The impact of hospitalization on mortality in patients with connective tissue disease-associated interstitial lung disease: a medical records review study

Abstract Background Interstitial lung disease (ILD) remains one of the most important causes of morbidity and mortality in patients with Connective Tissue Diseases (CTD). This study evaluated the impact of hospitalization on mortality in an ethnically and racially diverse cohort of CTD-ILD patients. Methods We conducted a medical records review study at Montefiore Medical Center, Bronx, NY. We included 96 patients and collected data on demographic characteristics, reasons for hospitalization, length of stay, immunosuppressant therapy use, and mortality. We stratified our patients into two cohorts: hospitalized and nonhospitalized. The hospitalized cohort was further subdivided into cardiopulmonary and non-cardiopulmonary admissions. Two-sample tests or Wilcoxon's rank sum tests for continuous variables and Chi-square or Fisher's exact tests for categorical variables were used for analyses as deemed appropriate. Results We identified 213 patients with CTD-ILD. Out of them, 96 patients met the study's inclusion criteria. The majority of patients were females (79%), and self-identified as Hispanic (54%) and Black (40%). The most common CTDs were rheumatoid arthritis (RA) (29%), inflammatory myositis (22%), and systemic sclerosis (15%). The majority (76%) of patients required at least one hospitalization. In the non-hospitalized group, no deaths were observed, however we noted significant increase of mortality risk in hospitalized group (p = 0.02). We also observed that prolonged hospital stay (> 7 days) as well as older age and male sex were associated with increased mortality. Conclusion Prolonged (> 7 days) hospital stay and hospitalization for cardiopulmonary causes, as well as older age and male sex were associated with an increased mortality risk in our cohort of CTD-ILD patients.

Hormonal profile of survivors of breast cancer with fatigue: A pilot study

Background & objectives: One of the most common problems experienced by breast cancer survivors (BCSs) is fatigue. There has been little research about the status of hormones in breast cancer patients as an aetiology of cancer-related fatigue (CRF). Hence, a pilot study was conducted to assess the levels of hormones such as thyroid, cortisol, dehydroepiandrosterone sulphate (DHEAS), oestrogen and progesterone in BCSs with fatigue. Methods: BCSs with complaints of fatigue were assessed using the Brief Fatigue Inventory (BFI) tool and evaluation of the hormone profiles was done in moderate-to-severe fatigued survivors. Data collected were analyzed to look for any association between fatigue and altered hormonal levels. Results: In this study, 56 per cent (n=62) of survivors experienced moderate-to-severe fatigue out of 110 patients reporting fatigue. Thyroid functions were deranged in 22 patients (35.48%). The thyroid stimulating hormone (TSH) levels were found to have a significant negative association with the severity of fatigue, (P<0.05). Twelve patients (19.35%) had reduced DHEAS levels suggestive of impaired hormone synthesis in the adrenal gland. Twenty two postmenopausal survivors (35.48%) had raised oestradiol levels. Interpretation & conclusions: The findings of this study suggest that the hormonal milieu, especially thyroid hormone and DHEAS may have a role in CRF experienced by BCSs and needs further exploration.

Acute Kidney Injury in Dengue Fever: A One-year Hospital-based Prospective Cross-sectional Study

Background and objectives: Dengue fever is amongst the most cardinal arthropod-borne infection among humans. Around the world, an estimated 2.5 billion individuals are at peril of infection, of which approximately 975 million reside in urban areas of tropical and subtropical nations like Southeast Asia, the Pacific, and surprisingly Americas. Acute kidney injury (AKI) is so far not a well-studied dengue complication. The renal abnormalities, though not common, are AKI, proteinuria, glomerulonephritis, and hemolytic uraemic syndrome, which are considered complications of the disease. This study was designed to evaluate the prevalence of AKI in DF and find out the predictors of the development of AKI in patients with DI. Methodology: This one-year hospital-based cross-sectional study was performed in the Department of General Medicine, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala from March 2020 to April 2021. A total of 120 eligible patients with DI were enrolled. These patients were evaluated for AKI based on acute kidney injury network (AKIN) criteria. Results: The majority of the patients were males 57.5% and the male to female ratio was 1.35:1. Most of the patients were aged between 31 and 50 years (40.8%) and the mean age was 42.23 ± 16.28 years. The majority of the patients (72.5%) had DF, 13.3% of the patients had dengue fever with warning signs and 14.2% of the patients had severe dengue. The prevalence of AKI was 27.5% in patients with dengue fever. Other than AKI, Acute respiratory distress syndrome (ARDS) (11.7%), Multiple Organ Dysfunction Syndrome (MODS) (3.3%), and sepsis (0.8%) were the complications noted. The majority of the patients (83.3%) improved and were discharged and mortality was noted in 16.7% of the patients. Also, significant differences were noted in patients with and without AKI.

