scholarly journals 375. Cryptococcal Antigenemia in Advanced HIV Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S196-S196
Author(s):  
Jatin Ahuja ◽  
Manish Soneja ◽  
Naveet Wig ◽  
Immaculata Xess ◽  
Ashutosh Biswas ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Care Center ◽  
Tertiary Care ◽  
Latex Agglutination ◽  
Cd4 Count ◽  
North India ◽  
World Health ◽  
P Value ◽  
The Mean

Abstract Background Diagnostic importance of asymptomatic cryptococcal antigenemia is being increasingly recognized in the last few years. Recently, WHO (World Health Organization) has recommended routine screening of CrAg (cryptococcal antigen) among PLHA with CD4 ≤100/mm3, albeit this procedure is not yet adopted by many developing countries including India. Methods We conducted a prospective observational study in a large tertiary care center of North India, upon ethical clearance. Latex agglutination test was performed to assess serum CrAg levels, followed by the lumbar puncture for detection of CrAg levels in the CSF. We analyzed the prevalence and treatment outcomes of cryptococcal antigenemia among PLHA with CD4 ≤ 100 cells/mm3. Detailed clinical examination was conducted, with follow-up of upto 3 months. Multivariate analysis was performed for the estimation of risk factors. Results The mean age (years) and BMI (kg/m2) of all the participants were 41.4 ± 11.2 and 22.1 ± 2.6, respectively. Notably, the mean CD4 count (cu.mm) at the time of recruitment was 62.3 ± 20.5. Noteworthy, 62 (60.8%) of the patients were ART naïve. We found 9.8% (n = 10) of the patients were positive for serum CrAg, and only 2.9% (n = 3) had clinical features of meningitis and 6.8% (n = 7) were asymptomatic (subclinical) CrAg positive. Strikingly, 3.9% (n = 4) of the asymptomatic cryptococcal antigenemia patients were also positive for CrAg in CSF, with 1.9% (n = 2) were only serum CrAg positive, and 1 patient was lost to follow-up (Graph 1). Multivariate analysis revealed that patients with long duration of HIV (P = 0.04), headache symptoms (P = 0.004) and possessing features of meningismus (P value=0.08) are more likely to be CrAg positive. Conversely, patients on fluconazole were protective against cryptococcal antigenemia (P = 0.1) as shown in Table 1. Overall mortality observed was 11.3% among advanced HIV patients. Moreover, mortality in CrAg-positive patients was 33.3% in comparison to CrAg-negative patients who had 9% (P = 0.06) in 3-months follow-up. Conclusion Cryptococcal antigenemia is common (9.8%) among patients with CD4 count ≤100/mm3 in India. Screening for CrAg should be made routine for PLHA with CD4 count ≤100/mm3 and if required preemptive treatment to be given in this regard. Disclosures All authors: No reported disclosures.

scholarly journals Effectiveness of Transjugular Intrahepatic Portosystemic Shunt in Variceal Bleeding: An Audit from a Tertiary Care Center in North India

2017 ◽  
Vol 01 (03) ◽  
pp. 150-155
Author(s):  
Arun Gupta ◽  
Ajay Mehta ◽  
Nitin Mishra ◽  
Rajendra Bansal ◽  
Ajit Yadav
Keyword(s):  
Variceal Bleeding ◽  
Patency Rate ◽  
Care Center ◽  
Tertiary Care ◽  
Portosystemic Shunt ◽  
North India ◽  
Related Complication ◽  
Variceal Bleed ◽  
Intrahepatic Portosystemic Shunt

