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Background and Aim: The correlation between clinical profile and angiographic severity in acute coronary syndrome (ACS) patients has been poorly documented. Hence, the present study aimed to study the clinical profile and correlate that with vessel burden, as witnessed by coronary angiography, in patients presenting to the hospital with ACS (ST-segment elevation myocardial infarction [STEMI]/non-ST-segment elevation [NSTE]-ACS) Materials and Methods: The study had enrolled 209 patients who had been diagnosed with ACS. All subjects were those who presented to the Emergency Medicine Department in a tertiary care center (south India). Coronary angiogram done for these patients by cardiologists was reviewed with a SYNTAX CALCULATOR (I AND II). Patient's baseline characteristics and clinical examination and interventional diagnosis details were obtained. Results: The clinical profile gathered from this geographical territory implied an increase in the angiographic severity of the coronary artery disease as measured by the SYNTAX score 1, with an increase in the duration of the said risk factor. Male gender was predominant and the major age group for ACS was 30 to 60 years. The most common presentation in ACS was STEMI. Diabetes and hypertension were the main risk factors for ACS. There was a striking occurrence of ACS among the young. Conclusion: STEMI was the major ACS presentation in this study population. The main risk factors noted were diabetes and hypertension. Besides smoking and alcohol abuse (in any study population), dyslipidemia was also a key risk factor observed. Mild left ventricular systolic dysfunction was predominant in this study. The SYNTAX score 1 increased with duration of observed and recorded risk factors.

BACKGROUND Malnutrition is one of the leading causes of morbidity and mortality in children under 5 years of age. Children with severe acute malnutrition have nine times higher mortality than those in well-nourished children. The purpose of this study was to describe the demography, clinical profile, and outcome of children with severe acute malnutrition aged between 6 months to 59 months admitted in nutrition rehabilitation centre at a tertiary care hospital in North East India. METHODS A cross sectional-observational hospital-based study was conducted between May 2019 and April 2020 on 140 children. Severe acute malnutrition was diagnosed as per WHO criteria by using standard techniques. Variables recorded were demographic factors, anthropometry, clinical profile, laboratory tests, and medical complications. The outcome indicators including hospital course were studied. RESULTS In the present study 63.6 % were males and the mean age of presentation was 20.0 ± 1.54 months. 57.1 % children were found to be having both weight for height z-score below – 3 SD and mid upper arm circumference less than 115 mm together. Acute gastroenteritis (45.2 %) was the most common co-morbid condition followed by respiratory tract infection (26.2 %). Iron deficiency anaemia was found in 70.7 % of study children. Recovery rate from severe acute malnutrition was 86.4 % with average weight gain of 6.4 g / kg / day. CONCLUSIONS Children with severe acute malnutrition tend to suffer from serious co-morbid conditions. Early identification and treatment in nutrition rehabilitation centre with facility for critical care support should become a key component of continuum of care for children with severe acute malnutrition. KEYWORDS Children, Clinical Profile, Facility-Based Care, Severe Acute Malnutrition, Outcome

Introduction: Despite recent reductions in the overall malaria case incidence, malaria remains an important public health issue. There has been a change in clinical and epidemiological profile of malaria in our country and vivax malaria known to be benign has been reported to cause severe complications. Therefore, the present study was conducted to delineate the clinical profile of malaria, proportion of severity, spectrum of complications, and presence of comorbidities among adult patients admitted at a tertiary health-care center in North India. Materials and Methods: This was an observational prospective study conducted in all adult patients (>15 years of age) diagnosed to have Plasmodium vivax malaria, Plasmodium falciparum, and mixed malarial infection at a tertiary care teaching hospital on the basis of peripheral smear or rapid diagnostic tests. Results: The study included 295 patients, the most common species was vivax (62%) followed by falciparum (29%) and mixed plasmodium spp. (9%). The mean age of the patients was 34.23 ± 15.7 years, with 64% male and 36% female. Out of all patients, 23% patients had at least one component of severe malaria. Severe anemia (hemoglobin

BACKGROUND The Covid-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a public health challenge being faced by the world currently. International and national responses to combat the Covid-19 pandemic have been very prompt with the setting up of dedicated Covid-19 hospitals. In the state of Odisha, situated in the eastern part of India, Kalinga Institute of Medical Sciences (KIMS), set up the first dedicated Covid hospital of the state. This study intends to chronicle the clinical profile, radiological presentations, laboratory findings, and clinical outcome of patients admitted to the KIMS Covid hospital. METHODS A retrospective analysis of the clinical and laboratory data of patients admitted with Covid-19 diagnosis at the dedicated Covid-19 hospital from 5th April 2020 to 4th June 2020 was done. RESULTS A total number of 272 Covid-19 cases were included in this study. Majority of the patients were males (83.57 %) and most of the patients (79.04 %) were asymptomatic. The mortality rate was 1.9 %. Fever (18.38 %), cough (17.27 %), dyspnoea (16.91 %) and myalgia (14.7 %) were the major symptoms observed. Severity was mild in 78.94 % cases. Delayed viral clearance was seen in 13 % cases. The typical features of novel SARS-CoV-2 infection was seen in 12 - 13 % cases in computed tomography (CT) images of thorax. c-reactive protein (CRP) was raised as a biomarker of inflammation. Of the 5 deaths encountered, 2 had diabetes mellitus, 2 were hypertensive and 1 had chronic obstructive pulmonary disease (COPD). CONCLUSIONS Covid-19 may have a delayed viral clearance beyond two weeks. A discordance between CT images and the clinical condition may also be observed. Diabetes, hypertension, and high blood CRP levels were significantly associated with mortality. KEYWORDS Covid-19, SARS-CoV-2, Clinical Profile, Radiological Findings, Comorbidities, Fatality

BACKGROUND Though epilepsy remains a significant problem for children and adolescents in our country, studies delineating the clinical profile and response to treatment in childhood epilepsy are lacking. The current study was carried out for obtaining a baseline profile and to predict the response to treatment in childhood epilepsy in India that may be helpful in planning management strategies from a public health point of view. METHODS Patients with clinical suggestion of active epilepsy (N = 141) from one month to 12 years, were enrolled into the study over a period of 1 year (February 2010 to January 2011) from the out-patient department and epilepsy clinic of Bangur Institute of Neurology. Detailed history was taken along with neurological examination. Electroencephalography (EEG) and neuroimaging (MRI / CT scan) were done on all patients. Each patient included in the study was kept in followup for a period of 6 months and their response to the treatment was recorded. RESULTS About 48.9 % (N = 69) patients had localisation related epilepsy while the rest had generalised epilepsy. Of those with generalised epilepsy, generalised tonicclonic seizures (GTCS) was by far the most common type. Of those with focal EEG activity, the highest proportion (50 %), were localised to the temporal lobe. Symptomatic aetiology accounted for 59.6 % (N = 84) of the patients. 20.6 % (N = 29) had poor response to treatment at 6 months follow-up. Abnormal neuroimaging (OR = 6.708) and abnormal EEG (OR = 6.357) were effective factors in predicting poor response to treatment. CONCLUSIONS Our study highlights the need to link specialised epilepsy services with primary health centres for early detection and treatment. EEG is an essential cost-effective modality in determining seizure localisation and response to treatment. KEYWORDS Paediatric, Epilepsy, Clinical Profile, Response to Treatment

Introduction: Breast cancer is second most common cancer all over the world. Majority of breast cancer cases are registered to hospital at a later stage of cancer presentation. Objective: To study socio-demographic, clinical presentation and outcome of Breast cancer patients attending tertiary care centre of Gujarat state. Method: This was a retrospective study made up of 5774 patients registered in tertiary care centre of Gujarat state. Data including patient’s socio-demographic information like age, marital status, education level and clinical diagnosis including clinical presentation at time of registration, treatment history etc was collected. The data was analysed using MS office 2010 and Epi Info software version 7.0. Result: The age ranged between 17-99 years, with a median of 50 years and interquartile range of 42-58 years. There were 62.07% patients presented with locally advanced breast cancer, while 17.57% patients had distant metastasis at diagnosis. Significant association (p

Background The clinical profiles and outcomes of cryptococcal meningitis have been shown to vary depending on the underlying condition. The aim of this study was to investigate clinical characteristics and outcomes in patients with and without type II diabetes mellitus. Methods A retrospective study was performed. Clinical data of HIV-negative cryptococcal meningitis patients with type II diabetes mellitus (n = 26) and without type II diabetes mellitus (n = 52) referring to the Jiangxi Chest Hospital between January 2012 to December 2018 were analyzed. The data were analyzed using chi square, none-parametric tests, and logistic regression. P-values Results In this study, cryptococcal meningitis patients suffering from type II diabetes mellitus had a higher mortality (23.08% vs. 7.69%; P = 0.055), and required longer hospitalization (59.58 vs. 42.88 days; P = 0.132). Moreover, cerebrospinal fluid examinations revealed that cryptococcal meningitis patients with type II diabetes mellitus had higher opening pressure (271.54 vs. 234.23 mmH2O; P = 0.125).The results of multivariate regression analysis revealed that cryptococcal meningitis patients with type II diabetes were more often presented with visual disorders (28.54% vs. 11.54%; [95% CI 0.056–0.705]; p = 0.012), and had higher cerebrospinal fluid protein levels (1027.62 ± 594.16 vs. 705.72 ± 373.88 mg/l; [95% CI 1.000–1.002]; p = 0.016). Among patients with type II diabetes mellitus, nausea and vomiting was more frequent at the initial visit in those died (100% vs. 50%; p = 0.027), and 66% of died type II diabetes mellitus patients were poorly controlled blood glucose level, compared with 30% in survival type II diabetes mellitus patients. Conclusion This study suggests that cryptococcal meningitis patients with type II diabetes mellitus differ significantly from cryptococcal meningitis patients without type II diabetes mellitus with respect to clinical symptoms such as visual disorders and cerebrospinal fluid examination. The presence of nausea and vomiting among type II diabetes mellitus patients could have implication in mortality.

