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Background: The lack of specialized geriatric healthcare in India, coupled with an aging population, has resulted in longer wait times, communication barriers, and a potential increase in unmet needs in a demographic that is already financially and socially vulnerable. This raises the need for exploring the perspectives and needs of the geriatric patient population to improve the quality and accessibility of the healthcare they receive. Objectives: This study was conducted to assess the perceptions and perceived needs of geriatric patients regarding current healthcare and their attitudes toward specialized geriatric healthcare. Materials and methods: Following the Institutional Ethics Committee (IEC), a cross-sectional study was carried out among 262 geriatric patients (age >60) from seven outpatient departments (OPD). A structured 10-item questionnaire was administered to assess the perceptions and perceived needs of the study population. Results: A total of 165 (63%) patients were not satisfied with the healthcare being provided to them. Around 96.1% of patients felt the need for a separate geriatric OPD/department. A total of 98% of patients had optimistic attitudes toward the possibility of specialized geriatric healthcare. A total of >80% of the patients were willing to spend more time for checkups and follow-ups regularly if that would improve their quality of life. Conclusion: This study showed a low satisfaction rate of geriatric patients with the current healthcare and a high felt need for specialized geriatric facilities. There was an overall positive attitude of patients toward the implementation of various facilities of specialized geriatric healthcare.
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Purpose: India has the largest population of youth in the world, thereby making them important contributors to the “India of Tomorrow”. Over 80% of knowledge gained is by the visual sense, thereby making school screening programs a necessity in our country. Data from the pre?COVID era, that is, 2017–18 was collected from close to 19,000 children in Gurugram, Haryana, a tier two city in National Capital Region, India. A similar prospective observational study is planned post COVID?19 (2022–23) for further analysis to depict the impact of COVID?19 in these areas. Methods: The program They See, They Learn was set at government schools in the area of operations (district of Gurgaon, Haryana), where the children and their families were unable to afford eye care services. All children who were screened underwent a comprehensive eye examination at the school premises itself. Results: A total of 18,939 students were screened over a period of 18 months, covering a total of 39 schools in the Gurugram belt, in the first phase of the program. Eleven point eight percent (n = 2254) of all school students had some form of refractive error. Girl students were found to have a higher refractive error rate (13.3%) compared to boy students (10.1%) across the schools screened. Myopia was the most common type of refractive error. Conclusion: School students require perfect vision or else they can be discouraged and may become a major burden to the economy of any developing nation. A school screening program aiming at populations that cannot afford such basic needs like spectacles is a must in all zones of the country
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ABSTRACT Focal Cortical Dysplasia (FCD) is a group of focal developmental malformations of the cerebral cortex cytoarchitecture. FCD usually manifests as medically intractable epilepsy, especially in young children. Live patients are diagnosed by radiological examination such as magnetic resonance imaging (MRI), fluorodeoxyglucose positron emission tomography (FDG PET), magnetoencephalography (MEG), diffusion-tensor imaging (DTI), and intracranial electroencephalogram (EEG). While some cases can be missed by radiological examination, they are usually diagnosed on the histopathological examination of the surgically removed specimens of medically intractable epilepsy patients. We report a case of a young girl with cerebral palsy, mental retardation, and seizure disorder who died in her sleep. The deceased was diagnosed with FCD type III with hippocampal sclerosis on histopathological examination at autopsy. H & E stain and NeuN immunohistochemistry neuronal cell marker were used to demonstrate the findings of FCD.
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Hepaticojejunostomy is currently the best treatment for post-cholecystectomy biliary strictures. Laparoscopic repair has not gained popularity due to difficult reconstruction. We present case of 43-year-old-female with Bismuth type 2 stricture following laparoscopic converted open cholecystectomy with bile duct injury done elsewhere. Position was modified Llyod-Davis position and four 8-mm robotic ports (including camera) and 12-mm assistant port were placed. The procedure included noticeable steps such as adhesiolysis, identification of gallbladder fossa, identification of common hepatic duct, lowering of hilar plate etc. Operating and console time were 420 and 350 minutes and blood loss was 100 mL. Patient was discharged on postoperative day 4. Robotic repair (hepaticojejunostomy) of biliary tract stricture after cholecystectomy is safe and feasible with good outcomes.
