Objectives:
The objectives of this study were to analyze the profile of outpatient department (OPD) attendance of a tertiary care hospital during pre- and post-pandemic lockdown period.
Materials and ...Methods:
All consecutive patients presenting to OPD from August 1, 2019 to November 23, 2020 were included in the study. The sample was divided into Zone R (Regular domain) and Zone L (Lockdown domain). Zone L was divided into three groups A, B, and C; representing attendance to be <30%, 30–60%, and >60% of previous (i.e., Zone R), respectively. The patient gender, intradepartmental, and inter departmental OPD attendance data were collected and analyzed.
Results:
n
= 428,322 patients attended the OPD in the study period. 301,586 patients presented in Zone R and 126,736 presented in Zone L (
P
= 0.000). Zone L recorded an OPD attendance drop to 42% of Zone R. The least attended an OPD (Group A) was ophthalmology, ENT, dermatology, surgery, and orthopedics versus highest attendance (Group C) was noticed in emergency OPD and oncology with a moderate decline in the rest (
P
= −0.00, 0.00, and 0.00, respectively). Both male and female attendance in the OPD showed a decline; however, the gender divide was apparent with significantly low women attendance in all the departments (
P
= 0.00).
Conclusion:
OPD attendance showed a significant reduction in COVID lockdown era hitting the non-emergent medical branches the most. The gender divide significantly widened with less female attendance recorded in most OPDs in pandemic lockdown. Apt administrative measures could prove fruitful by an improved OPD attendance and its psychosocial implications to a society with less disease burden.
Cardiovascular toxicity caused by cancer therapy is a challenging area which needs thorough evaluation and research. Numerous studies, meta-analyses and reviews have been published in the past ...discussing cardiotoxicity caused by chemotherapeutic agents. A brief review of the on-target and off-target cardiotoxicities caused by chemotherapeutic agents is presented here. Cardiotoxicities are broadly outlined in terms of left ventricular dysfunction, hypertension and thromboembolic events. The mechanisms leading to the cardiotoxicity profiles of various chemotherapeutic agents are discussed. The management of various cardiotoxicities of chemotherapeutic agents is also discussed.
BackgroundThe immunomodulatory effects of vitamin D are widely recognized and a few studies have been conducted to determine its utility in the treatment of tuberculosis, with mixed results. This ...study was conducted to see if vitamin D supplementation in patients with active pulmonary tuberculosis (PTB) in the Indian population contributed to sputum smear and culture conversion as well as the prevention of relapse.MethodsThis randomized double-blind placebo-controlled trial was conducted in three sites in India. HIV negative participants aged 15-60 years with sputum smear positive PTB were recruited according to the Revised National Tuberculosis Control Program guidelines and were randomly assigned (1:1) to receive standard anti-tubercular treatment (ATT) with either supplemental dose of oral vitamin D3 (60,000 IU/sachet weekly for first two months, fortnightly for next four months followed by monthly for the next 18 months) or placebo with same schedule. The primary outcome was relapse of PTB and secondary outcomes were time to conversion of sputum smear and sputum culture.ResultsA total of 846 participants were enrolled between February 1, 2017 to February 27, 2021, and randomly assigned to receive either 60,000 IU vitamin D3 (n = 424) or placebo (n = 422) along with standard ATT. Among the 697 who were cured of PTB, relapse occurred in 14 participants from the vitamin D group and 19 participants from the placebo group (hazard risk ratio 0.68, 95%CI 0.34 to 1.37, log rank p value 0.29). Similarly, no statistically significant difference was seen in time to sputum smear and sputum culture conversion between both groups. Five patients died each in vitamin D and placebo groups, but none of the deaths were attributable to the study intervention. Serum levels of vitamin D were significantly raised in the vitamin D group as compared to the placebo group, with other blood parameters not showing any significant difference between groups.ConclusionsThe study reveals that vitamin D supplementation does not seem to have any beneficial effect in the treatment of PTB in terms to the prevention of relapse and time to sputum smear and culture conversion.Trial registrationCTRI/2021/02/030977 (ICMR, Clinical trial registry-India).
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Maxillary anterior teeth play an important role in esthetics, speech, smile, and self-esteem of an individual. Although a clinician can restore missing teeth with artificial teeth, the importance of ...natural teeth in patient's overall personality cannot be ignored. The present article elucidates a technique for fabrication of immediate removable partial denture prosthesis using natural teeth to enhance esthetics and confidence of the patient.