BACKGROUND Government Medical College, Thiruvananthapuram, was converted to a Covid hospital but there was no shutdown or restriction of functioning of routine nonCovid treatment services. Objectives were to study the clinical profile of patients visiting ENT outpatient department during national lockdown period, evaluate the usage of safety practices by patients to protect from Covid-19 infection and determine the proportion of patients using teleconsultation services. METHODS This is a descriptive study. All patients, who attended and / or given dates to visit the ENT outpatient department during study period were included in the study. Data collected was analysed using SPSS software version 25. RESULTS Among patients who visited the outpatient department, 54.3 % were males. Majority belonged to age group of above 40 years. 82 % of old patients on followup could not attend outpatient because of lack of transportation. Majority of new cases were road traffic accidents and acute infections of ear and nose. Although majority had access to treatment from hospitals in their locality, they did not utilise the option. 98 % were aware of COVID-19 infection and were practicing safety precautions. Only 13 patients out of 219 were using the facility of teleconsultation. CONCLUSIONS This study reveals a wide gap in the present method of implementation of referrals to tertiary care. E medicine and teleconsultation services should be encouraged and used effectively. High rate of adoption of the safety measures among the public was another highlight obtained from this study. KEYWORDS Clinical Profile, COVID-19, Government Medical College, National Lockdown, Safety Practices

Background: Cystinuria is an inherited disorder that results in increased excretion of cystine in the urine. It accounts for about 1-2% of pediatric kidney stones. In this study, we sought to identify the clinical characteristics of patients with cystinuria in a national cohort. Methods: This was a retrospective study involving 30 patients from the Polish Registry of Inherited Tubulopathies. Initial data and that from a 6-month follow-up were analyzed. Mutational analysis was performed by targeted Sanger sequencing and, if applicable, MLPA analysis was used to detect large rearrangements. Results: SLC7A9 mutations were detected in 15 children (50%; 10 males, 5 females), SLC3A1 mutations in 14 children (47%; 5 males, 9 females), and bigenic mutations in one male patient. The first clinical symptoms of the disease were detected at a median of 48 months of age (range 3-233 months). When individuals with different mutations were compared, there were no differences identified in gender, age of diagnosis, presence of UTI or urolithiasis, eGFR, calcium, or cystine excretion. The most common initial symptoms were urolithiasis in 26 patients (88%) and urinary tract infections in 4 patients (13%). Urological procedures were performed in 18 out of 30 (60%). Conclusions: The clinical course of cystinuria is similar among patients, regardless of the type of genetic mutation. Most patients require surgery before diagnosis or soon after it. Patients require combined urological and pharmacological treatment for prevention of stone recurrence and renal function preservation.

Introduction Asthma is a complex condition characterized by the presence of chronic inflammation in the lower respiratory tract resulting in many disturbing symptoms. The study of the clinical profile of the population with asthma allows us to understand a trend of a specific disease taking into account several indicators and its clinical characteristics. Aim Evaluation of the clinical profile of patients with chronic bronchial asthma in Poland. Material and methods The study included 10400 adult patients, of both sexes, diagnosed with chronic bronchial asthma who started therapy based on inhaled glucocorticosteroids accompanied by salmeterol, and 52 allergists. The examination was performed in a doctor's surgery. Standardized questionnaire interviews were used in order to carry out the procedure. Results The age of the patients ranged from 18 up to 97 years. Most of them suffer from overweight and obesity. 45.3% of the patients smoked cigarettes or declared to be passive smokers. Current asthma control was poor: over 56% of the patients suffered from diurnal symptoms more often than twice a week, almost 55% from nocturnal symptoms, in 72% of the patients' physical activity was limited, whereas 57% required immediate treatment. Most commonly used drugs were inhaled glucocorticosteroids and short acting β2-mimetics. After treatment change, fewer patients suffered from asthma symptoms. Conclusions Adjusting the therapy according to the current guidelines and to the patient's needs helps to improve asthma control.

Introduction: Clinical presentation of the patient with COVID-19 in an emergency department is very important. The proper assessment of the symptom allows correct intervention. So, this study is conducted specifically to find out the clinical spectrum of the patient on presentation to the emergency department. Methods: This was a cross-sectional descriptive study. A retrospective analysis of patient records was done. There were 258 COVID-19 positive cases admission from 13th April to 13th August 2020. Out of these cases, 57 cases were excluded as they did not have respiratory symptoms but were admitted for other medical conditions. So, 201 symptomatic patients were analyzed in this study. Symptoms of all patients with the confirmed diagnosis of COVID-19 admitted from the emergency department were analyzed. Data entry was done in an excel sheet and presenting symptoms of COVID-19 positive patients were described along with their comorbid conditions. Results: Two hundred and one symptomatic patients were analyzed in this study. The mean age of study population was 37.9 years (median 37) with a minimum age of 2 months and a maximum age of 83 years. There were 114 (56.7%) male and 87 (43.3%) female; 109 (54.2%) patients were from outside the and 92 (45.8%) were from inside of Kathmandu Valley. The most common presenting symptom was fever 131 (65.2%) and cardiovascular condition including hypertension was the most common comorbid condition. Conclusions: Fever was the most common symptom of the patient presenting to the COVID19 emergency of our hospital. Moreover, fever needs to be analyzed carefully in terms of its onset total duration and associated cough, and underlying comorbid condition.

Background: Acute Pancreatitis is a common disease with wide clinical variation and its incidence is increasing. Acute pancreatitis is an inflammatory process leading to abdominal pain, progressive destruction of exocrine tissue and in some patients a loss of endocrine tissue as well, with multiple organ failure and high mortality. Severity of acute pancreatitis is linked to the presence of systemic organ dysfunction and/or necrotizing pancreatitis. Aims and Objective: The present study was aimed to study the clinical profile of acute pancreatitis, the etiology and complications of acute pancreatitis received treatment in the Department of Surgery, Tripura Medical College & Dr. BRAM Teaching Hospital, Agartala, Tripura. Materials and Methods: This was a hospital based retrospective study which was conducted from January 2019 to December 2019. All patients with a diagnosis of acute pancreatitis were included in this study in order to find out the clinical presentations from the available clinical, laboratory and radiological data. Result: Of the 100 patients in this study, 96 were male and 4 were female. Minimum age in our study was 10 years and maximum were 70 years. Maximum numbers of patients were below 45 years of age. Alcohol was identified as the most important etiological factor associated with acute pancreatitis. Among the known etiological factors 90% of the cases were related to alcoholism and 4% were due to gall stone disease. Abdominal pain and vomiting were the most common symptoms in our study. Epigastric tenderness was present in 90% of the cases and guarding/rigidity in 50% of cases. 14% patients showed jaundice as a sign of acute pancreatitis. There was no major difference between the CT grading system and clinical grading system. Most of the patients recovered with conservative treatment. Adverse outcome was noted in one patient with acute necrotizing pancreatitis. Conclusion: Acute pancreatitis is one of the leading causes of increase in morbidity and mortality to society. Clinical assessment along with radiological findings correlated well with the morbidity and mortality. Our study identifies alcoholism as one of the most important etiological factors.

Background Patient's financial ability is always the most critical imputes to treatment choice and adherence; as it translates into health outcomes such as survival rate and quality of life. Cancer care is likely to affect the patient's financial well-being, putting huge financial pressure to the families. Therefore, it is imperative to understand the confounding factors of financial toxicity among cancer survivors along the course of survivorship. Methods This study was designed in the form of cross-sectional analysis, in which, cancer survivors were recruited from the Sarawak General Hospital, the largest tertiary and referral public hospital in Sarawak. To capture the financial toxicity of the cancer survivors, the Comprehensive Score for Financial Toxicity (COST) instrument in its validated form was adopted. Multivariable logistic regression analysis was applied to determine the relationship between financial toxicity (FT) and its predictors. Results The median age of the 461 cancer survivors was 56 while the median score of COST was 22.0. Besides, finding from multivariable logistic regression revealed that low income households (OR: 6.893, 95% CI, 3.109-15.281) were susceptible to higher risk of financial toxicity, while elderly survivors above 50 years old reported a lower risk in financial toxicity. Also, survivors with secondary schooling (OR:0.240; 95%CI, 0.110-0.519) and above [College or university (OR: 0.242; 95% CI, 0.090-0.646)] suffer a lower risk of FT. Conclusion Financial toxicity was found to be associated with survivors age, household income and educational level. In the context of cancer treatment within public health facility, younger survivors, households from B40 group and individual with educational attainment below the first level schooling in the Malaysian system of education are prone to greater financial toxicity. Therefore, it is crucial for healthcare policymakers and clinicians to deliberate the plausible risk of financial toxicity borne by the patient amidst the treatment process.

Introduction The treatment of schizophrenia aims to reduce symptoms, improve quality of life and promote recovery from debilitating effects. Nonadherence to treatment is related to several factors and may lead to persistence of symptoms and relapse. Worldwide, the rate of nonadherence to treatment in individuals with schizophrenia is around 50%. Objectives To compare the clinical profile of nonadherent and adherent patients among individuals diagnosed with schizophrenia receiving treatment at psychosocial care centers in a city in southern Brazil. Method The clinical-epidemiological profile of patients with schizophrenia was retrospectively analyzed based on medical records entered into the system between January and December 2016, evaluating data at one-year follow-up. Results 112 patients were included. The disease was more prevalent in men; mean age was 40.5 years, being lower among men. Most of the sample had a low level of education, was unemployed/retired, did not have children and resided with relatives. The highest rate of diagnosis was among young adults. Psychotic symptoms were most frequently described, and the most commonly prescribed antipsychotic was haloperidol. The nonadherence rate was 15.2%; only one patient required admission to a psychiatric hospital. Among nonadherent patients, the mean time of attendance was 6 months; there were more nonadherent women than men. The most prevalent age range of nonadherence was 41-64 years. Psychosocial and clinical data were similar across the whole sample. Conclusion A nonadherence rate of 15.2% was found among individuals receiving treatment for schizophrenia, suggesting that psychosocial care centers were effective in treating and monitoring these patients.