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Purpose@#Feeding jejunostomy (FJ) is a critical procedure to establish a source of enteral nutrition for upper gastrointestinal disorders. Minimally invasive surgery has the inherent benefit of better patient outcomes, less postoperative pain, and early discharge. This study aims to describe our total laparoscopic technique of Witzel FJ and to compare its outcome with its open counterpart. @*Methods@#A retrospective database analysis was performed in patients who underwent laparoscopic (n = 20) and open (n = 21) FJ as a stand-alone procedure from July 2018 to July 2022. A readily available nasogastric tube (Ryles tube) and routine laparoscopic instruments were used to perform laparoscopic FJ. Perioperative data and postoperative outcomes were analyzed. @*Results@#Baseline preoperative variables were comparable in both groups. The median operative duration in the laparoscopic FJ group was 180 minutes vs. 60 minutes in the open FJ group (p = 0.01). Postoperative length of hospital stay was 3 days vs. 4 days in the laparoscopic and open FJ groups, respectively (p = 0.08). Four patients in the open FJ group suffered from an immediate postoperative complication (none in the laparoscopic FJ group). After a median follow-up of 10 months, fewer patients in the laparoscopic FJ group had complications such as tube clogging, tube dislodgement, surgical-site infection, and small bowel obstruction. @*Conclusion@#Laparoscopic FJ with the Witzel technique is a safe and feasible procedure with a comparable outcome to the open technique. Patient selection is vital to overcome the initial learning curve.
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Background:Diabetes mellitus has been firmly established as a risk factor for the prognosis of COVID-19. However, the impact of pre-COVID-19 glycemic control on prognosis is yet to be fully understood. Our study aimedto establish the effect of HbA1c at admission on the outcome of patients admitted with COVID-19.Methods:It was a prospective observational study of admitted adult patients with confirmed SARS-CoV-2 infection in a tertiary care centre based on data collected from the medical record section using the patient data registry between April 2021 to June 2021. Information regarding demographic and clinical features, laboratory values, and hospital outcomes was collected and analysed.Results:182 patients admitted to the hospital with COVID-19 during the study period were included, their mean age was 48.75 years, the mean HbA1c was 6.1. Males accounted for 69.8% (127) of the sample population. 41.2% (75) were known diabetics. 44.8% (81) were known hypertensives. The mortality rate overall was 25.3% (46). 63.7% (116) had HbA1c values >6.5.High HbA1c values was associated with longer duration of hospital stay (p=0.032), higher levels of inflammatory markers, increased need for mechanical ventilation (p=0.001), higher mortality rate (p=0.001).Conclusions:Patients with COVID-19 with poor glycemiccontrol as evidenced by admission HbA1c levels were found to have more severe disease course with increased level of inflammatory markers, longer duration of hospital stay and higher risk of mortality
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Management of non-union with bone gap in tibia is difficult, especially if superimposed by infection of bone. Various modalities have been described for the treatment of gap non-union, with their own advantages and disadvantages. A case of a paediatric patient with traumatic left tibia fracture which was complicated by subsequent osteomyelitis and non-union presented to tertiary care hospital. After failure of different modalities of treatment, to provide union, the patient was managed with tibialization of fibula with fibula strut graft supported by a rush nail