AbstractVariceal bleeding is one of the most feared complications of cirrhosis and portal hypertension. Transjugular intrahepatic portosystemic shunt (TIPS) is an effective minimally invasive option to achieve adequate decompression of the portal system. The aim of the study was to assess the efficacy and complications of TIPS in patients presenting with variceal bleed. It was a retrospective study done in a tertiary care center in North India in cirrhotic patients with acute or recurrent variceal bleed who underwent TIPS from April 2010 to October 2013. All the patients were followed up till April 2014. We could successfully implant TIPS in 100% of our patients with 100% success rate in controlling variceal bleeding immediately and during the follow-up period. Our primary patency rate was 94.5% and overall patency rate was 100%. Major TIPS-related complication was hepatic encephalopathy in 20% of patients; 7 of 22 patients died during the follow-up period. TIPS is a safe and effective procedure for control of acute or recurrent variceal bleed. Emerging evidence in favor of early TIPS is further going to expand its indication in variceal bleed. Hepatic encephalopathy was the major procedure-related complication in our study consistent with previous literature reports.

Long-Term Hearing Outcomes following Total Ossicular Reconstruction with Titanium Prostheses

2019 ◽  
Vol 161 (1) ◽  
pp. 123-129 ◽  
Author(s):  
C. Burton Wood ◽  
Robert Yawn ◽  
Anne Sun Lowery ◽  
Brendan P. O’Connell ◽  
David Haynes ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Ossicular Chain ◽  
Tertiary Care Center ◽  
Ossicular Chain Reconstruction ◽  
The Mean ◽  
Hearing Outcomes

Objective(1) Characterize a large cohort of patients undergoing total ossicular chain reconstruction with titanium prosthesis. (2) Analyze long-term hearing outcomes of the same cohort.Study DesignCase series with chart review.SettingTertiary care center.Subject and MethodsThis study reviews patients who underwent total ossicular chain reconstruction (OCR) with titanium prostheses (TORPs) at a single tertiary care center from 2005 to 2015. Patient charts were reviewed for demographic data, diagnosis, and operative details. Patients were included in statistical analysis if length of follow-up was 2 years or more. Evaluation of hearing improvement was made by comparing preoperative air-bone gap (ABG) and ABG at follow-up at 2 years.ResultsIn total, 153 patients were identified who met inclusion criteria. The mean age of included patients was 40 years (range, 6-89 years). Sixty patients (39%) had a history of OCR, and 120 patients (78%) had a diagnosis of cholesteatoma at the time of OCR. Preoperatively, the mean ABG was 36 ± 12, whereas the mean ABG at 2-year follow-up improved to 26 ± 13. This was statistically significant ( P < .0001) using a Wilcoxon matched-pairs signed rank test. Twelve patients (8%) required revision OCR. Two revisions were performed due to prosthesis extrusion (<1%).ConclusionTitanium prostheses lead to significant improvement in hearing over long periods. The results are sustained as far out as 5 years following surgery. In addition, rates of revision surgery with titanium TORPs are low. Based on this series, there are no readily identifiable predictors for outcomes following total OCR.

Supine versus prone PCNL in lower calyceal stone: Comparative study in a tertiary care center

2020 ◽  
pp. 039156032096240
Author(s):  
Sunirmal Choudhury ◽  
Paragmani Talukdar ◽  
Tapan Kumar Mandal ◽  
Tapas Kumar Majhi
Keyword(s):  
Prone Position ◽  
Care Center ◽  
Tertiary Care ◽  
Renal Calculus ◽  
P Value ◽  
Tertiary Care Center ◽  
Stone Free Rate ◽  
The Mean ◽  
Hemoglobin Drop ◽  
Free Rate

Introduction: Renal calculus disease is an age old disease of human being. PCNL (Percutaneous nephrolithotomy) stands as a gold standard treatment for large renal calculus which is traditionally being done in prone position. Objective: To evaluate the safety and efficacy of supine PCNL versus prone PCNL comparing intraoperative time, requirement of relook PCNL, post op hemoglobin drop, post operative hospital stay, post operative complication, SFR ( stone free rate). Methods and materials: It is a prospective study done in Urology department in a tertiary care center in Eastern India between October 2017 and October 2018. A total of 84 patients with lower calyceal renal stones underwent PCNL, 42 of them in supine and 42 in prone position. Lower calyceal stone, size measuring 1 to 2 cm were included in the study. Results: The mean intra operative time was 91.76 min in supine group and 85.43 min in prone group with a p value of 0.115. The mean hemoglobin drop was 1.11 g/dl and 1.18 g/dl in supine and prone position, respectively ( p value 0.75). The mean post operative hospital stay was 4.1 and 3.86 days in supine and prone group ( p value 0.58), respectively. Two patients in each group require relook PCNL. Stone free rate at 1 month was 95.23% and 90.47% ( p value 0.9), respectively in case of supine and prone group. Conclusion: Supine PCNL is feasible, comparable to prone PCNL in respect to operative parameters with relatively higher stone free rate though statistically insignificant.