Despite rapidly evolving knowledge about COVID 19 infection, routes of perinatal COVID 19 transmission and viral load in mother neonate dyad remain uncertain. Data were analysed to describe the clinicodemographic profile and viral load in neonates born to COVID 19 positive mothers. Of 2947 deliveries, 69 mothers were COVID 19 positive (2.3%), with 1 abortion, 2 macerated stillbirths and 2 fresh stillbirths as pregnancy outcomes. Of 65 tested neonates, 10.7% (7) were confirmed COVID 19 positive by RTPCR (reverse transcriptase-polymerase chain reaction). Viral load (cycle threshold, Ct of E, RDRp) in neonates was comparable with the Ct reported from adults; however, neonates had milder clinical manifestations. All 7 neonates who tested positive for COVID 19 were subsequently discharged. Six of the 7 neonates were asymptomatic and 1 neonate needed respiratory support (indication being prematurity) which resolved after 48 h. Maternal and neonatal comparison of Ct of E and RdRp gene was statistically non-significant (25.97 vs 19.68, p = 0.34 and 26.5 vs 25.0, p = 0.84). Viral loads of mothers with COVID 19 positive neonates compared with mothers with COVID 19 negative neonates for E and RdRp gene were also statistically non-significant (25 vs 27.19, p = 0.63 and 19.6 vs 27.6, p = 0.08). The majority (93%) of neonates tested later than 48 h (roomed in with mother and breastfed) tested negative. Conclusion: The study supports milder manifestation in COVID 19 positive neonates. Risk of transmission from COVID 19 positive mother to neonate by rooming-in and breastfeeding is low. In this study on a limited number of neonates, maternal viral load was not found to be associated with the positivity status or severity of the illness of neonate.What is Known:• Neonates born to COVID 19 positive mothers are at risk of COVID 19 infection.What is New:• Risk of transmission of COVID 19 from mother to neonate, with rooming-in and breastfeeding, appears low.• In this study on a limited number of neonates, maternal viral load of COVID 19 (E and RdRp cycle thresholds) was not associated with severity of illness or COVID 19 positivity in neonates. Electronic supplementary material The online version of this article (10.1007/s00431-020-03800-7) contains supplementary material, which is available to authorized users.

Aim: To collect and correlate the sociodemographic and clinical details of persons with spinal cord injury who were admitted to the Department of Neurological Rehabilitation. Objectives: To assess the sociodemographic characteristics and collect the clinical profiles of persons with spinal cord injury and to correlate their sociodemographic and clinical details. Materials and Methods: A retrospective file review was done over a period of 2 years from January 2017 to December 2018 to study patients with spinal cord injury who were admitted to the Neurological Rehabilitation ward of NIMHANS, Bengaluru, Karnataka, India. Results: A total of 60 patients were admitted with spinal cord injury. The mean age was 32.39 years and majority of the patients were young married males. Most of them belong to the low socioeconomic status and are housewives and daily wage laborers. Falls and road traffic accidents are the causes for the injury. Anxiety and depression are high among traumatic spinal cord injury patients. Conclusion: This information may contribute to prevent SCI and to improve the quality of life of patients with SCI. It has implications for the primary care physicians who are at first contact to identify and refer them for specialized super speciality district hospitals for further treatment as they pose a great threat to public health and their proportions are increasing. It is imperative that trauma care is included in graduate medical training as well to facilitate early intervention after initial screening.

Objectives. The present study aims to describe the clinical and biological profile of heart failure patients from central Romania. Material and method. A single centre-based retrospective, observational, descriptive study involving heart failure patients admitted from January 2018 to March 2020 was conducted. Only patients who had echocardiographic data determined by the same examiner were included. Patients were classified according to LVEF at admission in three subgroups: preserved LVEF subgroup (HFpEF, LVEF ≥ 50%), moderate LVEF subgroup (HFmrEF, LVEF 40-49%), reduced LVEF subgroup (HFrEF, LVEF < 40%) and their clinical and biological profile was assessed. Comorbidities were recorded using the Charlson comorbidity index (CCI). Outcomes. A total of 175 patients (57.7% males) were included in our study, with a mean age of 65.3 ± 11.7 years. 44% of patients had more than one hospital admission during the studied timeframe. Mean calculated left ventricular ejection fraction was 47.1% ± 12.1%. According to LVEF 62.8% of patients were in HFpEF group, 20.5% in the HFrEF group and 16.5% in the HFmrEF group. Dyspnoea was the most common presenting symptom in 65.7% of patients, being accompanied by fatigue in majority of cases (63.4%). Charlson comorbidity index mean value for the study population was 4.6 ± 2.1, 4.6 ± 2 in the HFpEF group, 5.2 ± 1.9 in the HFmrEF group and 4.03 ± 2.2 in the HFrEF group. Arterial hypertension was the most frequent comorbid condition and risk factor at the same time, in both men and women. Conclusions. The clinical and biological profile of the heart failure patients is complex, diverse and further research is needed for improving therapeutic and follow-up management of these patients.

BACKGROUND Urinary tract infection (UTI) is a common bacterial illness of paediatric age group. UTIs, especially in young children, have non-specific signs and symptoms that can be undetected or misdiagnosed. Delaying diagnosis and treatment of UTIs may result in long-term renal complications. We wanted to study the clinical profile and risk factors of urinary tract infections in childhood. METHODS This hospital based prospective study was conducted in paediatrics department of Karuna Medical College from June 2018 to December 2019. Children admitted in the department with culture positive urinary tract infection were included in the study. RESULTS In the present study, out of 80 cases with UTI, 54 were female children, and 26 were male children with a male to female ratio of 1:2.07. The most common presenting symptom was fever followed by crying during micturition. Most common risk factor in the present study was the presence of phimosis in 23 (28.75%) patients. Escherichia coli is the most common pathogen isolated (66.25%), followed by Klebsiella and Proteus. CONCLUSIONS UTI should be considered as a potential cause of fever in children. As the febrile children with UTI usually present with nonspecific signs and symptoms, urine culture should be considered as a gold standard for the diagnosis of UTI in children. Female sex, phimosis, constipation, and worm infestation were important risk factors for urinary tract infection in children.

Background: Dengue a vector-borne viral disease transmitted by mosquito and has several complications causing fatalities and a bad impact on society. The paucity of studies in Uttar Pradesh and lack of epidemiological data necessitated to take up this prospective study. Thus, the current study looked into the causes of heavy prevalence, urban v/s rural ratio, gender difference, various complications to formulate a strategy to limit the severity of the disease by early diagnosis and rapid intervention. The fever caused by dengue is characterized by body ache, petechial rashes, myalgia, and nausea and vomiting. There can be varied manifestations of dengue involving the lung, pleura, peritoneum, pericardium, and complications of liver, kidney, brain, muscle, eye, and other organs. The disease is characterized by thrombocytopenia, dehydration, bleeding tendencies, shock, and multiorgan dysfunction. Current estimates reports about 40% (2.5-3 billion) of the world population are at risk. Purpose: The study is aimed at detecting clinical signs and symptoms of patients with dengue fever presenting to TMU teaching hospital between January 2019 to December 2019. Material and Methods: A prospective observational study was undertaken in serologically confirmed cases of dengue. The disease was analyzed for its clinical profile, required investigations were done and evaluated. Results: In the present study the clinical outcome was: 1) Dengue fever without warning sign was (29.46%). 2) Dengue fever with a warning sign (57.87%). 3) Severe dengue fever (12.12%). Mortality noted in the present study was 1.8%. Bleeding manifestations were noted in 8.2% of patients. Thrombocytopenia (

Malaria infections in high endemic areas are not pathognomonic and often show non-specific symptoms. The Southwest Sumba district is a high endemic area of malaria with the annual parasite incidence (API) of 14.48‰. The research conducted in this area was to identify the clinical and hemoglobin profile of malaria patients and to obtain comprehensive information on the clinical characteristics of malaria in a high endemic area of Southwest Sumba district. This is a descriptive cross-sectional study. The data was obtained from the medical record of malaria patients between January 1st and December 31st, 2017 in Karitas Hospital, Southwest Sumba district. Inclusion criteria were patients with asexual stages of Plasmodium spp. on their Giemsa-stained thick and thin peripheral blood smears examination. Exclusion criteria were malaria patients with coexisting diseases and who had taken medication before admitted to the hospital. The total number of patients was 322 patients, 50.6% of the subjects were ≥ 15 years old and 59.3% were male. Among 322 patients, 133 subjects were treated as inpatients. The result shows that most infection was caused by a single infection of P. falciparum. The most common clinical symptom was fever (98.4%), followed by headache, vomiting, cough, and nausea. The most common physical finding was the axillary temperature of > 37.5°C (87.6%) followed by anemic conjunctiva and hepatomegaly, which was mostly found in pediatric patients. The number of patients with hemoglobin level ≤ 10 g/dL was 129. The MCV

Background Although there are numerous studies on meningitis and encephalitis separately, literature on meningoencephalitis is sparse. In this study we analysed the clinical profile of meningoencephalitis and its clinical outcome. Methods Fifty adults diagnosed with meningoencephalitis from July 2014 to July 2015 in a tertiary care hospital in South India were studied prospectively and their clinical presentation, aetiology and outcome were analysed. Results Among 50 patients, 33 (66%) were male; 39 (78%) were Conclusion Tuberculosis was the most common cause of meningoencephalitis in the studied population, often with subacute presentation, and outcome was good with early institution of antituberculous therapy.

Background Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory, demyelinating syndrome of the central nervous system (CNS) which affects the spinal cord and optic nerves. The aim of our study was to evaluate the clinical appearance of multiple sclerosis and neuromyelitis optica spectrum disease in young children in our community Materials and methods This cross-sectional study was done in the neurology departments of the Combined Military Hospital & Pak Emirates Military Hospital Rawalpindi for six months from April 2020 to September 2020. Eighty people between the ages of 18 and 45 with Guillain-Barre syndrome (GBS), multiple sclerosis (MS), and neuromyelitis optica spectrum disorder participated in this prospective research. The patient's demographic profile includes information such as age, gender, length and kind of sickness, and symptoms. The relationship of socio-demographic factors was assessed with the involvement of more than one organ system at the time of presentation. Results The final study comprised of 80 patients of whom 31 (38.5 percent) were men and 49 (61.25%) were women. Fifty-four (67.5%) patients were diagnosed with multiple sclerosis while 26 (32.5%) had neuromyelitis optica spectrum disorders. Most of the patients presented with sensory symptoms followed by visual disturbances. Twenty-nine (37%) had involvement of more than one system while 51 (63%) had involvement of only one system at the time of presentation. Female gender and having a diagnosis of multiple sclerosis had a statistically significant relationship with involvement of one than one system. Conclusions In individuals with MS and NMO, motor, sensory, and visual symptoms were often observed at the time of presentation. Involvement of one than one system at the time of presentation was fairly common among these patients and females and patients having a diagnosis of multiple sclerosis were more at risk of involvement of more than one system.