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Purpose: To study the effect of wound size modulation on pre?existing astigmatism by on?axis placement of incision in manual small?incision cataract surgery (MSICS). Methods: In this prospective interventional study conducted at a tertiary care centre, 40 eyes of 40 consecutive senile cataract patients with 1.00�00 D corneal astigmatism were enrolled for the study. MSICS by modified Blumenthal抯 technique was performed through 6.0, 6.5, and 7.0 mm on?axis incision in 1.0�49 D (group A), 1.50�99 D (group B), and 2.00�00 D (group C) astigmatism, respectively. Surgically induced astigmatism (SIA) was calculated by vector analysis and double angle plots (DAP) at 12 weeks postoperatively. Results: There were 22 males and 18 females with mean age of 58.12 � 1.18 years. The mean SIA at 12 weeks was 0.85 � 0.28 D in group A (17 eyes), 1.32 � 0.65 D in group B (10 eyes), and 1.91 � 0.69 D in group C (13 eyes). The overall median uncorrected visual acuity was 0.18 (IQR = 0 to 0.2). The mean astigmatism decreased from 1.95 � 0.74 D to 1.04 + 0.57 D (P = 0.00) in superior incision and from 1.70 + 0.50 D to 0.92 � 0.45 D (P = 0.00) in temporal incision group with central shift of centroid in all cases. Conclusion: The customization of on?axis external incision size can be used to manage pre?existing corneal astigmatism of less than 3.00 D using both temporal and superior incisions effectively
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Tourism is de?ned as the relationships and subsequent interactions among tourists, commercial enterprise suppliers, local governments, and other parties host neighbourhoods and places that care about luring and hosting tourists. This essay's goal is to examine how widespread a 2020-style pandemic might be the effects of COVID-19 will be seen globally in terms of trade and performance estimates of the harm done to international business. To comprehend the impact of the Corona Virus on the global industrial ?rm trade, math data from renowned and reliable data sources is gathered. Prior to May 14, 2020, neither China, where the pandemic began, nor Asian countries, where new instances are often rumoured, would be popular tourist destinations. Due to pandemics, potential travellers often arrange or cancel their plans for a destination that is plague-affected; they also postpone their journeys to avoid suspicious locations and persons. Such pandemic types disrupt traditional businesses like business and the retail services sector. A total of 29,000,303 tourists arrived in 2019 using an e-Tourist Visa. The economic rami?cations of this eruption are severe and could impact not just the tourist spots with a signi?cant concentration of cases, but also other areas. The respiratory illness outbreak in 2002 was an analogous situation. The World Business Organization has assessed its forecast for foreign arrivals and receipts for 2020 because business is currently one of the prettiest industries, but it emphasises that such projections are likely to be further updated. The UN agency for business predicts that international tour arrivals will decrease in 2020 by a tenth to a half-hour compared to numbers in 2019
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Purpose: Amblyopia is a serious condition resulting in monocular impairment of vision. Although traditional treatment improves vision, we attempted to explore the results of perceptual learning in this study. Methods: This prospective cohort study included all patients with amblyopia who were subjected to perceptual learning. The presenting data on vision, stereopsis and contrast sensitivity were documented in a pretested online format, and the pre? and post?treatment information was compared using descriptive, cross?tabulation and comparative methods on SPSS 2.2. The mean values were obtained, and P < 0.05 was considered statistically significant. Results: The cohort consisted of 47 patients (23 females and 24 males) with a mean age of 14.11 ± 7.13 years. A statistically significant improvement was detected in visual acuity after the perceptual learning session, and the median follow?up period was 17 days. Also, significant improvements were observed in stereopsis but not in the visual outcomes among the age groups. Conclusion: Perceptual learning with hand–eye coordination is an effective method for managing amblyopia. This approach can improve vision in all age groups. However, visual improvement is significantly influenced by ocular alignment.