A Comparative Study on Outcome of Amoebic Liver Abscess in Patients With and Without Alcoholic Liver Disease

Background: Amoebic liver abscesses (ALA) in the presence of Alcoholic liver disease (ALD) constitutes a high-risk group of patients who are prone to complications and may need more aggressive treatment. This study was aimed at evaluating disease course and outcomes in patients of ALA with ALD, in comparison to those without ALD. Material & Methods: This prospective observational study was conducted on 60 consecutive patients of ALA without ALD (Group-I) and 60 consecutive patients of ALA with ALD (Group II). Result: The patients ALA with ALD were older (47.2 ±13.3 years) than those without ALD (34.1±14 years). Mean size of the abscess cavity was significantly larger in patients with ALD (391.2± 208.7 cc in Group I and 594.3 ± 297.9 cc in Group II). In Group I, conservative management was most common (43.3%); while in Group II pigtail catheter insertion was the most frequently used modality of treatment (45%). Complications like empyema (6.6%), acute on chronic liver failure (8.3%) and impending liver failure (23.3%) manifesting as ascites and oedema were seen only in patients in Group II and they also had longer hospital stay. (4.87 days in Group I vs 8.37 in Group II). Conclusion: Patients of ALA with ALD have a more aggressive course of disease and should be managed with a lower threshold for abscess drainage.

A study of maternal outcome in first trimester bleeding

Background: The outcome of first trimester vaginal bleeding is a matter of debate. Vaginal bleeding is common and potentially alarming symptom in early pregnancy. First trimester bleeding is a common occurrence. It has been estimated to occur in 15-25% of all pregnant women. Objective of this study was to evaluate the various maternal outcomes in women with first trimester bleeding.Methods: This prospective observational study was conducted in the postgraduate department of obstetrics and gynecology, SMGS Hospital, Government Medical College, Jammu, Jammu and Kashmir, India. The study included 200 pregnant women presented with first trimester bleeding. All the women were followed prospectively till delivery and early postpartum period for various outcomes such as preterm delivery, PROM, PPROM, anemia, oligohydramnios, placental abruption, placenta previa and postpartum hemorrhage.Results: Out of 200 patients studied, 19% patients aborted. Ectopic and molar pregnancy was seen in 5% and 1.5% patients respectively. Out of 74.5% patients who continued pregnancy, maternal complications included anemia (52%), PROM (14.09%), oligohydramnios (6.71%), placenta previa (5.37%), PPH (4.03%), PPROM (2.68%), preeclampsia (2.01%), gestational hypertension (1.34%), abruption and post-datism (0.67% each).Conclusions: From the results of this study, it can be concluded that first trimester bleeding can be a predicting factor in terms of mother and infant consequences of pregnancy and it is necessary to increase the knowledge of pregnant women in this regard for closer care.

Role of Non-stress Test and Vibroacoustic Stimulation Test in Prediction of Perinatal Outcome in High-risk Pregnancies

Objectives: The aim of the study was to evaluate the fetal well being by non-stress-test (NST) and vibroacoustic stimulationtest (VAST) in high-risk pregnancies, to assess the perinatal outcome, to study the ability of the VAST to convert a false-positive(non-reactive) NST to a reactive one.Materials and Methods: Atotal of 100 pregnant women with >32 weeks gestation having certain high-risk factors were subjectedto NST and if NST came out to be non-reactive, vibroacoustic stimulation was given with artificial larynx. Perinatal outcome wasassessed by various parameters (meconium stained liquor, Apgar score at 5 min, neonatal intensive care units admission). Theresults were analyzed by Chi-square test to find the association between NST, VAST results, and perinatal outcome.Results: It was found that VAST reduced the number of false-positive results by 31%. As compared to NST, VAST had lesssensitivity (78.05% vs. 80.48%), and better specificity (95.08% vs. 83.61%), better positive predictive valve (91.43% vs. 82.35%)in predicting perinatal outcome.Conclusion: The addition of vibroacoustic stimulation to the NST reduced significantly the number of non-reactive tests. NSTwhen reactive does represents a satisfactory indicator for fetal well-being but non-reactive test needs further evaluation beforeany active intervention.

