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Background: Central nervous system tumors are the 10th most prevalent cause of mortality worldwide. The 2016 World Health Organization (WHO) classification of high grade gliomas (HGG) has identified Isocitrate dehydrogenase 1 (IDH 1) mutation as one of the primary molecular markers. Tumor protein 53 (p53) mutation is also closely associated with HGG. Aims and Objectives: The current study intended to ascertain the expression of IDH1 and P53 in patients with HGG and correlate that expression with clinical prognosis. Materials and Methods: The study included 34 patients with histopathological proven HGG. Relevant clinical information was recorded. The immunostaining results with anti-mouse monoclonal antibody for IDH 1 (R132H) and rabbit polyclonal antibody for p53 (RP 106-05) were statistically analyzed. Patients were followed up through telephone for a period of 1 year. Mortality within 1 year was regarded as a poor outcome. Results: About 85.29% (29/34) of the patients had Grade IV glioma, while only 14.71% (5/34) had Grade III glioma. Most patients with Grade III (3/5) (60.00%) and Grade IV (21/29) (72.41%) gliomas had p53 positivity. The majority of the patients with grade-III glioma (3/5) (60.00%) had IDH1 positivity, while most of the patients (23/29) (79.31%) with Grade IV gliomas had IDH1 negativity (P=0.0658). Age, gender, WHO grade, and adjuvant therapy did not show significant association with the outcome except for the p53 expression (P=0.0011*) and IDH1 expression (P=0.0025*). Correlation analysis showed a significant positive correlation between p53 makers with poor outcome (r=0.4781) and glioma grade (r=0.4028). Further, a negative yet insignificant correlation was recorded between IDH1 with age (r=-0.2285), p53 expression (r=-0.2568), and grade (r=-0.2988), although it showed a significant correlation with poor outcome (P=0.0001). Conclusion: p53-positive and IDH1-negative HGG had a significant correlation with the poor outcome. Thus, IDH1 and p53 are reliable markers for prognostication of HGG. [ABSTRACT FROM AUTHOR]

Objective: In developing countries like India where tuberculosis is highly prevalent, the incidence of pulmonary aspergilloma is also high. Mortality and morbidity associated with surgical treatment of aspergilloma in previous studies has discouraged surgeons from taking up surgery as the preferred treatment. This study focuses on the clinical outcome of patients with pulmonary aspergilloma and its surgical management. Methods: Fifty-one patients who underwent thoracotomy for pulmonary aspergilloma from 2015 to 2017 were studied retrospectively by reviewing their medical records. Results: The most common clinical presentation of pulmonary aspergilloma was hemoptysis, which occurred in 76.0% of patients. Tuberculosis was the most common pre-existing disease (72%). High resolution computed tomography of chest, showed the typical "air-crescent" sign in all patients. Systemic antifungal therapy neither palliated the clinical symptoms nor eradicated the aspergilloma, and transarterial embolisation was also unsuccessful. Surgery offered the only chance of cure for both unilateral and bilateral disease. Procedures varied from segmentectomy to pneumonectomy with most (75%) undergoing lobectomy. There was no death following surgery and postoperative complications occurred in 5 patients. Postoperatively, most of the patients were symptom-free. Conclusion: Symptomatic pulmonary aspergilloma patients are best treated by early surgical intervention with good results in experienced centers. [ABSTRACT FROM AUTHOR]