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Aim: There is a need for a better understanding of the relation of various neurological symptoms and complications with manifestations and outcomes of coronavirus disease 2019 (COVID-19). Hence, we planned this study to get an insight into the relation of neurological manifestations and COVID-19. Materials and methods: This was a retrospective study. All patients ?18 years in age, admitted with reverse transcription-polymerase chain reaction (RT-PCR) confirmed COVID-19 were included in the study. Their clinical records were accessed for collecting demographic and laboratory data. The data collected were analyzed for prevalence and pattern of neurological symptoms at admission and neurological complications developed during hospitalization. It was also analyzed to find the relation of neurological manifestations with duration of hospital stay, requirement of bilevel positive airway pressure (BiPAP) or ventilator, severity of disease, development of neurological complications, and mortality. Results: A total of 440 patients were included. The mean age was 59.28 ± 13.28 years. The most common neurological symptom at presentation was headache while the most common neurological complications were altered sensorium, cerebrovascular stroke, seizure, and encephalitis. Significantly, more patients with neurological complications than those without had severe disease and needed ventilation. Duration of hospitalization was significantly longer (16.26 ± 5.15 vs 12.73 ± 4.89, p = 0.0173) and mortality was also significantly higher (OR 6.59, 95% CI 2.23–19.43; p = 0.0006) in patients with neurological manifestations. Conclusion: The presence of neurological manifestations is associated with greater morbidity and mortality in patients with COVID-19 and thus warrants more aggressive treatment. However, a study of association of individual neurological manifestation with severity of COVID-19 will provide a more meaningful insight regarding the approach to the management of such patients
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Abstract Introduction: In developing countries like India, it is common for late presentation of Tetralogy of Fallot (TOF) patients to a hospital as compared to that of developed countries. The objective of this study is to analyze the surgical outcome of TOF patients with age > 15 years. Methods: This is a retrospective descriptive study of the surgical outcomes of 45 adult patients undergoing correction for TOF. Epidemiology, symptomology, and preoperative evaluation were performed. Results: Most of the patients were male (33 [73%]). The median age was 21 years. A total of 42 (93.33%) patients had subaortic ventricular septal defect (VSD), while three (6.6%) patients presented with doubly committed VSD. The most common type of right ventricular outflow tract (RVOT) obstruction was combined infundibular and valvular types, accounting for 34 cases (75.5%). Six patients had infundibular RVOT obstruction, while three patients (6.6%) had predominantly valvular pulmonary stenosis. We performed trans-right atrial repair in 33 patients. Right atrium-pulmonary artery approach was used in five patients (11.1%). The most common postoperative complication was right bundle branch block, seen in 14 patients, with a mortality rate of 2% in the early postoperative period. We achieved excellent early and midterm survival results and significant improvement in functions and disease-free quality of life. Conclusion: Intracardiac repair in adult TOF can be performed with low mortality, less residual RVOT obstruction, and need for revision of RVOT far less frequent by using the Jhajhria Infundibular Resection Adequacy Assessment technique (JIRAAT) to assess for adequacy of infundibular resection.
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BACKGROUND Seroprevalence studies on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can provide information on the target populations for vaccination. We aimed to evaluate the seroprevalence among healthcare workers (HCWs) at our tertiary care institution and to identify parameters that may affect it. METHOD We assessed seroprevalence of SARS-CoV-2 by the chemiluminescence immunoassay test among 3258 HCW in our hospital and evaluated as per gender, age, their previous Covid-19 diagnosis, role in hospital and type/risk of exposure. RESULTS Of 3258 participants, 46.2% (95% CI 44.4%– 47.9%) were positive for SARS-CoV-2 IgG antibodies (i.e. IgG ?15 AU/ml). Higher seroprevalence was seen in non-clinical HCWs (50.2%) than in clinical HCWs (41.4%, p=0.0001). Furthermore, people with a history of Covid-19 were found to have significantly higher antibody levels (p=0.0001). Among the HCWs, doctors and nurses had lower relative risk (RR) of acquiring Covid-19 infection (RR=0.82; 95% CI 0.76–0.89) compared to non-clinical HCWs. CONCLUSION Seroprevalence in HCWs at our hospital was 46.2%. Clinical HCWs had lower seroprevalence compared to non-clinical HCWs. Previous history of Covid-19 almost doubled the seropositivity, particularly in those with current infection.
