (5 mg/ml). Zone diameters were interpreted as per the approved Clinical Laboratory Standards (CLSI-M44-A) guidelines. Quality control for AFST was performed using C. albicans-ATCC 90028 and C. parapsilosis-ATCC 22019.Statistical analysisThe statistical analysis was done using Statistical Package for Social Sciences (SPSS) version. The P-value ˂0.05 were considered as statistically significant.ResultOut of 30 Candida species from suspected septicemia neonates, non-albicans Candida (NAC) species accounted for (87%) compared to C. albicans (13.4%). Candida tropicalis was predominant at 9 (30%) followed by C. glabrata 8 (27%), C.parapsilosis 4 (13.3%), and C. krusei 3(10%), Pichia species (4.2%), and C.auris (3.4%). Antifungal sensitivity of the NAC isolates demonstrated >85% resistance to fluconazole amongst C. glabrata, C. parapsilosis, though amphotericin B had 100% sensitivity in all Candida species. The risk factor for candidemia as observed in our study were low birth weight 26(87%), use of broad-spectrum antibiotics 25 (83.4%), presence of an orogastric tube 18 (60%), and total parental nutrition 9 (30%) were significantly associated statistically (P <.05, paired t-test). The overall mortality amongst these neonates was 16.6%.ConclusionFungal BSI has emerged as an important cause of morbidity and mortality in neonates. Reporting of fungal bloodstream infections and the spectrum of species involved are essential measures in neonatal intensive care units in order to implement appropriate preventive and therapeutic strategies.

Knowledge and risk perception towards human immunodeficiency virus and hepatitis B infections among medical students

Background and objectives: Nosocomial human immunodeficiency virus (HIV) and hepatitis B virus (HBV) infections are common occupational hazards transmitted through infected needle-stick injuries. Younger medical students are at a higher risk of exposure mainly because of their inexperience and ignorance. Both these infections are preventable if standard precautions and protocols for post-exposure prophylaxis are followed. The present study assesses the knowledge, and risk perception among medical students and interns towards HIV and HBV infections, to guide instructors in planning appropriate training programmes. Methods: Following approval of the institutional ethics committee of University College of Medical Sciences, Delhi, India, (UCMS) undergraduate medical students and interns were invited to respond to an indigenously designed questionnaire regarding HIV and HBV infections. Participation was voluntary and anonymous. The students were assessed vertically. Results: There was a gradual increase in the awareness regarding HIV and HBV infection with each passing academic year. The percentage of total questions answered correctly was highest (91.1%) in internship and lowest (71.5%) in the first semester. Awareness regarding HIV was greater as compared to HBV infection in all the groups. Interns had maximum awareness of post exposure prophylaxis available for both HIV and HBV infections. Ninth semester students scored the highest on pre-exposure prophylaxis for HBV infection. Overall, the interns were the most aware. Conclusion: Students’ knowledge on HIV and HBV infections improves as these areas are covered in greater detail during exposure to clinical disciplines. An early clinical exposure module for first year medical students in the Competency Based Medical Education curriculum may provide an opportunity to improve awareness, to reduce infection and subsequent morbidity. The students have greater awareness of HIV than HBV, though the risk of transmission is higher for the latter. Thus, shortcomings in imparting knowledge about hepatitis B must be identified and rectified.

Effect of vitamin D supplementation on serum VEGF levels in vitamin d deficient polycystic ovarian syndrome patients

To estimate and compare serum VEGF levels before and after vitamin D supplementation in vitamin D deficient PCOS patients. The present study was conducted in Department of Obstetrics and Gynaecology in collaboration with Department of Biochemistry at University College of Medical Sciences (UCMS) and Guru Teg Bahadur Hospital (GTBH), Delhi from November 2017 to April 2019 (including enrollment of subjects, data analysis and thesis writing). Considering a standard deviation of 36.5 before supplementation and 42.7 after supplementation in VEGF levels in case of PCOS patients in study of Irani et al., to estimate an absolute difference of 31 units pg/ml decrease in VEGF levels, at α= 5% and power= 80%, a sample of 26 cases is required. Since there is a follow up of 3 months adding an attrition of 15%, the total sample size becomes 30 cases. Significant increase in serum vitamin D levels post supplementation was observed from pre supplementation 9.524±4.41 to post supplementation 32.07±12.40; p-value &amp;#60;0.001. We observed significant fall in angiogenesis marker, serum VEGF levels post vitamin D supplementation from 773.547±344.173 to 639.97±119.02, p value 0.004 which suggests negative correlation between serum Vitamin D and serum VEGF levels. Vitamin D supplementation in PCOS patients who are vitamin D deficient, leads to significant fall in angiogenesis marker serum VEGF, which is manifested as improvement in clinical and biochemical parameters in these patients.

Evaluation of Two Doses of Intrathecal Clonidine on Analgesia and Haemodynamic Profile in Elderly Patients Undergoing Endoscopic Bladder SurgeriesA Randomised Clinical Trial

Introduction: Endoscopic bladder surgeries like Transurethral Resection Of Prostrate (TURP) and Transurethral Resection Of Bladder Tumour (TURBT) are performed preferably under spinal anaesthesia, using local anaesthetic like bupivacaine along with an adjuvant. Of these adjuvants used, clonidine is gaining popularity because of its safety and various advantages associated with its use. However its effect on haemodynamics, effect on block characteristics and analgesia in elderly patients has not been studied extensively. Aim: To evaluate the analgesic efficacy and safety of clonidine 30 µg and 50 µg, in elderly patients undergoing endoscopic bladder surgeries. Materials and Methods: It was a double blinded randomized control trial, conducted in Department of Anaesthesia, University College of Medical Sciences, Delhi, India, from September 2008 to October 2011. Sixty American Society of Anaesthesiology (ASA) grade I and II patients, of age 50-80 years, undergoing endoscopic bladder surgeries, were randomly allocated into three groups of 20 each. Group C received 12.5 mg of 0.5 % heavy bupivacaine (2.5 mL) without clonidine, while group A and group B received 30 µg and 50 µg, respectively of clonidine. Intraoperative non invasive and invasive haemodynamic monitoring was done. The duration of analgesia (the time from the intrathecal injection to Visual Analog Scale (VAS) score greater than 0 and Bromage Scale 3), quality of anaesthesia and haemodynamic were compared between the three groups. Analysis of variance (ANOVA) for repeated measures was used for analysing the collected data. Tukey’s Honest Significant Difference (HSD) test was applied as post hoc test whenever applicable. Results: The mean duration of complete analgesia was 3.32±1.80 hours in group A, 6.30±1.45 hours in group B, and 2.22±0.92 hours in group C. The duration of complete analgesia was significantly longer in group A and B, when compared to group C. The mean duration of effective analgesia was 6.05±0.88 hours in group A, 8.65±1.75 hours in group B, and 4.68±1.77 hours in group C. The duration of effective analgesia was significantly longer in group A and B, as compared to group C. Following intrathecal injection, there was no significant difference in heart rate, Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP), cardiac output, stroke volume, systemic vascular resistance in between groups. There were no significant side effects in any of the groups. Conclusion: Intrathecal clonidine in a dose of 30 µg and 50 µg provides faster onset, better quality and prolonged duration of block with stable haemodynamic and minimal side effects in patients undergoing endoscopic bladder surgeries.