Introduction: One of the most common obstetrical interventions is the induction of labour. Cervical ripening drugs are typically used before conventional methods of induction since they are linked to an increased risk of protracted labour, chorioamnionitis, and Caesarean Sections (CS) during labour induction when an unfavourable cervix is present. The two major techniques for cervical ripening are mechanical interventions, such as the insertion of balloon catheters, and the application of pharmacologic agents, such as prostaglandins. It is widely accepted that the induction of labour, which ultimately leads to vaginal delivery, is largely dependent on the condition of the uterus' cervix. Aim: To compare the efficacy of a combination of Foley bulb catheter and intracervical Dinoprostone and intracervical Dinoprostone alone for the induction of labour. Materials and Methods: A prospective observational study was performed over 150 pregnant mothers from May 2018 to April 2019. in the labour room of North Bengal Medical College and Hospital, a tertiary care institution in Darjeeling, West Bengal, India. The pregnant women were divided into two groups: intracervical Dinoprostone gel alone (Group-1) and a combination of intracervical Foley catheter and intracervical Dinoprostone gel (Group-2) with n=75 patients in each group. Group-1 received intracervical Dinoprostone gel 0.5 mg, which was repeated every 6 hours, a maximum of three doses, or until she went into active labour, whichever occurred earlier. In Group-2, a 16 F Foley catheter was inserted into the cervix, inflated, and a single dose of intracervical Dinoprostone gel 0.5 mg was given alongside it. Participant demographic characteristics, medical and pregnancy history, indication for labour induction, labour course, and outcomes were collected. The collected data were analysed with the mean and standard deviation for numerical variables and counts and percentages for categorical variables. Odds ratio was calculated where deemed relevant. Results: The induction to delivery time was considered the primary outcome and was shorter in Group-2 by 28 minutes (p=0.342). Among the secondary outcomes, the duration of the latent phase of labour was shorter in Group-2 by 57 minutes, and the proportion of patients delivering within 12 hours was also higher (28%) but statistically insignificant (p>0.05). The rates of CS were unaffected by the mode of induction. None of the two methods were found to be inferior to the other in respect to neonatal outcomes or complications of labour like chorioamnionitis and postpartum haemorrhage. Conclusion: The combination of Foley catheter with intracervical Dinoprostone gel did not prove to be more efficient than intracervical Dinoprostone alone for labour induction in the current study. [ABSTRACT FROM AUTHOR]

Background and Objective: Pediatric renal transplantation is a life‑saving procedure for children with end‑stage renal disease. This study aims to analyze the outcomes of pediatric renal transplants at our center, focusing on patient demographics, donor sources, surgical techniques, posttransplant complications, graft survival, and rejection rates. Methodology: A retrospective analysis was conducted on 43 pediatric kidney transplant recipients. Data on recipient age, gender, donor type, pretransplant dialysis, donor characteristics, surgical techniques, native kidney disease, induction therapy, maintenance immunosuppression, posttransplant infections, graft survival, and rejection episodes were collected and analyzed. Results: We performed 43 pediatric kidney transplants in total. The average age was 13.7 years (±3.81), with 8 (18.6%) being under the age of ten, 11 (25.6%) being between the ages of eleven and fourteen, and 24 (55.8%) being between the ages of fifteen and eighteen. There were 43 recipients: 27 males and 16 females. There were four (9.3%) deceased donor renal transplants and 39 (90.7%) live‑related kidney transplants. Right internal iliac artery and right external iliac vein anastomosis were found in 32 (74.4%) cases, right external iliac artery and right external iliac vein in 9 (20.9%), right common iliac artery and right common iliac vein in 1 (2.3%), and right common iliac and right internal iliac in 1 (2.3%). Induction was used in 27 recipients (62.8%). Graft survival was seen at 1 year in 42 (97.7%) patients and at 5 years in 34 (81%). Biopsy‑proven rejection occurred in 22 (51.2%) of the recipients, with antibody‑mediated rejection occurring in 8 (18.6%) and cellular rejection occurring in 22 (51.2%). Graft loss was caused by acute cellular rejection in three (23.1%) cases, graft pyelonephritis in 2 (15.4%), and an unknown cause in 2 (15.4%). There were no significant connections with antibody‑mediated rejection. Conclusion: Our study provides valuable insights into the outcomes of pediatric renal transplantation at our center. Despite the challenges of graft rejection and posttransplant infections, favorable graft survival rates were achieved. Cellular rejection emerged as a significant risk factor for graft survival, highlighting the importance of effective immunosuppressive management. Our findings emphasize the need for close follow‑up, infection control measures, and individualized immunosuppressive strategies to optimize long‑term outcomes in pediatric renal transplant recipients. Further research is warranted to refine protocols and address the specific needs of this vulnerable patient population. [ABSTRACT FROM AUTHOR]