The present study was aimed to evaluate the retinoprotective effects of Moringa oleifera (MO) in Streptozotocin-induced diabetic rats.
The study was continued for 24 weeks and evaluated for ...inflammatory (tumor necrosis factor TNF-α and interleukin IL-1β, angiogenic (vascular endothelial growth factor VEGF and protein kinase C PKC-β) and antioxidant (Glutathione, Superoxide dismutase, and Catalase) parameters. Retinal leakage was checked by Fluorescein angiography (FA) and fundus photographs were evaluated for retinal vessel caliber (arteriolar and venular). Transmission electron microscopy was done to determine basement membrane (BM) thickness.
The results of the present study showed potential hypoglycemic and retinal antioxidant effects of MO. In the present study, a significant rise in the expression of retinal inflammatory (TNF-α and IL-1β) and angiogenic (VEGF and PKC-β) parameters was observed in diabetic retinae as compared to normal retinae. However, MO-treated retinae showed marked inhibition in the expression of inflammatory and angiogenic parameters. Further, in the present study, diabetic retinae showed dilated retinal vessels as compared to normal. However, MO-treated retinae showed marked prevention in the dilatation of retinal vessels. Fluorescein angiograms obtained from diabetic retinae showed leaky and diffused retinal vasculature. On the other hand, MO-treated retinae showed intact retinal vasculature. Further, results of the transmission electron microscopy study showed thickened capillary BM in the diabetic retina as compared to normal retinae. However, treatment with MO prevented thickening of capillary BM.
Our result suggests that MO may be useful in preventing diabetes induced retinal dysfunction.
To evaluate the profile of strabismus and amblyopia in patients presenting to a tertiary care institution in order to understand the disease burden.
A retrospective, prospective hospital-based ...observational study was conducted at a tertiary level eye care hospital in India. All patients with strabismus or amblyopia who presented over a 1-year period were identified and referred to the squint clinic, where they were evaluated with a detailed clinical history and examination.
A total of 24475 patients were evaluated, of which 1950 had strabismus or amblyopia. The overall magnitude of amblyopia and strabismus was 2.0% 95% confidence interval (CI), 1.8-2.2) and 6.9% (95% CI, 6.6-7.2), respectively. About 20% of those seeking an ophthalmic consultation were children and they constituted over half of the population referred to the squint clinic. Among younger children, the burden of amblyopia and strabismus was 84.4% and 26.6%, respectively. Among the referred patients, strabismus was noted in 84.6% (N = 1649), most of the cases of which was of the comitant subtype (78.1%, N = 1288) with an equal distribution of exotropia and esotropia. Paralytic 12.9% (N = 251) and restrictive 4.7% (N = 85) squint constituted the remaining burden of strabismus.
Strabismus and amblyopia affect a sizeable proportion of patients presenting to a tertiary care ophthalmology setup. A significantly higher burden is present in the pediatric population. The majority of the cases of strabismus are of a comitant variety, which do not merit tertiary level eye care. There is a need to improve pediatric eye care at a secondary level to reduce the immense burden on tertiary referral centers.
Objective: Neurological emergencies saw a paradigm shift in approach during the coronavirus disease-2019 (COVID-19) pandemic with the challenge to manage patients with and without COVID-19. We aimed ...to compare the various neurological disorders and 3 months outcome in patients with and without SARS-CoV-2 infection. Methods: In an ambispective cohort study design, we enrolled patients with and without SARS CoV-2 infection coming to a medical emergency with neurological disorders between April 2020 and September 2020. Demographic, clinical, biochemical, and treatment details of these patients were collected and compared. Their outcomes, both in-hospital and at 3 months were assessed by the modified Rankin Scale (mRS). Results: Two thirty-five patients (235) were enrolled from emergency services with neurological disorders. Of them, 81 (34.5%) were COVID-19 positive. The mean (SD) age was 49.5 (17.3) years, and the majority of the patients were male (63.0%). The commonest neurological diagnosis was acute ischemic stroke (AIS) (43.0%). The in-hospital mortality was higher in the patients who were COVID-19 positive (COVID-19 positive: 29 (35.8%) versus COVID-19 negative: 12 (7.8%), P value: <0.001). The 3 months telephonic follow-up could be completed in 73.2% of the patients (142/194). Four (12.1%) deaths occurred on follow-up in the COVID-19 positive versus fifteen (13.8%) in the COVID-19 negative patients (P value: 1.00). The 3-month mRS was worse in the COVID-19 positive group (P value <0.001). However, this was driven by higher in-hospital morbidity and mortality in COVID-19 positive patients. Conclusion: Patients with neurological disorders presenting with COVID-19 infection had worse outcomes, including in-hospital and 3 months disability.