Aims Atrial high rate episodes (AHRE) are associated with increased risks of thromboembolism and cardiovascular mortality. However, the clinical characteristics of patients developing AHRE of various durations are not well studied. Methods This was an ancillary analysis of the multicenter, randomized IMPACT trial. In the present analysis, we classified patients according to duration of AHRE ≤6 minutes, >6 minutes to ≤6 hours, >6 hours to ≤24 hours and >24 hours, and investigated the association between clinical factors and the development of each duration of AHRE. Results Of 2,718 patients included in the trial, 945 (34.8%) developed AHRE. The incidence rates of each AHRE duration category were 10.7, 24.0, 0.14, and 0.07%, respectively. Using Cox regression analysis, heart failure was inversely associated with AHRE 6 minutes. Female gender was inversely associated with AHRE >6 minutes to ≤6 hours (HR 0.72, 95% CI 0.54–0.96, p=0.027) and >6 hours to ≤24 hours (HR 0.70, 95% CI 0.49–1.02, p=0.061). Hypertension was associated with AHRE >24 hours (HR 2.13, 95% CI 1.24–3.65, p=0.006). Conclusion AHRE >6 minutes to ≤6 hours were most prevalent among all AHRE duration categories. Age and history of AF/AFL were risk factors for AHRE >6 minutes. Women were at lower risk for AHRE >6 minutes to ≤24 hours, while hypertension was associated with AHRE >24 hours. Funding Acknowledgement Type of funding sources: None. Cumulative incidence of each AHRE burden

Thyroid disorders sometimes have extra-thyroidal manifestations. Hyperthyroidism is a clinical syndrome resulting from excessive secretion of thyroid hormones. The most common cause is Graves’ disease. About 0.5–4.3% of patients with Graves’ disease have an infiltrative dermopathy called thyroid dermopathy, which is due to excessive deposition of glycosaminoglycans from activated fibroblasts. Skin fibroblasts are activated by thyroid stimulating hormone receptor antibodies the whole process being initiated by T lymphocytes. Rarely, thyroid dermopathy is also found in other thyroid disorders such as Hashimoto thyroiditis. The diffuse non-pitting edema variant is the most common clinical presentation. Other variants include the nodular, plaque, mixed, and elephantiasis types. Usually, the main concerns of the patients are cosmetic, discomfort, and difficulty in wearing shoes. Thyroid dermopathy usually presents after the diagnosis of Graves’ disease, but it may also present together or sometime after this condition. Rarely, thyroid dermopathy presents before the diagnosis of Graves’ disease is made. Apart from the shin and feet, other sites that can be affected include the arms, forearms, back, thighs, pinna, and nose. The management is multidisciplinary, involving dermatologists and endocrinologists. Usually, controlling the thyroid dysfunction does not translate into regression of the skin lesions. However, many patients have their thyroid dermopathy regress spontaneously, while others usually require local therapy. Other therapeutic options include systemic therapy such as pentoxifylline, compressive physiotherapy, and surgery.

Introduction:approximately 6000 Cameroonian women died of cancer in 2018, and the breast is the most affected with 2625 new cases. The aim of this study was to establish a pattern of malignant breast tumours in Yaoundé (Cameroon). Methods:this study was a descriptive and analytical retrospective study of breast cancer between January 2010 and December 2015 in Yaoundé General Hospital (YGH) after the Institutional ethics committee approval. The variables studied were the socio-demographic characteristics, risk factors for breast cancer, types of tumours and type of treatments. The 5-year survival was analyzed by the Kaplan-Meier method. The adjusted hazard ratios and their 95% confidence intervals were calculated to assess the association between studied variables and patient survival through the cox regression using SPSS 23 software. The difference was considered significant at p < 0.05. Results:among the 344 files collected in this study, breast cancer patients were predominantly female (96.64%, n = 288) aged 45.39 ± 13.35 years, with invasive ductal carcinoma (68.03%, n = 270), located in the left breast (52%, n= 147). The average tumour size was ~6.5 ± 0.3 cm and diagnosed in grade II of Scarf Bloom Richardson (SBR) in 60% (n= 150) of cases. The 5-year survival was 43.3%. Factors associated with this poor survival were the religion (aHR 5.05, 95% CI: 1.57 - 16.25; p = 0.007 for animist and aHR 4.2, 95% CI: 1.53 – 11.46; p = 0.005 for protestant), location of the tumour (aHR 6.24, 95% CI: 1.58 - 24.60; p = 0.012), tumor height (aHR 0.21, 95% CI: 0.04 - 1.11; p = 0.011) and the time spent before medical treatment (aHR 5.12, 95% CI: 0.39 - 8.38; p = 0.011). Conclusion:the young age, large tumour size and high histological grade in our studied population suggest a weak awareness of women about breast cancer. Action should be taken in early screening to improve the management of breast cancer in Cameroon.

Aim: The authors have proposed to assess peripheral adenopathies in a series of hospitalized children in order to identify and define clinical and morphological profiles of different types of lymph node (LN) diseases. Materials and Methods: The studied group consisted of 58 patients less than 18 years of age. The investigation algorithm included: gender, age, site, involvement, side, extension and histopathological (HP) type of LN lesions. Tissue fragments were processed using classical histological techniques (formalin fixation and paraffin embedment) and stained with Hematoxylin–Eosin (HE). In some cases (tuberculous lesions and lymphomas), special stainings (Ziehl–Neelsen) and immunohistochemistry were used. Stratification scales of cases were defined according to each parameter in order to compare the data. All obtained data were assessed individually, compared to each other and with similar data from the literature with the help of a statistical apparatus [χ2 (chi-squared) test and analysis of variance (ANOVA) test] in some cases. Results: The young patients were slightly more frequently boys, of all ages but with a mean age of 10 and half years. The affected LNs belonged most often to neck region, either on the left or on the right side but sometimes bilateral or even on the midline; usually, more than one LN was involved in the area. In most of the cases, the lesions were localized in only one LN area. HP picture was dominated by the inflammatory processes, firstly the nonspecific ones, followed by tuberculosis. Discussions: Our observations fitted, for each parameter, with the wide ranges found in the literature. Comparisons between parameters’ variations revealed differences, sometimes significant that we tried to organize in clinical and morphological profiles. Conclusions: The assessment of our data allowed us to define some clinical and morphological profiles of different types of adenopathy that, by improvement on studies including larger series, could be of real use in daily pediatric practice.

We describe the epidemiological characteristics and associated risk factors of those presenting at a large testing centre for SARS-CoV-2 infection. This is a retrospective record review of individuals who underwent SARS-CoV-2 testing by reverse transcription–polymerase chain reaction (RT-PCR) at a high-throughput national-level government facility located in the north of India. Samples collected from 6 April to 31 December 2020 are included in this work and represent four highly populous regions. Additionally, there was a prospective follow-up of 1729 cases through telephone interviews from 25 May 2020 to 20 June 2020. Descriptive analysis has been performed for profiling clinic-epidemiological aspects of suspect cases. Multivariable logistic regression analysis was undertaken to determine risk factors that are associated with SARS-CoV-2 test positivity and symptom status. A total of 125 600 participants' details have been included in this report. The mean (s.d.) age of the participants was 33.1 (±15.3) years and 66% were male. Among these tested, 9515 (7.6%) were positive for COVID-19. A large proportion of positive cases were asymptomatic. In symptomatic positive cases, the commonest symptoms were cough and fever. Increasing age (groups 20–59 and ≥60 years compared to age group less than 5 years), male sex, history of international travel, symptoms for SARS-CoV-2, and participants from Delhi and Madhya Pradesh were positively associated with SARS-CoV-2 test positivity. Having co-morbidity, risk behaviours and intra-familial positivity were associated with a positive odds ratio for exhibiting SARS-CoV-2 symptoms. Intensified testing and isolation of cases, identification of both asymptomatic and symptomatic individuals and additional care of those with co-morbidities and risk behaviours will all be collectively important for disease containment in India. Reasons for differentials in testing between men and women remain an important area for in-depth study. The increased deployment of vaccines is likely to impact the trajectory of COVID-19 in the coming time, and therefore our data will serve as a comparative resource as India experiences the second wave of infection in light of newer variants that are likely to accelerate disease spread.

Background: Most COVID-19 studies conclude old age and coexisting illnesses as mortality determinants owing to different populations or methodologies, or omitting factors affecting outcomes. Methods: We analyzed COVID-19 patients’ data (N = 391) of Dubai Hospital between January 1, 2020 and June 30, 2020. Results: Only 19 patients (4.8%) were UAE nationals, while 372 (95.2%) were expatriates. Median age was 48 (interquartile range, 40–56) years; 22% were p = 0.04). Eighty-five percent of ICU patients required invasive mechanical ventilation, 78% vasopressors, 88% sedation, 84% muscle paralysis, while none require any of these in the medical group. Survivors had fewer patients with sedatives (p = 0.01). The median length of stay in the hospital was 19 days, ICU stays 14 days, and ventilator 11 days. The Mann-Whitney test showed that survivors spent more days in the ICU (median [IQR] 18 [6.5–29.5] vs. 11 [4–18], p value 0.003) and the hospital (32 [14.5–49.5] vs. 14 [7–21], p value 0.001) than nonsurvivors. Ferritin and D-dimers were higher in nonsurvivors, but CRP was lower in nonsurvivors (ferritin (ng/mL) median (IQR) 1,434 (661.5–2206.5) versus 1,362 (630–2,094), p value = 0.017, CRP (mg/L) 118.7 (53.4–184) versus 134.9 (66.5–203.2), p value 0.001 and D-dimer (µg/mL) 1.54 (0–3.13) versus 1.09 (0–2.51), p value = 0.001). Multiple logistic regression analysis determined age, fever on admission, use of oxygen, mechanical ventilation, and steroids as predictors of survival. Conclusions: COVID-19 patients were young males with pre-existing conditions. Ferritin, CRP, and D-dimers were higher in nonsurvivors. Treatment with chloroquine, antivirals, and anticoagulation was not different between survivors and nonsurvivors. Steroid use was a survival predictor.