BACKGROUND - INH is an important first line Anti TB drug and unexpectedly, Mono resistance to INH has been found to be as high as 17.3% in India as per the India TB Report, 2023. This reduces treatment success rates and increases incidence of MDR-TB. The regimen used in these patients as per guidelines is 6LRZE (6 months of Levofloxacin, Rifamycin, Ethambutol and Pyrazinamide) AIM AND OBJECTIVE -To study the incidence, outcome and side effect profile of INH mono resistant TB when treated with H Mono Poly DR Regimen and to study the side effects of long term usage of Levofloxacin and Pyrazinamide. METHODOLOGY- 78 INH Mono resistant patients were diagnosed at the Designated Microscopy centre attached to the Respiratory Medicine OP, ACSR Govt. Medical College between 1st January 2023 and 1st July 2023 (6 months) and H Mono Poly DR regimen started. RESULTS: Out of the 78 INH MONO resistant patients, 30% belonged to 41-50 year age group (23 patients). 75% were males (57 patients), 10% developed side effects (8 patients) and about 23 % had comorbidities (18 patients). At the end of 6 months, 88.5% were declared cured (69 pts) and the Treatment Failure rate was 6.41% (5 patients). 3 deaths due to unrelated causes occurred during treatment [ABSTRACT FROM AUTHOR]

Aims: Intussusception is a common pediatric surgical emergency and an indicator for primary healthcare. We report our experience with childhood intussusception at a tertiary care hospital in the private sector in Central Kerala and add our refinement to the technique of hydrostatic saline reduction which had more desirable outcome. Settings and Design: Children presenting with the diagnosis of intussusception which were managed in our department of pediatric surgery at a private hospital in Kerala, India. Subjects and Methods: Eighty children, up to 15 years of age, (43 boys, 37 girls) confirmed to have intussusception on ultrasound and managed in our institution from October 2016 to July 2020 with hydrostatic saline reduction. Sixty-two (77%) of them were aged 3 months to 3 years (numbers <10 to be written in words); the age of idiopathic intussusception. Statistical Analysis Used: SPSS V25. Association between variables using Chi square test and independent t test. Results: A total of 80 children met the criteria out of that (n = 79) had successful nonoperative reduction. Hydrostatic saline enema 73, One Barium and five air enema. A child presented in shock was taken up for laparotomy and reduced operatively. Six recurred within 24 h (7% early recurrence) and a second attempt at nonoperative reduction succeeded in all six of them. (numbers <10 in words). Eleven children (14%) had a late recurrence, the attempt at saline hydrostatic reduction was successful in only 3 (27%) and 8 went on to have surgery. Six were successfully reduced operatively and 2 had resection anastomosis. Conclusions: After excluding those who need surgery on clinical grounds, we report a 98.7% success with nonoperative reduction for the first instance of intussusception, a 24 h recurrence of 7%, with successful repeat reductions in all. With the refinement in the technique, we could achieve a desirable outcome. At the first presentation, surgery was indicated in 1 of the 80 children. We report a late recurrence rate of 14%, with a 27% success rate for nonoperative reduction. No pathological lead points were identified even in this group. All the children had an uneventful and a faster recovery. In our series, we had 97.5% follow up rate. [ABSTRACT FROM AUTHOR]