Paratubal Atypical Proliferative Serous Tumour in a Young Adolescent Female - A Diagnostic Dilemma

Introdcution: Paratubal atypical proliferative serous tumoursare rare usually arising from the mesothelium or from theremnants of mesonephric and paramesonephric ducts. Wepresent a rare case of paratubal borderline serous tumour in ayoung adolescent female presenting clinically as an omentalcyst.Case Report: A 14-year old unmarried female presentedwith abdominal pain in right iliac fossa. MRI revealed awell demarcated space occupying lesion in the pelvis almostin midline measuring 12x11x8cm. Lesion was abutting anddisplacing overlying bowel loops with likely adhesionssuggestive of complex omental cyst. The patient underwentcystectomy. The final histopathologic report confirmed thecyst as Paratubal atypical proliferative serous tumour.Conclusion: We experience a rare case of atypical proliferativeserous tumour of paratubal origin. The patient was youngestthan any of the other cases reported in the literature. Fertilitysparing surgery should be considered as a standard treatmentof borderline paratubal tumour, if patient desires futurefertility.

p16 promoter methylation, expression, and its association with estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 subtype of breast carcinoma

Objectives: The purpose of the study is to investigate p16 protein expression and promoter methylation of p16 gene and their association with molecular subtypes based on parameter such as estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). Materials and Methods: A total of 114 breast cancer tissue biopsies were collected for methylation-specific polymerase chain reaction (MSP) and immunohistochemical (IHC) analysis. Results: Seven tissue microarrays were constructed. p16 protein expression was studied in 114 cases, of which 35/114 (30.7%) cases showed strong expression and the majority of them had ER-positive tumor (57.6%), and it was statistically significant (P < 0.0074). Similarly, p16 expression was reduced in the majority of PR-negative tumors (83.9%) and the association was statistically significant (P = 0.0026). p16 methylation was studied in 114 cases and was positive in 71.0% cases. Conclusion: High p16 protein expression was associated with ER-positive, PR-negative, and HER2-negative tumors which is associated with poor prognosis. p16 protein expression may be used as a prognostic indicator to predict treatment response to hormonal therapy.

To Study The Prevalence of HPV Genome in HIV Positive Women in Comparison to HIV Negative Women in India

Cervical cancer is the second most common cancer among women worldwide. Infection with the Human Immunodeficiency Virus (HIV) is associated with an increased risk of prevalence of HPV. Cervical cancer is most common in age group 45-55 years. The various risk factors include age at first intercourse, multiple sexual partners, use of oral contraceptives pills, parity, family history, associated genital infections, and immunosuppression etc. Sexually transmitted human papilloma virus (HPV) infection is the most important risk factor for cervical intraepithelial neoplasia and invasive cervical cancer. Objective: To study the prevalence of HPV in the study group comprising of 100 HIV positive women and 100 HIV negative women. Methods: The present study was conducted in the department of Pathology, GMC, Patiala on 100 cervical brushings prepared from HIV positive patients attending ART Centre and 100 HIV negative femalesat GMC andRajindra hospital, Patiala. The cervical brushings were analysed in the Department of Pathology, Government Medical College Patiala. HPV detection was done on samples of cervical brushings. Results: In the 200 cases studied, 74 cases were positive for HPV infection. Out of 74 cases, 51 (51%) cases were HIV positive and 23 (23%) cases were HIV negative. Conclusion: It was seen that prevalence of HPV was higher in HIV positive cases as compared to HIV negative cases.

A Study of Comprasion of Conventional Cytology with Liquid Based Cytology of Thyroid FNAC – A Study of 100 Cases

Background: Fine Needle Aspiration (FNA) cytology of the thyroid has been increasingly utilized for the investigation of thyroid lesions. FNA of the thyroid gland is considered to be most cost effective and accurate primary diagnostic procedure for thyroid nodules. In the recent years many approaches has been devised to improve the quality of thyroid FNA cytology because the conventional smear (CS) is subject to error in sample collection and slide preparation. The liquid based cytology (LBC) originally developed for the application of gynaecologic cervical smears, has progressively gained for application of both non gynaecologic and fine needle aspiration cytological material. According to the Wilcoxon signed ranked test for thyroid lesions LBC was not useful in goitre and infectious lesions. It gave better results in anaplastic and medullary carcinoma. So conventional smear is more sensitive, specific and accurate than LBC. Methods: in this prospective study, we had 100 cases of thyroid. In each case, two passes were performed. The first pass was for CS and the second pass yielded material for LBC. Both CS and LBC smears were compared for cellularity, background blood and necrotic cell debris, cell architecture, informative background, presence of a monolayer of cells and nuclear and cytoplasmic details and test on an for statistical analysis. Results: Diagnostic accuracy was better in CS compared withLBC smears as CS was most sensitive (93.18%) and accurate (91.75%) method for analysis of thyroid while LBC method is sensitive (89.04%) and accuracy (86.59%).Conclusion: Conventional smear is more sensitive, specific and accurate than LBC because LBC introduce more cytological artifacts to thyroid aspirates.