Carcinoids of the ampulla: Long-term follow-up after endoscopic resection.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 430-430
Author(s):  
George Nyasha Baison ◽  
Nadav Sahar ◽  
Morgan M Bonds ◽  
Janelle F Rekman ◽  
Flavio G. Rocha ◽  
...  
Keyword(s):  
Endoscopic Resection ◽  
Care Center ◽  
Benign Lesion ◽  
Tertiary Care ◽  
Case Series ◽  
World Health ◽  
Long Term Follow Up ◽  
Well Differentiated

430 Background: Neuroendocrine tumors (NET) or carcinoids of the ampulla are exceedingly rare in comparison to duodenal NET. Surgical management is widely accepted as the treatment of choice, but for patients that refuse surgery or are poor operative candidates, endoscopic resection may be option. We present a consecutive case series at a tertiary care center describing our experience with endoscopic resection of ampullary NET. Methods: This is a restrospective review with a long-term follow-up of patients with ampullary NET that were endoscopically resected. Outcomes were analyzed based on the histopathologic classification system proposed by the World Health Organization in 2000. Results: Twelve patients (9 male, 3 female), ranging in age from 41 to 86 (mean 59) underwent endoscopic ampullectomy for ampullary NET, with a mean follow-up time of 5 years. Patients had refused surgery or were poor surgical candidates. All, but one incidentally found case, were symptomatic on presentation, with gastrointestinal bleeding being the main symptom. No patients had a hormonal syndrome. The mean size of the lesions was 21 mm (6 mm to 35 cm). Six (50%) patients had a well-differentiated, benign lesion, 6 (50%) patients had a well-differentiated NET with unknown malignant potential (gangliocytic paragangliomas). Eight (67%) were completely excised during the initial endoscopy with 4 requiring re-excision. Only 2 patients developed recurrence, after 2.5 and 10 years and this necessitated a pancreaticoduodenectomy. Five patients had complications (2 for bleeding and 3 for post-ERCP pancreatitis), with zero deaths. Conclusions: Unlike duodenal carcinoids, ampullary NET are rare. Pancreaticoduodenectomy can be offered to fit patients except for gangliocytic paragangliomas that do not require an aggressive operation. However, for those that refuse surgery or are poor candidates, endoscopic ampullectomy can be an option with acceptable short and long-term outcomes.

scholarly journals Assessment of Location of Mental Foramen in Mandible Using Cone Beam Computerized Tomography

2020 ◽  
Vol 10 (4) ◽  
pp. 291-295
Author(s):  
Shoaib Rahim ◽  
Maria Shakoor ◽  
Ali Qureshi
Keyword(s):  
Computerized Tomography ◽  
Care Center ◽  
Tertiary Care ◽  
Mental Foramen ◽  
Cone Beam ◽  
P Value ◽  
Mandibular Symphysis ◽  
Cone Beam Computerized Tomography ◽  
The Mean ◽  
Inferior Border