Background: Acute upper‑limb ischemia (AULI) is not always as limb‑threatening as those in the leg, so thrombo‑embolectomy is not always as necessary for limb salvage. Objective: To evaluate “the outcomes of limb and life at the end of one month, in patients with AULI” and to analyze the following factors: presentation from the time of the acute event, evaluation of limb at the time of presentation regarding its viability, and compare the outcomes in early presentation vs late presentation. Methodology: This was a retrospective study; hence, clinical profiles of all patients during the past seven years were reviewed for those presenting with AULI. Data on anticoagulation were collected, imaging and operative procedures were extracted. All statistical analyses were performed using SPSS 11.0 for Windows. Results: In our study, 25 (42.4%) patients were included due to native arterial thrombosis, 11 (18.6%) due to embolic disease, and the same percentage due to exposure to a high‑altitude area (HAA) (more than 9000 feet). 4 (6.8%) patients had thoracic outlet syndrome and cervical rib, and 5 (8.5%) had hypercoagulable disorder. Our study population was younger with a mean of 44.9 years with an SD of 13, and the majority were male (5 out of 59 were female). 16 were active smokers, and 2 were former smokers. The left upper limb incidence was 59% (n = 35), and the right upper limb was 41% (n = 24). In our study, the most common site was the brachial artery 53% (26 out of 49) and axillary artery 35% (17 out of 49) when iatrogenic, traumatic, and thoracic outlet syndromes are excluded. Out of the 59 patients, 39 patients had undergone color Doppler flow imaging of the affected limb and 30 patients had undergone CT angiography of the arch and the limb. Two patients presented with gangrene to the forearm, and 12 patients underwent Colour doppler flow imaging (CDFI) before they presented to our center. In our study, 37% of the patients presented within 48 hours of the onset of symptoms, out of which above‑elbow amputation was done in only 1 patient, that is, 4.5%, and 24% of the patients presented within an 8–14‑day period, among which one patient (11%) had undergone above‑elbow amputation and 22% of the patients presented after 14 days, in which there were 2 above‑elbow‑amputation patients (15%) with a statistically non‑significant P value of 0.5. A total of 45 patients were managed with anticoagulation. A detailed discussion on the treatment outcome of each case has been presented in the article. Conclusion: CT angiography, when available, is a well‑accepted first‑line investigation for AULI. When we compare AULI with lower‑limb ischemia, collateral circulation conservative management is also an option, provided that it is not associated with tissue loss. AULI like lower‑limb ischemia has better limb salvage when diagnosed and intervened early. [ABSTRACT FROM AUTHOR]

Background: Acute poisoning is a major health problem with significant morbidity and mortality affecting people of all age groups. Acute poisoning approximately constitutes 10% admissions in medical emergency departments in India. Objective: Present study was aimed at finding out the clinical pattern and outcome of acute poisoning at a tertiary care hospital, Karnataka. Materials and methods: A prospective observational study was conducted over a period of 18 months. Information like name of poisonous substances, mode of poisoning, investigation reports and outcome was collected in the pre-structured proforma and analysed using SPSS version 20. Results: Out of 100 acute poisoning cases, 49 were males and 51 females. Most common age group involved was 21-30 years of age (38%). Organophosphate poisoning was the most common type of poisoning. Mortality was highest in paraquat poisoning (100%). Overall mortality was 15%. Conclusion: Current study showed increase in incidence of poisoning in younger generation. Organophosphate poisoning was the most common type of poisoning. Low cost and easy accessibility of OP compounds may be one of the reasons. Rat poisoning, usage of household cleansing agents and corrosive poisons (paraquat) are also in increasing trend. [ABSTRACT FROM AUTHOR]