Pattern of Pathological Lesions in Females of Age Less Than 30 Years Presenting With Palpable Breast Lump

Background: Although breast cancer is extremely uncommon during childhood and adolescence, breast concerns and problems among females of this age group are a relatively common occurrence. Objective: The study is conducted to evaluate spectrum of lesions of breast in patients presenting with breast lump and evaluate role of FNAC in lesions of breast. Methods: In present study, fine needle aspiration cytology (FNAC) was done on hundred (100) female patients less than 30 years of age and these were later on operated and histopathology specimens were available for correlation. Results: Out of 100 patients 93% were benign and 7% were malignant. Fibroadenoma was most common present in 63% cases, fibrocystic disease in 11%, phyllodes tumor in 2 % cases, 2% of atypical cases, 1% as papilloma, 1% as mastitis, 7% as malignant. The sensitivity of FNAC was 85.7% specificity was 100%, accuracy was 99%. Conclusion: It was concluded from the present study that expertise of FNAC has reached high accurate levels, FNAC report can be of great value in young females presenting with breast lump.

Evaluation Of Efficacy Of 0.2% Chlorohexidine Mouthwash As A Pre-Procedural Rinse In Reduction Of Streptococcal Colonies Following Ultrasonic Scaling: A Pilot Study.

Objectives: To evaluate the efficacy of chlorohexidine mouthrinse as a pre-procedural rinse in reducing streptococcal bacterial colonies.Study Design: A single-centre, double-masked, placebo-controlled randomised clinical trial conducted over a period of 15 days. 6 patients were included in the study, patients were first asked to rinse with the placebo (distilled water) for 1 minute before the scaling of control site followed by test site rinsing with chlorhexidine mouthwash for 1 minute. The microbial contamination was checked in the operatory, operator’s mouth mask, the patient’s chest, the operator’s chest and the patient’s breath with the help of agar plates. Results: The results revealed that there was statistically significant reduction in the Colony Forming Units (CFU's) formation. Paired sampled t test was used for checking the statistical significance, confidence interval (CI) was 95% and (p<0.05).There was statistical reduction in CFU's in breath sample, 30 minutes after scaling and less number of CFU’s were formed on the operator’s mask after the scaling of the patients with the use of chlorhexidine as the pre-procedural rinse compared to distilled water. Conclusion: The 0.2% chlorohexidine mouth rinse as a pre-procedural rinse has comparatively greater efficacy than distilled water in reduction of streptococcal colony forming units, however this finding was not statistically significant.[Sachit A NJIRM 2016; 7(5):46-52]

Application of a stool antigen test to evaluate the burden of Helicobacter pylori infection in dyspepsia patients.

Helicobacter pylori (HP) is causally associated with peptic ulcer disease and gastric carcinoma. Determination of the prevalence of HP infection in dyspepsia patients’ in particular geographical area is imperative for the appropriate management of dyspepsia. HP antigen detection in stool is a noninvasive diagnostic test of HP infection. This prospective study was conducted to find out the prevalence of HP infection based on stool antigen testing in dyspeptic patients who had also undergone upper gastrointestinal (GI) endoscopy. This study highlights the high prevalence of HP infection in dyspeptic Indian patients, particularly males, and emphasizes the growing importance of the bacterium causing infection among children. We also found HP stool antigen testing to be superior to upper GI endoscopy for detecting HP infection. Hence, we recommend initial testing for HP stool antigen in dyspeptic patients before initiating treatment and before carrying out any invasive procedure such as endoscopy.

The Quantified Human Gracilis-A Guide to Improve Aesthetic and Functional Outcomes.

Background: A functioning gracilis muscle is considered the ideal flap to improve the functional/aesthetic outcome with minimal donor site morbidity. This graceful and slender muscle with special attributes is increasingly being used for covering soft tissue defects, repair of urogenital fistulas and restoration of anal function. Only some studies describing the quantification of this muscle are available and population attributes of the muscle have not been taken into consideration. The present study quantifies the human gracilis muscle in a North Indian population. Methods: The morphometry of gracilis was studied in 50 inferior extremities obtained from 25 phenol embalmed adult North Indian cadavers with known age and sex. The length and width of the aponeurotic origin, the length of the muscle belly, length of the distal tendon of insertion were measured. The muscle, tendon ratios were derived. Results: The mean estimates for various morphological features of gracilius muscle were standardized for North Indians. All the origins and insertions for the muscle correlated with the standard textbook descriptions. No variation was found from a standard textbook pattern in the present sample. The reconstructive procedures should take the local population profile into consideration. Conclusion: The results will aid the clinician in choosing an appropriate muscle and tendon lengths in surgeries. This definitely will lead to better functional and aesthetic outcomes in restorative procedures.