Background: Polypharmacy is a becoming more prevalent in older adults and adverse risk increases with age-related change. Adverse drug reactions (ADRs) are common in older adults and worrisome aspect of treatment in elderly. Aims and Objective: The study aimed to identify the common clinical conditions leading to polypharmacy and to compare the adverse drug profiles of the 2 groups. Materials and Methods: This case-control study was conducted in Hospitals attached to BMCRI, where 200 patients aged 65 or more were interviewed. 100 elderly patients using 5 or more drugs were identified as cases and assessed against a control group of 100 patients. Results: Our study found that ADRs were found to be three times higher in individuals on polypharmacy compared to the control group (OR 3.4675 95% CI 1.6241 to 7.4035). The most commonly occurring ADRs were dyspepsia (OR 1.9259), drowsiness (OR 3.5926) and fatigue (OR 1.5319) with increased incidence in the case group. The most common conditions associated with polypharmacy were found to be hypertension (53%), diabetes mellitus(46%), COPD(14%) and IHD(14%). 66% of the study group had two or more of the above diseases, whereas in the control group only 32% had multiple illnesses. The most commonly prescribed medications were antihypertensives (61%), hypolipidemics (44%), antiplatelets (41%) and antibiotics(40%). Conclusion: Polypharmacy in the elderly comes with a significant increase in adverse effects. The reduced pill burden will not only decrease ADRs and improve compliance, but will also result in greater patient satisfaction and mental health, thereby improving the quality of geriatric care.

Aim: Although chronic kidney disease (CKD) remains an important health challenge in our environment, late presentation of the patient for nephrology care is common. We opined that dissemination of information on the sociodemographic distribution, clinical presentation and common etiology of CKD among our patient will increase individual and medical professionals’ awareness of the disease. In addition, it is believed that this will ultimately result in lower threshold for screening and early referral for specialist renal care.Methods: This was a cross-sectional descriptive study involving 152 patients with any form of renal disease either seen primarily at, or referred to the adult nephrology clinic of the hospitals between January 2013 and December 2015. The socio-demographic parameters, clinical characteristic and laboratory data were extracted with a proforma designed for data collection.Results: Of the 152 patients analyzed, 87 (57.24%) were males. The mean age was 49.29±15.92 years. About one quarter were within the age range 51-60 years. More than half (53.9%) were rural dweller. Common indication for referral includes abnormal renal ultrasound findings, elevated serum creatinine and urea, and abnormalities in urine analysis. Malaise, reduce urinary flow and body swelling were the common symptoms at presentation in 50.65%, 40.1% and 34.2% respectively among the patients. The median eGFR was 18.78 (7.86-84.55) ml/min/1.73m2. Across all age groups, majority (48.0%) presented in stage 5 CKD. Hypertensive nephrosclerosis (27.0%), chronic glomerulonephritis (14.5%) and diabetes nephropathy (9.2%) were found to be the leading causes of CKD. Majority of the patients (40.8%) were worked up for and commenced on hemodialysis soon after presentation. Among the end stage renal disease patient, only 7 (4.6%) had renal transplantation at referred centers. Focal segmental glomerulosclerosis was the commonest histological findings among the nephrotic syndrome patient while membranous nephropathy was documented in only 2 patients. Conclusion: Most patients present to the nephrology clinic of our hospital at advanced stage of CKD. We observed that hypertensive nephrosclerosis and glomerulonephritis are the leading causes of their kidney disease., Amaç: Her ne kadar kronik böbrek hastalığı (KBH), çevremizdeki önemli bir sağlık sorunu olsada, nefroloji bakımı için hastanın geç sunumu sıktır. Sosyodemografik dağılım, klinik prezentasyon ve KBH’ın ortak etiyolojisi hakkındaki bilgilerin yayılması, bireysel ve tıbbi profesyonellerin hastalık bilincini artıracağını belirledik. Ek olarak, bunun sonuçta tarama için daha düşük eşik ve uzman böbrek bakımı için erken sevk ile sonuçlanacağına inanılmaktadır.Yöntemler: Ocak 2013 ve Aralık 2015 tarihleri arasında hastanelerin yetişkin nefroloji kliniğinde ya da öncelikle görülen veya herhangi bir renal hastalığı olan 152 hastayı kapsayan ve kesitsel tanımlayıcı bir çalışmadır. Sosyo-demografik parametreler, klinik özellikler ve Laboratuar verileri, veri toplama için tasarlanmış bir proforma ile çıkarıldı.Bulgular: Analiz edilen 152 hastanın 87'si (%57,24) erkekti. Yaş ortalaması 49.29 (15,92) idi. Yaklaşık dörtte biri 51-60 yaş aralığındaydı. Yarıdan fazlası (%53,9) kırsalda yaşayanlardandı. Yönlendirme için ortak endikasyon anormal renal ultrason bulgularını, yüksek serum kreatinin ve üre ve idrar analizindeki anormallikleri içerir. Malaise, üriner debiyi azaltan ve vücut şişmesi, hastalar arasında sırasıyla %50,65, %40,1 ve %34,2 oranında sık görülen semptomlardı. Medyan eGFR, 18.78 (7.86-84.55) ml/dk/1,73 m2 idi. Tüm yaş gruplarında çoğunluk (%48,0) evre 5 KBH’da ortaya çıkmıştır. KBH'ın başlıca nedenleri arasında hipertansif nefroskleroz (%27,0), kronik glomerülonefrit (%14,5) ve diyabet nefropatisi (%9,2) bulundu. Hastaların çoğunluğu (%40,8) başvuru yapıldıktan kısa bir süre sonra hemodiyaliz için çalışmaya başlandı. Son dönem böbrek hastaları arasında sadece 7'sine (%4,6) sevk edilen merkezlerde böbrek nakli yapıldı. Fokal segmental glomerüloskleroz, nefrotik sendromlu hasta arasında en sık görülen histolojik bulgulardı, sadece 2 hastada membranöz nefropati kaydedildi.Sonuç: Çoğu hasta, hastanemiz nefroloji kliniğine KBH'nin ileri evresinde başvurmaktadır. Hipertansif nefroskleroz ve glomerülonefritin, böbrek hastalıklarının önde gelen nedenleri olduğunu gözlemledik.

Purpose The present study aimed at understanding the stress and perceived stigma among parents of children with epilepsy seeking treatment at a tertiary referral center for neurology in South India. Materials and methods Parents of sixty children suffering from epilepsy in the age group of 4–15 years were interviewed to explore parental stress and perceived stigma. They were recruited consecutively over a period of 6 months in 2015. Tools administered were Childhood-Illness related Parenting Stress Inventory (Manford in J Neurol 264(8):1811–24, 2017) and the Parent Stigma Scale (Baca et al. in Value Health 13(6):778–786, 2010). Results The mean age of parents was 37.2 years, and the majority of parents who used to bring their child to the hospital were male (71.7%) and educated up to the secondary/intermediate level (36%) and were from lower socio-economic status. The mean age of children with epilepsy was 8.4 years with the majority of them being male (66.7%), affected with chronic seizures (58.3%) with most commonly occurring seizure type being generalized seizures (50%), with a co-morbid diagnosis of cerebral palsy (26.7%). A significant number of parents reported difficulty in communicating with medical team (58.3%) and significant others (51.7%) about their child’s seizures and difficulty in making decisions related to their child’s medical care (43.3%) which strained their financial resources and created difficulty in adequate role functioning. Findings indicated that most of the parents of children with chronic seizures perceived reactions of others to be negative (53.3%) and would limit family social interaction which resulted into emotional reaction in the form of anger, guilt, fear, anxiety, and depression. Conclusion Parents are important figures in the process by which children with epilepsy came to acknowledge themselves being different from other children. Parents often feared divulging their child’s epilepsy to their friends and relatives because they experienced a sense of shame, self-blame, and rejection which also increased their stress.

BACKGROUND Acute viral hepatitis is a common cause of acute jaundice in India. Every year, we are getting outbreaks of viral hepatitis, most commonly in rainy season, leading to significant morbidity and mortality. Therefore, it is important to carry out an observational study to know the demographic profile, aetiology, clinical features, complications and mortality of viral hepatitis patients, so that appropriate measures can be taken to rectify deficits in the management of such patients for better outcome. MATERIALS AND METHODS This study was an observational study conducted in Department of Medicine, King George’s Medical University, Lucknow, India for a period of three months in rainy season from July 2018 to September 2018. Patients’ data was analysed for age, sex, occupation, address, clinical features, complications and outcome. RESULTS 100 cases consisting of 56 males and 44 females were enrolled in the present study. The mean age of admitted patients was 33±14 years. 65 cases were from urban and 35 cases were from rural areas. Most of the patients belonged to low socioeconomic status. Common presenting complaints were nausea, vomiting, yellowish discolouration of eyes and urine, fever, fatigue, loss of appetite and upper abdominal pain. Most common signs were icterus followed by tender hepatomegaly. Virology suggested that hepatitis E was the most common virus detected followed by hepatitis A, B and C. Co-infection with hepatitis A and E was observed in 8 patients leading to higher morbidity and mortality. Hepatic encephalopathy and haematuria was observed in 20 and 6 patients respectively. All patients were managed conservatively, and most patients were discharged in satisfactory condition. In spite of our best efforts, 27 patients expired. CONCLUSION Acute viral hepatitis is a public health problem causing significant morbidity and mortality. Most of the patients had hepatitis E and A, which are transmitted through faeco-oral route. Longer duration of symptoms, deeper level of coma in hepatic encephalopathy, bleeding manifestations, higher TLC, PT, INR, urea and creatinine are associated with higher mortality rate. So, public awareness programmes to maintain hygiene, clean drinking water, use of sanitary toilets and vaccination against hepatitis B and A should be promoted by the health care professionals.