Introduction: Drug abuse is a global public health issue that poses significant challenges to healthcare systems particularly in intensive care units (ICU). This study aims to assess the clinical profile and outcomes of drug abuse patients admitted to ICU of a tertiary care hospital in North India. Methods: A prospective observational study was conducted over period of 3 years involving drug abuse patients admitted to the ICU. Demographic data, clinical characteristics, substance abuse patterns, co-morbidities, severity scores and outcomes were recorded. Results: A total of 35 patients were included in the study. All patients were males with a mean age of 29.1(± 11.68). 25 patients were from rural areas. 42.8% were unemployed. Most of the patients (85.7%) were unmarried. 34.3% were students. Mean APACHE II score on ICU admission was 13. Most of patients were admitted for heroin overdose (60%). All 35 patients admitted in ICU had low Glasgow coma scale (GCS< 7). 32 (91.4%) patients had associated respiratory failure. 7 patients had cardiovascular instability. 4 (11.4%) patients developed multi-organ failure during the ICU stay. Mean duration of ICU stay was 3.4 (± 2.68). 23 (65.7%) patients got extubated within 24 hours of ICU admission. 4 patients expired (11.4% mortality) in study group. Sepsis was cause of death in one patient, 3 patients died of multi-organ failure Conclusion: Most of the overdose was due to opioids specifically of heroin. CNS depression was found in all drug overdose patients followed by respiratory failure. Multi organ involvement have poor outcome. Mortality ensued in 11.4% of admitted patients as a result of sepsis and multi-organ failure. Majority of the patients had good outcome especially patients who presented early to healthcare facility. [ABSTRACT FROM AUTHOR]

Background: Due to strict protection of wild animals and encroachment on their habitat, the number of injuries and deaths caused by wild animals is increasing in central India. The purpose of this study was to report the injuries caused by wild animal attacks and discuss the management methods and its consequences. Methods A retrospective study was conducted from January 2021 to June 2023 in a plastic surgery department of a tertiary care hospital in central India. A total of 508 cases (372 males and 136 females) with a history of wild animal attacks were recorded in a period of time. From research. Results 80% of the victims were attacked in the fields and 20% in the forest while collecting firewood or keeping cattle. Tears in the head and neck, fractures in the upper limbs and the face and skull were significant observations. In most patients, the long-term consequences were permanent facial disfigurement, hearing loss, loss of fingers, residual neurological deficits, and persistent psychiatric complications. Conclusion Wildlife injuries are a neglected part of trauma. A high index of suspicion is required when treating these injuries, as underlying bone and soft tissue injuries may be overlooked. The management of these injuries includes all trauma subspecialties to achieve the best functional outcome. [ABSTRACT FROM AUTHOR]

Introduction: Organo-phosphates are widely used in horticulture and agriculture in developing countries and therefore poisoning with these agents is common either by unintentional or suicidal ingestion. In developing countries like India, it is still a major public health problem because of its association with high morbidity and mortality. Organo-phosphates may cause deformation of erythrocyte membranes by acute and chronic inflammation. Hence, it is expected that Red cell distribution width (RDW) levels may be increased in Organophosphorus (OP) poisoning and can thus aid in prognosis. Objectives: 1. To assess red cell distribution width and serum cholienesterase levels on admission. 2. To assess correlation between red cell distribution width and outcome in organophosphorus poisoning. Methodology: A prospective interventional study was conducted among 100 Organophosphorus poisoning cases admitted in our hospital. A detailed history was obtained using a pre-designed, structured proforma followed by a detailed systemic examination. Relevant investigations were conducted which included red cell distribution width. Chi-square test was used to assess the relation between red cell distribution width and outcome in organophosphorus poisoning. Results: Among 100 participants, majority were males (65%) and between 21-30 years age group (43%). Most common compounds involved in poisoning wereMonocrotophos (36%) Chlorpyrifos (34%), Duration of exposure for 69% of them was 1-2 hours. 50% of them had RDW ≤ 13 and 50% had RDW > 13. There were 6 deaths among 50 subjects with RDW >13 and only 1 death among 50 subjects with RDW ≤ 13 and this difference was statistically significant (P<0.05). Conclusion: In this study RDW was significantly associated with outcome and served in assessing the outcome in OP poisoning. We conclude that RDW is simple test which can be measured easily at the time of admission and used as a predictor of outcome in OP poisoning. [ABSTRACT FROM AUTHOR]