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Fluorosis is a public health problem that is caused by excess intake of fluoride through ground/deep bore water. It gets deposited in the bones, teeth, and soft tissues. Fluoride in the human body acts as a “double-edged sword.” Fluoride is beneficial in small amounts but toxic in large amounts. People who have consumed 10–20 mg of fluoride per day for more than 10–20 years may develop crippling skeletal fluorosis. Stiffness and pain in the major joints, including the neck, back, hips, and knees, reduce mobility. The bone structure may change and ligaments may calcify in extreme cases, resulting in muscular weakness and pain. Here, we have reported a case of chronic quadriparesis due to compressive cervical myelopathy. After extensive workup, diagnosis of skeletal fluorosis was made.
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Background & objectives: The COVID-19 pandemic has caused significant global morbidity and mortality. As the vaccination was rolled out with prioritization on healthcare workers (HCWs), it was desirable to generate evidence on effectiveness of vaccine in prevailing real-life situation for policy planning. The objective of the study was to evaluate the safety, effectiveness and immunogenicity of COVID-19 vaccination among HCWs in a tertiary care hospital. Methods: This prospective observational study was undertaken on the safety, immunogenicity and effectiveness of the ChAdOx1 nCoV- 19 coronavirus vaccine (Recombinant) during the national vaccine roll out in January-March 2021, in a tertiary care hospital, New Delhi, India. Results: The vaccine was found to be safe, with local pain, fever and headache as the most common adverse events of milder nature which generally lasted for two days. The adverse events following vaccination were lower in the second dose as compared to the first dose. The vaccine was immunogenic, with seropositivity, which was 51 per cent before vaccination, increasing to 77 per cent after single dose and 98 per cent after two doses. Subgroup analysis indicated that those with the past history of COVID-19 attained seropositivity of 98 per cent even with single dose. The incidence of reverse transcription (RT)-PCR positive COVID-19 was significantly lower among vaccinated (11.7%) as compared to unvaccinated (22.2%). Seven cases of moderate COVID-19 needing hospitalization were seen in the unvaccinated and only one such in the vaccinated group. The difference was significant between the fully vaccinated (10.8%) and the partially vaccinated (12.7%). The hazard of COVID-19 infection was higher among male, age >50 yr and clinical role in the hospital. After adjustment for these factors, the hazard of COVID-19 infection among unvaccinated was 2.09 as compared to fully vaccinated. Vaccine effectiveness was 52.2 per cent in HCWs. Interpretation & conclusions: ChAdOx1 nCoV-19 coronavirus vaccine (Recombinant) was safe, immunogenic as well as showed effectiveness against the COVID-19 disease (CTRI/2021/01/030582).
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Background: Spontaneous ascitic fluid infection (SAI) is common in cirrhotic patients leading to significant morbidity and mortality. Third-generation cephalosporins are currently recommended as first-line therapy. This is a retrospective observational study that aims to determine bacterial etiology, susceptibility patterns of SAI, and its correlation with model for end-stage liver disease-sodium (MELD-Na) and Child–Turcotte–Pugh (CTP) score. Materials and methods: The present study was conducted on 274 consecutive cases admitted in Bombay Hospital and Medical Research Centre, Mumbai, India. Cases of cirrhosis (irrespective of etiology) with ascites between the ages of 18–85 years were included in this study. Ascitic fluid of every patient was aspirated under all aseptic measures and was sent for biochemical, culture, and cytological analysis. Results: Of the 274 patients studied, 34 (12.4%) patients were diagnosed to have SAI. Culture-negative neutrocytic ascites (CNNA) was present in 27 patients, spontaneous bacterial peritonitis (SBP) was present in six patients, and monomicrobial bacteriascites was seen in one patient. Mean age of patients enrolled was 56.05 ± 2.47 years. Eighty-two percent were males and 18% were females. Alcohol (45.45%) was the leading cause of cirrhosis followed by nonalcoholic steatohepatitis (NASH) related cirrhosis (26.47.7%) and hepatitis C virus (HCV) related cirrhosis (11.46%) and cryptogenic cirrhosis (8.82%). Average MELD-Na score was 25 and the CTP class C was most common. Klebsiella pneumoniae was the most commonly isolated organism followed by Escherichia coli. The various factors that predispose to development of SBP include low ascitic fluid protein concentration, a high level of serum bilirubin, deranged serum creatinine, high Child–Pugh score, and high MELD-Na score. Conclusion: Ascitic fluid analysis remains the single most important test for identifying and assessing a course of SBP. Early diagnosis and treatment will reduce the mortality rate in these patients.