Objective: To determine the mean distance of mental foramen from the base of the mandible and mandibular symphysis in patients reporting to tertiary care center using Cone Beam Computerized Tomography (CBCT). Study design and setting: Cross-Sectional Study was carried out in the Prosthodontics Department, Foundation University College of Dentistry, Islamabad from March 2019 to August 2019. Methodology: Total 100 patients between the age of 20-45 years were participated. CBCT investigation was carried out and measurements of mental foramen from the base of the mandible and mandibular symphysis in patients were recorded with the help of measuring tools in the software and noted down on the performa. SPSS version 20 was used analyze the data. P value less than 0.05 was considered as statistically significant. . Frequency and percentages were calculated for variable gender (qualitative). For quantitative variables like age, distance mental foramen from the mandibular Symphysis and inferior border of mandible, mean + SD were calculated. Independent samples t-test was used to compare quantitative variables like distance MF from the mandibular symphysis/midline and inferior border of mandible. P values < 0.05 was considered as statistically significant. Results: The Mean+SD distance of anterior border of mental foramen from symphysis on left and right side were 24.12+2.835 and 24.88+2.637 and from the lower border of mandible were 11.97+1.359 and 12.00+1.764 respectively. Conclusion: The mean vertical and horizontal distances calculated in this study can provide a useful guide to dentist to safely place dental implants within the inter-foraminal region in our population

Breast cancer in young women in India.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e11506-e11506
Author(s):  
Sanjay P Deshmukh ◽  
Anupama Dutt Mane
Keyword(s):  
Breast Cancer ◽  
Triple Negative ◽  
Care Center ◽  
Tumour Size ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
P Value ◽  
Breast Cancer Patients ◽  
Women In India

e11506 Background: The incidence of breast cancer is rising in India. It presents at a younger age in Indian population as compared to the western countries. Methods: This is a retrospective review of all breast cancer patients less than 40 years of age treated in single tertiary care center from June 2006 to June 2011. The aim was to assess the factors that may influence clinical outcome and prognosis including demographics, clinical characteristics, surgical and pathological findings and the treatment given. Clinical data was collected from medical records and histopathology reports. Independent variables like age, stage at presentation, surgery type, chemotherapy, radiation, tumour size, grade, nodal status, no. of positive nodes, perinodal extension, lymphovascular extension, ER, PR and Her2 neu were analysed. Results: Out of a total of 613 patients, 91 were under 40 years of age, corresponding to a prevalence of 14.8%. Median age was 35 years with the youngest being 23 years old. Maximum patients were in the age group of 36-40 years. Lymphovascular emboli was positive in 42 patients (48.8%) and perinodal extension was positive in 36 patients (41.8%). 30 patients(34.8%) had ER positivity, while 39 patients (45.3%) had PR positivity. Her 2 neu receptors were positive in 20 patients (23.2%). 39 patients were triple negative (45.3%). The median follow up period for all the patients was 28 months with the DFS being 76.1% and OS being 88.3%. In univariate analysis, factors significantly associated with survival were stage at presentation (p value- 0.026), presence of lymhovascular emboli (p value- 0.019) and presence of perinodal extension (p value- 0.007 ).Grade of the tumour also correlated with survival , however it was not statistically significant (p value- 0.086). Statistical analysis was done with SPSS 17. Conclusions: The incidence of breast cancer in younger women in India is high with increased number of triple negative patients. Overall survival is quite similar to that of the western population. Longer follow up and more studies are required to confirm this finding.

scholarly journals Plasmablastic Lymphoma: A Clinicopathological Study from a Tertiary Care Cancer Center in South India

2020 ◽  
Vol 9 (02) ◽  
pp. 105-108
Author(s):  
Manasi C. Mundada ◽  
Faiq Ahmed ◽  
Rachna Khera ◽  
Sudha Murthy ◽  
Senthil Rajappa ◽  
...  
Keyword(s):  
South India ◽  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
B Cell Lymphoma ◽  
Plasmablastic Lymphoma ◽  
World Health ◽  
Proliferation Index ◽  
Cancer Center