Background: Most of the data on neuroendocrine tumors (NETs) are from the Western literature. Indian studies regarding clinicopathological characteristics and treatment outcomes are lacking. Methods: This is a prospective observational study of all new patients with NETs (except small-cell lung cancer) registered at our tertiary care cancer institute from November 2014 to November 2016. A total of 97 new patients were registered, of which 20 were lost to follow-up before starting any planned treatment. Epidemiological and clinicopathological features of all these 97 patients were studied, and the remaining 77 patients were analyzed for treatment response and survival analysis. Results: The median age at diagnosis was 49 years (20–74 years) with male preponderance (M: F = 1.85:1). The most common primary site of origin was pancreas (34/97 = 35%), followed by unknown primary origin (19%), small intestine (9%), and pulmonary (6%). Of 97 patients, 91 (93.8%) presented with nonfunctional symptoms, 3 (3.1%) had purely functional symptoms, and 3 (3.1%) presented with both functional and nonfunctional symptoms. The most common presenting symptom was abdominal pain (59.7%), followed by jaundice (9.3%), whereas watery diarrhea (83.3%) and flushing (66.7%) were the most common functional symptoms. Sixty-six percent (64/97) of cases were metastatic at presentation. A strong correlation was noted between the primary site of origin and metastatic presentation (P = 0.016). Chemotherapy was the most common primary therapy (40.2%), followed by surgery (28.6%), watchful waiting (15.6%), and somatostatin analogs (11.7%). The median event-free survival was highest for patients undergoing surgery (10 months). Conclusions: The clinicopathological profile of NETs in the Indian population differs from Western countries. Majority of patients present with metastatic disease, thus representing a need for creating awareness among patients and medical fraternity and formulating Indian guidelines for optimized treatment.

Background: Postural orthostatic tachycardia syndrome (POTS) is an autonomic disorder characterized by the clinical symptoms of orthostatic intolerance such as light-headedness, fatigue, sweating, tremor, anxiety, palpitation, exercise intolerance, and near syncope on standing in the absence of orthostatic hypotension. Objective: The objective of this study is to evaluate the clinical profile and autonomic parameters in patients with POTS. Materials and Methods: A total of 70 patients with POTS underwent cardiovascular autonomic function tests, i.e., heart rate (HR) response to deep breathing, heart rate and blood pressure (BP) changes in Valsalva maneuver and tilt study in the autonomic laboratory of the Department of Neurology from January 2014 to February 2016 using WR Medical Works, USA. Results: Mean age of cohort was 28.07 ± 10.64 years, and there were 36 (51%) women. Light-headedness 59 (84.3%) was the most common orthostatic symptom, followed by dizziness 56 (80%), palpitation 41 (58.57%), anxiety 26 (37.14%), loss of consciousness 21 (30%), disequilibrium 19 (27.14%), visual symptoms 12 (17.14%), weakness 8 (11.43%), and shortness of breath 2 (2.86%). The average heart rate response to deep breathing was 24.79 ± 7.20 bpm. Average Valsalva ratio was 1.78 ± 0.30. During the tilt, average maximum HR increase was 43.47 ± 11.19 bpm. Conclusion: POTS is an underrecognized disorder and majority of them present with vague orthostatic symptoms ways, hence clinicians should be made aware of the symptomatology. The tilt table test with beat-to-beat monitoring of HR and BP is the standard test for diagnosis.

Introduction: An abdominal aortic aneurysm (AAA) is defined as an aortic diameter at 1.5 times the normal diameter at the level of the renal arteries, which is approximately 2 cm. Existing data of clinical profile of AAA are mainly based on screening studies in the Western population. Materials and Methods: This is a retrospective observational study which included 165 patients who underwent conventional open repair for elective AAAs in a single center from January 2008 to August 2016. Results: The mean age of the patient cohort was 64.9 years with majority (92.7%) of them being a male cohort (male: female, 12.75:1). The mean size of the aneurysm was 6.8 cm. Ninety-six percent of the patients were hypertensive, 86% were smokers, 4.2% of patients had chronic obstructive pulmonary disease, and 16% of patients had preoperative renal dysfunction. Fifty-four percent of the patients had significant coronary artery disease (CAD), of which 19% underwent coronary intervention. Eighty-two percent of patients had infrarenal and 18% had juxtarenal AAA. Thirty-three percent of the patients who underwent open repair had concomitant common iliac artery aneurysm/ectasia. Conclusion: Clinical profile of AAA in this study shows a significantly high preponderance for males, hypertensive patients, and smokers, which have already been established as significant risk factors. Moreover, majority of the patients had significant CAD detected by routine preoperative cardiac evaluation which shows the significant coexistence between AAA and CAD in our population. Apart from coronary angiogram, evaluating patients with dobutamine stress echocardiography for inducible ischemia will act as a guide to detecting patients who are likely to benefit from revascularization and who are at increased risk of periprocedural cardiac events.

Introduction Obstructive jaundice is associated with high morbidity and mortality. Obstructive jaundice is not a definitive diagnosis. Detailed evaluation to establish the etiology of the cholestasis and cause of obstruction is crucial to avoid secondary pathologic changes and to plan different surgical techniques to intervene at an early stage. Materials and Methods A cross-sectional study was conducted among 50 cases of surgical obstructive jaundice at Shri Ram Murti Smarak Institute of Medical Sciences (SRMSIMS), Bareilly. Results The mean age of this study population was 48.44 ± 8.2 years, and 48% (24) patients had obstructive jaundice of benign etiology, whereas 52% (26) had malignant etiology. Among males, the common presentation was choledocholithiasis in benign disease and carcinoma of the gallbladder among malignancy. In females also, disease presentation was similar to that of males. Percutaneous transhepatic biliary drainage (PTBD) was the most common method of biliary decompression in malignant group. For biliary decompression in patients of benign etiology, common bile duct (CBD) exploration with T-tube drainage was done in most cases. Conclusion Obstructive jaundice has different etiologic spectrum in both males and females. Irrespective of etiology, common presentation was pain (94% of the cases). Most patients with malignant etiology presented with palpable lump. PTBD was the most common method of biliary decompression in malignant group. CBD exploration with T-tube drainage has higher values of decrease in serum bilirubin, serum bilirubin (indirect), serum alkaline phosphatase, and albumin.

Background: The prevalence of dermatophytosis in Indonesia reach 52% of all fungal infections and is dominated by tinea corporis. Purpose: This study aimed to describe the clinical profile of tinea corporis patients in the Outpatient Unit of Dermatology and Venereology, Dr. Soetomo General Hospital, Surabaya. Methods: This study was a descriptive study with a case series method from patient medical records in the mycology division of the Outpatient Unit of Dermatology and Venereology, Dr. Soetomo General Hospital, Surabaya from January 1, 2014 to December 31, 2015 with 339 samples. Results: This study showed that tinea corporis patients were dominated by women counting for 113 patients in 2014 and 84 in 2015. Tinea corporal patients were dominated by the post-puberty age group between 40 and 50 years. Tinea cruris is the most common comorbid infection in this case. There were 85.25% of patients who showed positive results for hyphae structure, 72.57% of patients showed negative results for blastospore structure, and 64.31% of patients showed negative results for examination of Wood’s lamp. There were 100 patients in 2014 and 86 patients in 2015 who received oral griseofulvin pharmacological therapy and 86.30% of these patients showed improvement in results after two weeks of treatment. Conclusion: Tinea corporis mostly attacks women and post-puberty age groups with tinea cruris as the most comorbid infections. The characteristic of tinea corporis could be shown as positive result for hyphae and negative for blastospore through the KOH test, and oral Griseofulvin is the most pharmacological therapy used for treatment

BACKGROUND Dengue is a mosquito borne infection and is a major public health concern around the world. There has been a rapid increase in the infection rate and nearly 400 million people across the globe are at risk of dengue infection. This infection is caused by dengue virus (DENV) which is a member of the genus flavivirus of the family flaviviridae, and is a single-stranded positive sense RNA virus. There are four DENV serotypes (DENV 1-4) found in tropical and subtropical regions of the globe DENV cycles between the vectors viz; Aedes aegypti, Aedes albopictus and human beings. MATERIALS AND METHODS This observational study was carried out at R L Jalappa hospital the teaching hospital of Sri Devaraj Urs Medical College, Tamaka, Kolar, Karnataka. The study period was from October 2016 to January 2017. A total of 72 patients who were diagnosed as dengue fever who met the inclusion and exclusion criteria were enrolled in this study. RESULTS The number of male patients was 49 contributing to 68% and the number of female patients was 23 contributing to 32%; maximum were in the age range of 26 to 45 years (70.8%). With highest number of patients presenting with fever and pain abdomen (n=32) as the most predominant clinical presentation followed by fever and breathlessness (n=12). Hepatomegaly has been the most predominant clinical sign followed by icterus and petechiae. Dengue serology results indicated that out of the 72 patients, 55 patients were positive for NS1Ag (76.3%), 10 patients had IgM positivity (13.88%) and 7 patients had IgG positivity (9.7%). Ultrasound abdomen showed findings of thickened and oedematous gall bladder (n=53, 73.6%), free fluid in abdomen (n=32, 44.4%) and hepatosplenomegaly (n=43, 59.7%). CONCLUSION The present study suggests that fever with abdominal pain could be one of the presenting symptoms among the patients infected with dengue virus and a radiological evaluation might be of relevance in medical management of dengue infection.