Clinico-Cytological Spectrum Of Thyroid Mass Lesions Using FNAC And Corellating Biopsy.

Abstracts: Background: Fine needle aspiration technique generally applied, involves firm attachment of the aspiration needle to a syringe usually held in a specially designed syringe holder ie franzen’s handle, that enables single handed application of suction. The main aim of suction is to hold the cells against sharp cutting edge of the needle. It is the initial screening test for patients with thyroid lesions. Objective is 1) to find out diagnostic accuracy and role of fine needle aspiration cytology in the diagnosis of thyroid lesions, and to establish cyto-histopathological correlation. 2) to find out sensitivity, specificity, positive and negative predictive value, pitfalls and complications of fnac in the diagnosis of thyroid lesions. Methodology & Results: The present study was carried out on 110 patients presenting with thyroid lesions. FNA was conducted in cytology department of mmimsr mullana from July 2011 to Nov. 2013. In all cases, a thorough clinical examination including detailed history, general examination and local examination of thyroid gland was performed and findings recorded. FNA was performed in all cases without anesthesia keeping in view the clinical diagnosis. Equipments: included disposable syringe(10 ml), 2.5 cm long and 23-25 gauge disposable needles, Coplin jars , Cotton, and Clean glass slides. Chemicals and reagents included Spirit, Fixatives (alcohols) and Reagents for hematoxylin and eosin stain (H&E), Giemsa stain,and papanicolaou stain etc. Conclusion: FNAC is a well developed, cost effective and frequently used method carring low morbidity. It is also widely accepted as most accurate procedure to differentiate benign and malignant thyroid nodules and helps preoperatively in selecting patients for surgery. FNAC used together with other diagnostic modalities such as thyroid scanning, ultrasonography, thyroid hormone profile and antibody level measurements enhances diagnostic accuracy of the technique.

A study to evaluate the correlation of serum albumin levels with chronic periodontitis.

Context: Periodontitis is a chronic inflammatory disease caused by bacterial infection of the supporting tissues around the teeth. Serum albumin levels might be the practical marker of general health status. Albumin concentration is associated with nutrition and inflammation. Aims: The aim of this study was to evaluate the relationship between periodontal health status and serum albumin levels. Subjects and Methods: A total of 60 subjects of both genders with age range of 40–70 years were included in the study. Patients were divided into two groups viz. Group I; clinically healthy subjects and Group II; patients with chronic periodontitis, that is, loss of attachment ≥5 mm. Serum albumin concentration was estimated by bromocresol green albumin method. Statistical Analysis Used: Student’s unpaired t‑test. Results: The mean value of serum albumin levels for Group I was 4.815 g/dL with standard deviation (SD) of 0.127 and for Group II, the mean value of serum albumin levels was 4.219 g/dL (SD 0.174). The difference between serum albumin levels in Group I and Group II were found to be statistically significant (P ≤ 0.001). Conclusions: The findings of this clinical trial suggest an inverse relationship between the serum albumin concentration and chronic periodontal disease.

Teaching healthcare management to medical students: An early experience.

Background. Public health services throughout the country are managed by healthcare professionals. However, our presentday medical education does not prepare students to undertake these supervisory and managerial responsibilities. Their lack of preparation results in poor quality of patient care and service and suboptimal use of valuable resources. We introduced medical graduates to concepts of healthcare management and collected their feedback to assess if they find this knowledge relevant and useful. Method. Concepts of healthcare management relevant to healthcare professionals such as hospital set-up, hospital support services, quality in healthcare, evidence-based care, managed healthcare, etc. were introduced in a series of lectures during the postgraduate orientation programme at our institution. Student feedback was collected through a questionnaire with items rated on the Likert scale as well as through a few openended questions. Data was analysed for probability of responses on a binomial scale. Results. Students perceived the course material to be useful and agreed that training in leadership and management skills should be part of their medical education. Seventy per cent felt that such training should be imparted during the period of internship. Conclusion. Current medical education should prepare healthcare professionals to be able to deal with the intricacies of healthcare delivery systems in addition to their clinical skills. Training in healthcare management relevant to the needs of healthcare professionals should be integrated into the medical curriculum.