Background: Skin mottling as a clinical perfusion marker in septic shock is significantly associated with severity and outcome in white-skinned population and its validity as a clinical sign in dark-skinned population is not known. The objectives of this study were to evaluate mottling in septic shock in the Indian ethnic population who has different skin color as compared to the white-skinned population and to assess mottling as an outcome predictor with capillary refill time (CRT) and other biochemical parameters which are the established clinical markers of perfusion in septic shock. Materials and methods: We conducted a prospective observational study of patients with skin color categories 21-34 on the von Luschan scale or Fitzprick type IV-VI who had septic shock needing a high dose of norepinephrine ≥0.2 µg/kg/min after fluid optimization. The study was conducted in a mixed medical-surgical ICU over 12 months. Two blinded experts (a Dermatologist and a plastic surgeon) independently classified the skin type, validated the occurrence of mottling, and scored mottling in our patients. We recorded the demographics, hemodynamic variables, and mottling score and observed the incidence of mottling and its correlation with predictors of the severity of septic shock. We also compared CRT, arterial lactate, central venous oxygen saturation, and venoarterial PCO2 gap with occurrence of mottling in septic shock patients. Results: We included 108 patients with age 61 ± 16 years. Mean Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores at enrolment were 10.3-21.9, respectively. Incidence of mottling was 20.3% (22/108). CRT >3 seconds was observed in 50.9% (55/108). Development of mottling was significantly associated with 90-day mortality; 20/22 (90.9%) patients died in the mottling group versus 58/86 (65.1%) in the non-mottling group (p = 0.028). Capillary refill time >3 seconds did not corelate with mortality; 40/55 (72.7%) Patients with CRT >3 seconds died versus 32/53 (60.4%) patients died in CRT ≤3 seconds group. Occurrence of mottling could predict mortality; positive predictive value of 90.9% which was comparable to positive predictive value of lactate levels >4 mmol/L, i.e., 94.1%. Conclusion: The incidence of mottling in septic shock is much less in patients of Indian ethnicity with brown skin color than in white-skinned population. Occurrence of mottling and not delayed CRT, is a better predictor of outcome in this setting. [ABSTRACT FROM AUTHOR]

Background: Despite the availability of several pharmacological and nonpharmacological treatments, a significant proportion of patients with alcohol dependence relapse to alcohol use after treatment. The objectives of this study were to determine the 6-month course and outcome in treatment-seeking individuals with alcohol dependence syndrome and to determine the sociodemographic and clinical correlates of the outcome in these patients. Materials and Methods: A longitudinal observational study was conducted in treatment-seeking male patients with alcohol dependence syndrome. Baseline sociodemographic and clinical details were gathered using a structured pro forma. The patients were followed up at 2 weeks, 1 month, 3 months, and 6 months. During the follow-up evaluation, abstinence status, number of abstinent days, and number of heavy drinking days were noted. Logistic regression was conducted to evaluate the factors associated with abstinence at 6 months. Results: Ninety-four patients were recruited for the study. The mean age of the participants was 43.98 years (standard deviation (SD) 10.68). Two patients were lost to follow-up. At the end of 2 weeks, 74 (80.43%) out of 92 participants remained abstinent. At the end of 1 month and 3 months, 59 (64.13%) and 38 (41.3%) participants of 92 were abstinent, respectively. At the end of 6 months, 26 (30.23%) of 86 patients were abstinent. Among those who were not abstinent at 6 months, the mean number of abstinent days was 113 (SD 51.62) days and the mean number of heavy drinking days was 56 (SD 51.62) days. Outpatients were found to have 2.91 times higher odds of remaining abstinent at 6 months when compared to inpatients. Conclusion: Nearly one-third of treatment-seeking patients with alcohol dependence syndrome remained abstinent at the end of 6 months. The locus of treatment was associated with abstinence at 6 months. [ABSTRACT FROM AUTHOR]