Introduction. The acute coronary syndrome is one of the main causes of cardiovascular mortality, especially in case of comorbidities. One of the most common concomitant diseases and a risk factor of acute coronary syndrome development is essential arterial hypertension. The Helicobacter pylori infection is one of the most common infections worldwide and there is an evidence about extra abdominal manifestation of this infection including coronary artery disease due to the systemic inflammation that leads to the endothelium damage with the consequent dysfunction and enhances coagulation and atherogenesis. Nevertheless, different trials showed controversial results regarding Helicobacter pylori infection impact on coronary artery disease development and course. The possible link between Helicobacter pylori infection and electrocardiogram (ECG) and echocardioscopy changes in acute coronary syndrome without ST segment patients with essential hypertension of different age is unclear and requires clarification. Aim. To investigate the clinical presentation features, electrocardiogram and echocardioscopy changes acute coronary syndrome without ST segment elevation patients of different age with essential hypertension and Helicobacter pylori infection. Materials and methods. We examined 197 patients that were hospitalized with acute coronary syndrome without ST segment elevation and preexisting essential arterial hypertension with dyspeptic complaints in the Thanscarpathian Regional Clinical Cardiology Dispensary and cardiology intensive care unit in the Central City Clinical Hospital (Uzhhorod). The patients were examined and treated according to the acute coronary syndrome without ST segment elevation, essential arterial hypertension and dyspepsia management protocols. All patients were divided by the groups of men and women infected and not infected with Helicobacter pylori (HP + and HP – respectively). Results. The pain syndrome evaluation by the 10-point scale revealed significantly higher pain intensity in HP+ groups of acute coronary syndrome without ST segment elevation and essential arterial hypertension patients in both genders versus HP- groups and in men versus women regardless of HP infection. Physical examination showed significantly higher prevalence of calf edema among both male and female acute coronary syndrome without ST segment elevation and essential arterial hypertension patients infected with HP versus the groups of HP- ones. Abdominal ultrasound detected the significant progression of hepatomegaly in HP+ versus HP- males while in females the liver size difference in HP+ versus HP- group was not significant. ECG of HP+ versus HP- acute coronary syndrome without ST and essential arterial hypertension patients showed significantly higher frequency of rhythm disorders among men, while in women the heart rate changes (both tachycardia and bradycardia) prevailed as well as signs of left ventricular hypertrophy and myocardium ischemia. Echocardioscopy revealed significantly lower ejection fraction in the group of HP+ acute coronary syndrome without ST segment elevation and essential arterial hypertension males versus HP- ones and in men versus women regardless of HP infection while in women the difference in ejection fraction was not significant in HP+ and HP-groups. The frequency of left ventricular hypertrophy was higher in the groups of HP+ patients (80.0 % in men and 40.0 % in women) versus HP- groups (70.0 % among men and 28.0 % in women respectively) as well as the prevalence of left atrium dilatation (in 70.0 % of HP+ men versus 56.0 % in HP- men and 50.0 % versus 14.0 % in HP+ and HP- women respectively). The obtained data indicate the possible association of Helicobacter pylori infections and left heart overload with heart failure progression. Conclusions. The pain intensity and calf edema degree were significantly higher in HP+ acute coronary syndrome without ST segment elevation patients with essential arterial hypertension versus HP- ones showing worse clinical profile in case of Helicobacter pylori infection, especially in men. ECG of acute coronary syndrome without ST segment elevation with essential hypertension and Helicobacter pylori infection patients versus HP- patients detected significantly higher prevalence of arrhythmias in men and the heart rate changes in women infected with Helicobacter pylori. Echocardioscopy revealed significantly lower ejection fraction as well as left ventricular hypertrophy and left atrium dilatation in the HP+ acute coronary syndrome without ST segment elevation and essential arterial hypertension patients and in men versus women. The obtained data indicate a possible association of Helicobacter infection and left heart overload with heart failure progression.

Objectives The clinical course and progression of acute pancreatitis are poorly understood to date, necessitating more studies of clinical profiles during the disease. Moreover, understanding the etiologies and clinical presentations of acute pancreatitis (AP) in children can contribute to early diagnosis and, hence, earlier interventions. Therefore, this article aims to study the clinical profiles of children with acute pancreatitis (AP) in relation to complications and other variables. Study design We retrospectively studied 56 patients who presented with AP to the pediatric department in Salmaniya Medical Complex between January 2006 and December 2017. Cases of chronic pancreatitis and ages above 12 years were excluded. The data concerned demographics, etiology, clinical data, hospital course, and outcomes. Results The study included 56 patients aged a mean of 8.46 years (male:female - 33:23). The average hospital stay was 7.68 days. Patients received parenteral feeds a mean of 2.77 days. All patients had an ultrasound, nine required CT scans (16.1%), and five MRIs (8.9%). There were 18 local complications (32.1%): pseudocysts (n=3, 5.36%), cholangitis (n=2, 3.6%), and edema (n=13, 23.2%). There were 23 intensive care unit (ICU) admissions (41.1%). No mortalities occurred but there were six recurrences (10.7%). Symptoms of abdominal pain, vomiting, fever, and nausea occurred in 100%, 57.1%, 35.7%, and 23.2% of patients, respectively. Etiologies were 41.1% biliary, 23.2% idiopathic, 19.6% traumatic, and 8.93% drug-induced. Leukocytes were elevated in 20 patients (35.7%), c-reactive protein (CRP) in five (8.93%), serum amylase in 45 (80.4%), and urinary amylase in all 56 patients (100%). Conclusion Most pediatric AP cases were attributed to biliary causes followed by trauma. Age was significantly correlated with complication rates (P=0.013). Abdominal pain was a more common symptom than vomiting. Leukocytosis was associated with ICU admissions. There was no significant relation between c-reactive protein, serum amylase, or urinary amylase, and complications or ICU admissions. Pediatric AP was self-limiting and there were no fatalities.

Cognitive impairment is a common non-motor symptom in Parkinson’s Disease (PD) and an important source of patient disability and caregiver burden. The timing, profile and rate of cognitive decline varies widely among individuals with PD and can range from normal cognition to mild cognitive impairment (PD-MCI) and dementia (PDD). Beta-amyloid and tau brain accumulation, oxidative stress and neuroinflammation are reported risk factors for cognitive impairment. Traumatic brain injury and pesticide and tobacco exposure have also been described. Genetic risk factors including genes such as COMT, APOE, MAPT and BDNF may also play a role. Less is known about protective factors, although the Mediterranean diet and exercise may fall in this category. Nonetheless, there is conflicting evidence for most of the factors that have been studied. The use of inconsistent criteria and lack of comprehensive assessment in many studies are important methodological issues. Timing of exposure also plays a crucial role, although identification of the correct time window has been historically difficult in PD. Our understanding of the mechanism behind these factors, as well as the interactions between gene and environment as determinants of disease phenotype and the identification of modifiable risk factors will be paramount, as this will allow for potential interventions even in established PD.

Objective: Overall, a handful of studies are available on the outcomes of acute-on-chronic pancreatitis (ACP). We aimed to provide a more complete and updated picture of ACP. Methods: We evaluated consecutive patients of acute exacerbation of chronic pancreatitis (CP) in a tertiary care center located in north India and studied their epidemiological profiles, etiological factors as well as outcomes. Results: Forty-five patients of ACP with a mean age of 37±13 years were evaluated. The majority of the patients were male (75%) and alcohol was the most common detectable etiology while no etiology could be identified in 35% of patients after extensive laboratory investigations and imaging. Moderately severe pancreatitis was noted in 73% of patients and 49% of patients had necrotizing pancreatitis out of which the majority (33%) had both pancreatic as well as extra-pancreatic necrosis (EPN). Five patients (11%) were subjected to percutaneous catheter drainage. Persistent organ failure was noted in 9% of patients and two (4.5%) patients had died from organ failure. Conclusion: To conclude, this study has demonstrated that ACP has a milder disease course and low morbidity and mortality. Early elimination of the etiological factor is essential for optimal outcome.

Introduction During pregnancy, liver dysfunction is more frequent than expected and may require specialized care. For the early diagnosis, it is important to determine if changes in liver physiology may develop into liver disease. Liver disease during pregnancy may require intervention from a hepatologist for adequate monitoring of mother-fetus health outcomes. This study was aimed to evaluate the clinical profile and predictors of maternal mortality in patients with liver diseases among Asian-Indian-females. Methods We conducted a prospective, open-label, consecutive all-comers study of 2,663 pregnant Asian Indian women admitted in the hospital, which included 92 with liver dysfunction. The medical aspects of the pregnancy were then followed prospectively with laboratory and clinical data during the hospital stay and analyzed. The current study was approved by the Institutional Ethical Committee. Results We found that 92 out of 2,663 patients had liver dysfunction with a prevalence of 3.45%. Fifty-four (58.7%) patients had icterus followed by fever in 23 (25.0%), hypertension in 22 (23.9%), central nervous system manifestations in 21 (22.8%), abdominal pain in 19 (20.6%), vomiting in 19 (20.6%), and pruritus in six (6.5%). Predictors of maternal mortality were icterus (p = 0.04), hepatomegaly (p = 0.04), presenting serum-bilirubin greater than 10 milligram% (mg%) (p = 0.008). The most common etiology was acute viral hepatitis (45.6%), followed by a hypertensive disorder of pregnancy (29.3%), acute fatty liver of pregnancy (1.1%), cholestatic jaundice (9.8%), hyperemesis gravidarum (2.2%), septicemic hepatitis (3.3%), dengue immunoglobulin M (IgM), and plasmodium vivax malaria antigen positive in (2.2%) each. Four patients (4.3%) were leptospira IgM reactive and had co-infection with hepatitis E virus. There was one patient (1.1%) with underlying chronic liver disease. Idiopathic liver disease was present in 5.4% of patients. Conclusion Liver disease is relatively common in Indian pregnant women. It is associated with high maternal and perinatal mortality, even in a tertiary referral center. When managing pregnancy in a tertiary care center, for adequate follow-up of the disease and to prevent adverse consequences for mother and child, it is important to discard liver alterations early. For this purpose, liver disease during pregnancy needs early diagnosis for proper management. Furthermore, it is difficult to manage patients with preexisting liver disease, and it may require specialized intervention from a hepatologist and a gastroenterologist.