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The presence of emulsified silicone oil in the eye can lead to many complications, glaucoma being one of the most common. Adequate IOP control is difficult to achieve with medical management alone; surgical intervention is often required. Glaucoma drainage device implantation is often the preferred line of surgical intervention in such cases due to trabeculectomy failure from emulsified silicone oil droplets and associated conjunctival scarring. However, the silicone tube of Ahmed glaucoma valve (AGV) may attract the silicone oil droplets, causing blockade of the tube with persistent raised IOP postoperatively. We report one such case where post?AGV silicone oil tube occlusion was treated with semi?conservative surgical management instead of revising the entire surgery or implantation of another drainage device. Our surgical technique of intracameral “vent and flush” offers rapid and effective IOP control in such cases. Postoperatively, normal IOP was achieved. Patency of tube continued to be maintained along with normalization of IOP on subsequent follow?ups.
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Background: The OSA is commonly found in ILD with overall incidence varying from 17 to 88 %. The morbidity and mortality of OSA are high when it occurs with chronic respiratory diseases like ILD. There is lack of data on sleep breathing disorder in ILD patients from India. The present study aims is to assess the occurrence of OSA in ILD patients and its correlation with other parameters. Method: Prospective observational study of 41 ILD patients of one year duration. All patients underwent detailed clinical examination, radiological, laboratory investigations and Type 1 diagnostic polysomnography according to AASM guideline. The severity of OSA was defined as per AHI and the correlation of OSA with other parameters were assessed.
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Bipolar disorder (BD) displays abnormalities in protein kinase C (PKC) signaling, and evidence suggests that inhibiting PKC may help treat mania. Endoxifen a potent inhibitor of the PKC signaling pathway, is effective in controlling acute bipolar mania, atdoses of 8 mg OD, for a period of 3-weeks. Here we present the case of a patient with severe mania, increased alcohol consumption administered endoxifen 8 mg BID for a period of 3-months, to achieve a better response. High-dose, long-term treatment with endoxifen was efficacious in controlling manic symptoms, with no adverse effects. Additionally, the patient didn抰 consume alcohol during the course of treatment. This case showed the long-term effectiveness and safety of high-dose endoxifen to control mania in a patient with BD.
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A 70-year-old man presented with generalized weakness, easy fatigability, and early satiety of 2-month duration. On examination, he had severe pallor and massive splenomegaly. Hematological investigations revealed bicytopenia with hypergammaglobulinemia and acute kidney injury. Bone marrow aspiration cytology was suggestive of plasma cell dyscrasia. Monoclonal protein peak (due to heavy chain of IgG type) was found on serum protein electrophoresis, and lambda light chains and IgG heavy chains were elevated on immunofixation. The patient was diagnosed as a case of multiple myeloma and was started on bortezomib杔enalidomide杁examethasone regimen. After 7 months of chemotherapy, his spleen had regressed, and the patient had become asymptomatic. Presentation with massive splenomegaly is usually a feature of Waldenstrom抯 macroglobulinemia. However, rarely multiple myeloma may have extramedullary manifestations such as splenomegaly as the primary presenting feature.