Introduction: Acute Kidney Injury (AKI) poses life-threatening risks in pregnancy, leading to adverse perinatal and maternal outcomes. Aim: To estimate the incidence of Pregnancy-Related Acute Kidney Injury (PRAKI) and describe maternal and foetal outcomes in cases of Acute Renal Failure (ARF) at a tertiary care institute. Materials and Methods: A prospective descriptive study was conducted on 104 antenatal women with ARF attending King George Hospital, Visakhapatnam, Andhra Pradesh, India, from January to December 2020. A total of 7,409 deliveries occurred during the study period, and antenatal women with evidence of pre-existing renal disease were excluded. A detailed history was obtained, and evaluation included renal function tests and a total abdominal scan. Mode of delivery, foetal deaths, stillbirths, maternal deaths, and APGAR scores were analysed. Laboratory findings were also reported. Data analysis was performed using coGuide statistical software, and results were expressed in terms of frequency and percentages. Results: The incidence of PRAKI was 14 per 1,000 deliveries (1.4%). The mean age of the participants was 24.05±4.11 years. The majority (78 out of 104, 75%) were in the third trimester. Out of the 104 cases of PRAKI, 77 (74%) were due to hypertension. There were 16 (15.4%) maternal deaths and 19 (21.8%) perinatal deaths. Results: The incidence of PRAKI was 14 per 1,000 deliveries (1.4%). The mean age of the participants was 24.05±4.11 years. The majority (78 out of 104, 75%) were in the third trimester. Out of the 104 cases of PRAKI, 77 (74%) were due to hypertension. There were 16 (15.4%) maternal deaths and 19 (21.8%) perinatal deaths. [ABSTRACT FROM AUTHOR]

Background and Aims: A rapid surge in rhino-orbito-cerebral mucormycosis (ROCM) cases was reported during the second wave of COVID, especially in India, needing extensive surgical debridement along with medical management. The present study was planned to observe perioperative anesthesia challenges and outcomes of patients with ROCM during the second wave of the COVID-19 pandemic. The primary objective was to observe intraoperative anesthesia challenges and the secondary objectives were to observe postoperative challenges and outcomes of patients. Material and Methods: This was a single-centered, bidirectional (retrospective and prospective) observational study, conducted at a tertiary care center. We enrolled 218 adult patients scheduled for surgical debridement of ROCM under general anesthesia. Demographics, COVID status, comorbid illness, intraoperative challenges (difficult airway, hemodynamic instability, blood loss), and postoperative outcome (postoperative mechanical ventilation, and mortality rate) were noted. Results: The majority of the patients were males (71%) and had diabetes mellitus (54%). COVID-associated mucormycosis was seen in 67% and 41% of them received steroids. Post-induction hypotension was noted in 20.6% of patients, and 14.2% had intraoperative hypotension out of which 5.5% required vasopressor support. Difficult mask ventilation and difficult intubation were reported in 7.3% and 6.4% of patients, respectively. No significant difference was found among intraoperative challenges when COVID mucormycosis was compared to non-COVID mucormycosis. Postoperative mechanical ventilation and ICU care were required in 41.3%, whereas mortality was seen in 11.5% of patients. The mortality was significantly more (P = 0.041) in patients with COVID mucormycosis (13%) compared to that with non-COVID mucormycosis (4.2%). Cbonclusion: Diabetic male patients who received steroids during COVID illness are at the highest risk of developing ROCM. Difficult airway and hemodynamic instability, are significant perioperative challenges encountered by anesthesiologists. Postoperative ICU management is crucial for decreasing postoperative morbidity and mortality. [ABSTRACT FROM AUTHOR]