Abstract Background Plasmablastic lymphoma (PBL) is a rare aggressive B cell lymphoma that is commonly encountered in patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). In this case series, we describe the clinicopathological features of cases of PBL seen at a tertiary care center in South India. Materials and Methods Medical records of patients diagnosed with PBL between January 2009 and November 2017 were reviewed. PBL was defined as per the World Health Organization 2016 classification for hematopoietic and lymphoid neoplasms. The slides were reviewed with hematoxylin and eosin along with immunohistochemistry (IHC) including CD45, CD20, PAX5, CD79a, CD3, CD5, CD138, MUMI, EMA, ALK, and Ki67. Epstein-Barr virus (EBV) association was documented by rapid in situ hybridization (RISH) studies wherever possible. The demographic data, clinical presentation, treatment details, and outcomes are elaborated using descriptive statistics. Results During the study period, nine patients with PBL were identified. The median age at presentation was 47 years (range: 36–54 years). All patients had associated HIV/AIDS, eight (89%) had extranodal disease, and six (66%) had advanced clinical stage (stage III). All biopsies were positive for CD45, CD138, and MUM1, and negative for CD79a and T cell markers with a high Ki67 proliferation index (85–90%); CD20 was faint positive in one patient, and CD56 was positive in one (11%) patient. EBV-RISH was tested in two patients and was positive in one. Bone marrow was uninvolved in all the cases. At the time of last follow-up, three patients were alive. Treatment details were available in six patients. With frontline therapy, four patients achieved a complete remission (CR) and one patient developed progressive disease. Three of four patients in CR are alive till the last follow-up. Conclusion PBL is a rare form of lymphoma with predominant association with HIV, extranodal location, and characteristic IHC pattern.

scholarly journals A clinical profile of liver function tests in COVID-19 patients at tertiary care centre from north India

2021 ◽  
Vol 9 (9) ◽  
pp. 2633
Author(s):  
B. P Priyadarshi ◽  
Avdhesh Kumar ◽  
Vipul Singh ◽  
Sanjay Kumar Varma ◽  
Ravi Yadav ◽  
...  
Keyword(s):  
Liver Function ◽  
Hospital Stay ◽  
Human Life ◽  
Multiorgan Failure ◽  
Tertiary Care ◽  
Abnormal Liver Function ◽  
North India ◽  
World Health ◽  
Duration Of Hospital Stay ◽  
The Mean

Background: The coronavirus is a large group of virus, which spread rapidly as an epidemic in china and was named initially as 2019 novel corona virus and subsequently named as Coronavirus disease 2019 (COVID-19) by World Health Organization (WHO). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to a dramatic loss of human life globally and manifests a variety of clinical symptoms varying from fever, cough, headache, myalgias, nausea, vomiting to more severe pneumonia, ARDS, septic shock and multiorgan failure. SARS-CoV-2, primarily affect respiratory system but COVID-19 patients also have varying levels of liver injuries or liver dysfunction. This retrospective study was designed to analyze the clinical features, liver function and duration of hospital stay with confirmed cases of covid-19 in a tertiary care centre.Methods: We conducted a cross-sectional study in the Isolation ward, Level -2 Covid Hospital, Government Medical College, Kannauj, Uttar Pradesh (India), from April to June 2021. A detailed history and examination was carried out as per the pre-designed proforma. The liver function test included alanine transaminase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and total bilirubin. Patients were considered with abnormal LFTs when any value of these tests was higher than upper limit of normal.Results: One hundred and ten patients with covid-19 were enrolled during the study period. There were 74 males (67.2%) and 36 (32.7%) females.  The mean age of study population was 49.07±12.05 years. In present study, the mean value of serum bilirubin, SGPT, SGOT and ALP were 0.85±0.47 mg/dl, 74.6±66.9 IU/L, 48.45±36.86 IU/L and 229.25±69.79 IU/L, respectively. In present study, the abnormal liver function was seen in 67.2 % cases with COVID-19 patients. The mean duration of hospital stay among normal LFT and abnormal LFT patients group were 13.33±2.12 and 17.10±2.07 days, respectively.Conclusions: The present study highlighted that abnormal liver function was observed in 67.2% cases with COVID-19 patients. Further research should focus on the cause of liver injury in covid 19 and on treatment and outcome.