Objectives: Khuzdar, the largest city of Southern Balochistan, is endemic for malaria with API of 6. The study was aimed at comparing the clinico-lab profile of severe and uncomplicated malaria in the region and to determine any association with age. No such study is reported in the region so far. Methods: A prospective clinical observational study was conducted in Combined Military Hospital, Khuzdar between 2018 and 2020. A total of 210 Malaria patients, irrespective of age and gender were included. Cases were categorized into severe and uncomplicated according to WHO criteria. The clinical parameters and lab profile of severe and uncomplicated cases were compared and data was analyzed using SPSS 23.0. Categorical variables were analyzed for association of clinical features with severe malaria using Fisher exact test. Continuous variables were compared between uncomplicated and severe malaria using Mann-Whitney U –test. Statistical significance of lab parameters with type of malaria was derived using Kruskal Wallis. Results: Uncomplicated and severe cases were 191 (91%) and 19 (9%) respectively. Severe malaria was significantly associated with jaundice, bleeding from gums, epistaxis, pallor, vomiting, respiratory distress, thrombocytopenia, low Hb, raised serum bilirubin and raised PT (p value

Contains fulltext : 236294.pdf (Publisher’s version ) (Open Access) Forensic psychiatric patients form a very heterogeneous population regarding psychopathology, criminal history, and risk factors for reoffending. Therefore, the present study aimed to investigate whether there are more homogeneous classes of forensic patients based on DSM-IV-TR Axis I and II diagnoses and previously committed offenses, by means of explorative latent class analysis (LCA). It was also investigated which risk and protective factors are significantly more prevalent in one class compared to other classes. The study sample contained 722 male forensic psychiatric patients who were unconditionally released between 2004 and 2014 from high-security forensic clinics. Data were retrospectively derived from electronic patient files. Five distinctive patient classes emerged: class with only Axis II diagnosis, class with multiple problems, antisocial class, psychotic class, and intellectually disabled class. These classes differed significantly in risk and protective factors. This study contributes to the understanding of patient classes and provides directions for future, class-tailored interventions. 13 p.

Objective: To describe clinical profile and management pattern of headache in patients presenting to a tertiary care center. Methods: In this observational study, demographics, radiological investigations, triggers, and treatment pattern in patients aged ≥ 14 years presenting with headache were recorded. Disability and severity of headache were assessed with Migraine Disability Assessment (MIDAS) score, Visual Analogue Scale (VAS), and Headache Impact Test (HIT-6) in case of migraineurs and VAS and HIT-6 for all other headache disorders. Patients were evaluated at baseline and after three and six months post-treatment. Results: Out of 400 patients (60.25% females and 39.75% males), 277 (69.25%) had primary headache among whom 119 (42.96%) had migraine without aura. Stress, menstruation, fasting, and inadequate sleep were common triggers for migraine. Nausea, vomiting, photo-phonophobia and neck pain were the most common accompanying symptoms in patients with headache. Out of 106 (38.3%) patients with tension-type headache, 68.9% were episodic. In the migraine subset, 81% presented with moderate to severe disability at baseline, which changed to minimal to mild disability at three and six months post-treatment (p < 0.001). For abortive treatment, 130 (79.7%) patients were prescribed naproxen, domperidone, and sumatriptan. In 69 (42.3%) patients, valproic acid/divalproex was used for prophylaxis. Most common causes of secondary headaches (30.75%) were intracranial bleeds and cerebral venous sinus thrombosis. Most common abnormalities on computerized tomography were intracerebral hemorrhage, subarachnoid hemorrhage, sinusitis, and space-occupying lesions (SOLs). Conclusion: In our study, migraine was the most common etiology of headache. Headache was more common in females than males, and primary headache was more common than secondary headache. Sodium valproate was the commonly used prophylaxis in migraine.

Background – COVID-19 caused by SARS-CoV-2 leads to myriad range of organ involvement including liver dysfunction. Aim To analyse the liver function in patients with COVID-19 and their association with respect to age, sex, severity of disease and clinical features. Materials and methods This study was a cross-sectional study done at Rajendra Institute of Medical Sciences, Ranchi. 91 patients admitted with confirmed SARS-CoV-2 infection were included in this study and divided into asymptomatic, mild, moderate and severe groups. Liver function tests were compared among different severity groups. Results Of 91 patients with COVID-19, 70 (76.9%) had abnormal liver function. Aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), total bilirubin levels was 1–2 × ULN in 33(36.3%), 34(37.3%), 12(13.2%), 6(6.6%) cases and >2 × ULN in 20(22%), 18(19.8%), 7(7.7%) and 2 (2.2%) cases respectively. Mean AST and ALP levels among different severity groups of COVID-19 was statistically significant (p 0.05). There was no statistical difference between males and females with regard to abnormal liver function. Liver injury was seen in 64.3% cases of hypertension and 73.3% cases of diabetes. Fever, myalgia, headache and breathlessness were found to be correlated significantly with severity of disease. Conclusion Liver injury is common in SARS-CoV-2 infection and is more prevalent in the severe disease group. Aspartate transaminase and alkaline phosphatase are better indicators of covid-19 induced liver injury than alanine transaminase and total bilirubin., Highlights • Liver injury was seen in 76.9% cases of COVID-19 and in 64.3% cases of hypertension and 73.3% cases of diabetes. • Mean AST & ALP among various severity groups of COVID-19 was statistically significant (p 0.05).

Objective: To describe the clinical, socio-demographic, and functional profile of children with Attention Deficit Hyperactivity Disorder (ADHD) referred to a tertiary care center in Kerala, India. Methods: A retrospective descriptive study was conducted from records of developmental evaluation clinic over a period of one year. All-consecutive cases the first time diagnosed as ADHD were enrolled. Autism Spectrum Disorder, genetic disorders, and children with sensory impairments were excluded. Clinical profile was based on presenting symptoms, gender, and socio-demographic characteristics; functional status assessed by Conner’s 3 Parent Scale and cognitive status by Intelligence Quotient. Results: ADHD prevalence in a clinically referred sample was 12.7%. Boy to girl ratio was 6:1. The mean age of presentation was 8.2 years (SD 6.09). The most common presenting symptom was hyperactivity and behavioral problems followed by poor scholastic performance and poor memory. The functional status assessment showed major concerns in all six domains - Inattention, Hyperactivity, Learning Problem, Executive Functioning, Aggression, and Peer relation, in the majority of children. Children presenting with ADHD symptoms at a later age (9-12 years) had lower IQ scores than those diagnosed at a younger age. Conclusion: Course of childhood ADHD shows a consistent clinical and functional pattern. Early diagnosis and quantification of difficulties at the outset is suggested, which can help in providing early intervention and is likely to improve long-term outcome in these children.

Introduction: breast cancer is the second most diagnosed cancer worldwide. We aimed to depict the diagnostic approach as well as the epidemiologic and clinical profile of patients with breast cancer at Potchefstroom regional hospital, South Africa. Methods: this descriptive open-cohort study included patients with primary invasive breast cancer, confirmed by histology results and treated at the hospital from 01 January 2012 to 31 December 2018. Data such as demographics, patient history, histology, breast clinical findings, physical mass description and diagnostic investigations were captured from hospital registries and patient files. Results: one-hundred-thirty-eight patients (mean age 56.2 (SD: 14.4) (95% CI 54.6-59.7) years) met inclusion criteria. Most patients were female (98.6%), from African (67.4%) or Caucasian (23.9%) descent. Findings included mostly left-side breast involvement (51.8%), lesions in the upper-outer quadrant (43.1%), extensions to the skin (25.6%, N = 39), and tumour size of 2 ≤ 5 cm (49.3%), or > 5 cm (39.1%). Most patients (57.9%, N = 135) were categorised as BIRADS-5, with a ductal pattern (89.6%) (p < 0.01). Patients mostly presented in stages II to IV of disease (89.1%; p < 0.05). Late-stage (stages III-IV) at time of diagnosis (n = 84) was significantly associated with mass location (p = 0.006; Cramér's V = 0.280), tumour size (p < 0.001, Cramér's V = 0.239), and skin changes (p = 0.027, Cramér's V = 0.492). Conclusion: most patients consulted at late-stage of the disease, indicating a need for the promotion of breast awareness campaigns, early detection, and timeous referral.

Amaç: COVID-19 akut solunum yetmezliğine neden olabilen, ilk kez Aralık 2019’da Çin’in Wuhan şehrinde ortaya çıkan yeni zoonotik bir enfeksiyöz hastalıktır. Bu çalışmanın amacı Türkiye’de bir üçüncü basamak hastaneye başvuran COVID-19’lu hastaları analiz etmektir.Yöntemler: Çalışmada, COVID-19 hastalık tanısı almış 49 hastanın (20 kadın, 29 erkek) demografik özellikleri, klinik semptom ve bulguları, komorbiditeleri, laboratuar sonuçları, toraks bilgisayarlı tomografi (BT) bulguları ve sağkalım, yoğun bakım ünitesine (YBÜ) ve servis yatışlarını değerlendirdik.Bulgular: Vakaların 20’si (%40,9) kadın ve 29’u (%59,1) erkekti. Hastaların ortalama yaşı 56,20 (17,65) idi. En sık görülen semptom öksürüktü (%75,5). Hipertansiyon en sık eşlik eden hastalıktı (%26,5). 42 hastanın (%85,7) troponin I değeri negatifti (referans değer, Aim: COVID-19 is a new zoonotic infectious disease that can cause acute respiratory failure, which first occurred in Wuhan, China in December 2019. The aim of study was to analyze cases with COVID-19 admitted to a tertiary care center in Turkey.Methods: We evaluated demographic characteristics, clinical symptoms or signs, comorbidities, laboratory results, chest computed tomography (CT) findings and outcomes including hospitalization, intensive care unit (ICU) admission and survival of 49 patients (20 females, 29 males) diagnosed with COVID-19 disease.Results: Twenty (40.9%) of the cases were female and 29 (59.1%) were male. The mean age of the patients was 56.20 (17.65) years. The most common symptom was cough (75.5%). Hypertension (26.5%) was the most prevalent comorbid disease. Troponin I result of 42 (85.7%) patients were negative (reference value