Video-assisted thoracoscopic surgery (VATS) in the pediatric population is a challenging task for any anesthesiologist, moreover considering the high incidence of associated congenital anomalies ...which are individual predictors of poor prognosis. A thorough preoperative evaluation, knowledge of the physiology of one lung ventilation - pertaining to various methods of lung isolation, individualized meticulous planning, and continuous vigilance to detect any untoward event at the earliest with good communication between the anesthesiology and surgical teams contributes to a safe and successful surgery. We present a case series of anesthetic management of congenital diaphragmatic hernia with VATS.
Malaria is a major public health problem in the south-east Asian region. Among all countries in the SE Asian region the highest number of cases and deaths are reported from India. Children below 14 ...years of age contribute to approximately 42% of all the deaths. A majority of the deaths are attributed to severe malaria which is caused by Plasmodium falciparum. It is considered that causes a benign causing febrile illness without significant complications. However, in recent years, the spectrum of is shifting from being the cause of benign fever, to more severe complications. There have been case reports of complications like thrombocytopaenia, cerebral malaria, a disseminated intravascular coagulation, the acute respiratory distress syndrome, hepatic dysfunction and renal involvement. Most of the case reports are from the adult population, with an occasional occurrence of paediatric cases.
To highlight the increasing number of severe manifestations in P.vivax malaria in the children who were admitted in the malaria transmission season of 2011, at a tertiary care hospital.
A descriptive, cross-sectional study.
Children with an acute febrile illness of a duration of < 7 days, which was confirmed as Plasmodium vivax positive malaria by testing the peripheral smears and/or by Rapid Diagnostic Testing, who were admitted in the paediatric ward of a tertiary care hospital in New Delhi (India), during May 2011 to October 2011, Case records of context cases were analysed retrospectively.
The data was summarised by calculating the rates, ratios, proportions, means, standard deviations and the 95% confidence intervals. The Chi square test was applied to assess the significant difference between two qualitative variables.
Among the case records of 54 patients, 40.7% were below 5 years. 61% were males and 38.9% were females. Besides hepatomegaly and splenomegaly which were the most common symptoms, which were seen in 81.5% and 72.2% children respectively, the various unusual manifestations seen were severe thrombocytopaenia (37%), jaundice with deranged LFT values (25.9%), abnormal bleeding (18.5%), impaired consciousness with a GCS of < 9 (18.5%), severe anaemia (14.8%), hypotension (11.1%), repeated convulsions (7.6%), pulmonary oedema/ARDS (5.6%) and ascites (5.6%). One case each showed haemoglobinuria, and pleural effusion.
Plasmodium vivax is emerging as a cause of severe malaria. There is a further need to study the pathophysiology, virulence factors and the molecular mechanisms which are involved in malaria.
Introduction: Evaluating the adrenal glands for size is fundamental in their imaging and to ascertain its normality or abnormality. Awareness of the range of normal size and shape is useful for ...adequate interpretation of computed tomography (CT) scans in patients with suspected adrenal pathology. Material and Methods: CT body scans of 1250 patients without evidence of adrenal disease were reviewed to determine the shape and size of normal adrenal glands. Patients with conditions that are known to affect the adrenal glands or any known malignancy were excluded from the study. Furthermore, patients with any evidence of focal adrenal enlargement or malignancy on imaging were not included in the study. All measurements were made on 64-slice contrast-enhanced CT axial sections and only those images were selected in which the adrenals were adequately visualized. Three measurements were made: maximum width of the body of the gland and maximum width of both the limbs (medial and lateral); all measurements were taken perpendicular to the long axis of the body/limb. Results: Based on our study, we came to the conclusion that the average width of the body of the right and left adrenal glands is 6.9 ± 0.31 mm and 5.4 ± 0.24 mm, respectively (though maximum width of the body may reach up to 11 mm) and that normal adrenal limbs should not measure >5 mm. Discussion and Conclusion: The most common shape of the adrenal glands was found to be Y shape, followed by the V and triangular shapes. The values provided in the present study may be used as a reference standard for the CT evaluation of the adrenal glands in the Indian population in particular.
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