scholarly journals Craniomegaly in Neonate and Infants Requiring Neurosurgical Intervention: An Experience at Tertiary Care Center

2022 ◽  
Author(s):  
Sangh Mittra ◽  
Hanuman Prasad Prajapati ◽  
Raj Kumar
Keyword(s):  
Head Circumference ◽  
Care Center ◽  
Tertiary Care ◽  
Dandy Walker Malformation ◽  
Improved Outcomes ◽  
History Of ◽  
The Mean ◽  
Walker Malformation ◽  
Age Range

Abstract Background The identification of neurosurgical causes of craniomegaly and early institution of therapy requires for better clinical and functional outcomes. Aims and Objectives The aim of this study was to evaluate the neurosurgical causes, managements, and outcomes of craniomegaly in neonate and infants. Materials and Methods The cases with a history of head enlargement from neonatal period were included in this study. Their causes, managements, and outcomes were recorded retrospectively during the period of January 2010 to February 2013, in neurosurgery department at SGPGIMS Lucknow, and June 2018 to June 2020, at UPUMS, Saifai, Etawah, UP, India. Results Out of 41 cases, there were 30 (73.14%) cases of hydrocephalus, 4 (9.76%) Dandy-Walker malformation, 2 (4.88%) subdural collection, 2 (4.88%) arachnoid cyst, 1 (2.44%) craniosynostosis, and 2 (4.88%) with tubercular meningitis. The age range of our cases was 18 to 178 days and the mean age was 102.54 ± 50.73. Preoperative head circumference range was 39 to 62 cm (mean: 55.27 ± 6.58cm). Majority of the cases (n = 32, 78.05%) were managed with ventriculoperitoneal shunt surgeries. Out of 41 cases, 33(80.49%) had improved outcomes, 7 (17.07%) stabilized, and mortality occurred in 1 (2.44%) case. Postoperatively, there was improvement in the head circumference (range: 39–60 cm and mean: 46.15 ± 5.83 cm) on 6 to 24 months (mean: 17.85 ± 5.18 months) of follow-up. Conclusion Hydrocephalus was the commonest neurosurgical cause of head enlargement in neonate and infants. Shunt surgery was the most common form of management of these cases. Early detection, institution of therapy, and periodic follow-up program for diagnosing and treating complications were the key to successful outcomes in these patients.

scholarly journals Qualitative and quantitative assay of glucose 6 phosphate dehydrogenase in patients attending tertiary care center

2020 ◽  
Author(s):  
Uday Sharma ◽  
Satyendra Mishra ◽  
Narayan Gautam ◽  
Badri Kumar Gupta
Keyword(s):  
Qualitative Method ◽  
Care Center ◽  
Tertiary Care ◽  
Screening Method ◽  
Hemoglobin Concentration ◽  
P Value ◽  
Mean Corpuscular Hemoglobin ◽  
Hemolytic Crisis ◽  
The Mean ◽  
Glucose 6 Phosphate Dehydrogenase

Abstract Objectives The study was carried out to with the aim to find out the frequency of G6PD deficiency among the patients attending the hospital and to rationalize methemoglobin reduction test (Qualitative method) in reference to the spectrophotometric assay (Quantitative method). Timely screening of the patients for Glucose 6 phosphate dehydrogenase deficiency with appropriate screening method can play an important role in preventing hemolytic crisis that arises from therapeutic use of oxidative drugs like primaquine. Result The frequency of Glucose 6 phosphate dehydrogenase deficient cases was 3% by both of the employed tests. The mean ± SD of Glucose 6 phosphate dehydrogenase activity in the patients under study was 15.34 ± 4.7 IU/l in males, 16.01 ± 3.74 IU/l in females. G6PD activity was positively associated with reticulocyte count (r = 0.289, p-value = 0.004) and negatively with mean corpuscular hemoglobin concentration (r = -0.220, p-value = 0.028). The correlation of Red blood corpuscular count and Glucose 6 phosphate dehydrogenase was statistically significant (p-value = 0.048).

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