Thrombocytopenia in patients with systemic lupus erythematosus (SLE) is associated with higher morbidity and mortality. We report frequency, associations and short-term outcome of moderate-severe thrombocytopenia in a prospective inception cohort from India (INSPIRE). We evaluated consecutive SLE patients classified per SLICC2012 for the occurrence of thrombocytopenia and its associations. The outcomes assessed included bleeding manifestations, kinetics of thrombocytopenia recovery, mortality and recurrence of thrombocytopenia. Among a total of 2210 patients in the cohort, 230 (10.4%) had incident thrombocytopenia, of whom moderate (platelet count [PC] 20–50 × 109/L) and severe thrombocytopenia (PC < 20 × 109/L) were noted in 61 (26.5%) and 22 (9.5%), respectively. Bleeding manifestations were generally limited to the skin. Compared to controls, cases had a higher proportion of autoimmune haemolytic anaemia (p < 0.001), leukopenia (p < 0.001), lymphopenia (p < 0.001), low complement (p < 0.05), lupus anticoagulant (p < 0.001), higher median SLEDAI 2 K (p < 0.001) and lower proportion of anti-RNP antibody (p < 0.05). There was no significant difference in these variables between moderate and severe thrombocytopenia. There was a sharp rise in PC by 1 week that was sustained in the majority through the period of observation. There was three times higher mortality in the severe thrombocytopenia group as compared to moderate thrombocytopenia and controls. The thrombocytopenia relapse and lupus flare rates were similar across categories. We report a low occurrence of major bleeds and higher mortality in those with severe thrombocytopenia as compared to moderate thrombocytopenia and controls. Key Points • Severe thrombocytopenia occurs in 1% of patients with SLE; however, major bleeds are uncommon. • Thrombocytopenia has a strong association with other lineage cytopenias and lupus anticoagulants. • Response to initial glucocorticoids therapy is quick and is well sustained with additional immunosuppressants. • Severe thrombocytopenia increases mortality threefold in SLE. [ABSTRACT FROM AUTHOR]

Background: Neonates undergo transition at birth from breathing fluid to breathing air. If this change is not tolerated by neonate, need of assisted ventilation arises. Non-invasive ventilation (NIV) refers to any mode of respiratory support provided through nasal airway. Using RAM’S cannula as an interface, complications of invasive ventilation can be prevented, and therefore it can be impactful in improving respiratory care in neonates. Aims and Objectives: The aim of the study was to find the association of clinicoetiological factors and the outcome of NIV using RAMS’s cannula in neonates. Materials and Methods: This prospective observational study was done from March 1, 2021 to August 31, 2022 at Neonatal Intensive Care Unit of a Tertiary care center in Central India. Neonates given NIV through Ram’s cannula were enrolled. Primary diagnosis of subjects and clinical parameters - birth weight, gestational age, duration of NIV given, and severity of respiratory distress were recorded and analyzed to find an association with the outcomes. Informed consent was obtained from parents. Results: 100 neonates (62 male) were given NIV. 78 neonates were weaned off from NIV and 22 needed intubation. Duration of NIV, gestational age, severity of respiratory distress, and birth weight were found to be statistically significant. Weaning was more in gestation >34 weeks, weight >1 kg, duration of NIV given <3 days, and neonate having mild respiratory distress. Conclusion: NIV through RAM’s cannula is useful in both respiratory and non-respiratory illness. Higher rates of NIV failure were seen in the duration of NIV >7 days, weight <1 kg, and gestation <34 weeks. [ABSTRACT FROM AUTHOR]

Background: Estimating the morbidity and mortality in the emergency department (ED) only allows the pediatricians to assess the prognosis of the patient and plan therapies accordingly. This study was conducted to develop and validate a simple scoring system and establish a correlation between clinical parameters and the outcome of the patient. Subjects and Methods: Nine parameters, i.e., body temperature, respiratory rate, heart rate, blood pressure (BP), pulse oxygen saturation (SpO2), capillary refill time, level of sensorium, presence of seizure, and random blood sugar level, were documented, at the time of admission. Parameters were assigned a score of "0" if it is normal. An abnormality in the above parameters were indicated by a score ranging from 1 to 3. The primary outcome was assessed in terms of death/survival. Results: Out of the total, 57.2% required critical care, and mortality was reported in 14.75% of cases. On univariate analysis, seven clinical parameters were significantly associated with mortality. In multivariate logistic regression analysis, abnormalities in BP, SpO2, and temperature were independent predictors of mortality (P < 0.05). The receiver operating characteristic was 0.798 (95% confidence interval, 0.755-0.836; P < 0.0001) for the outcome of mortality (the predictive ability of score of 79.8%). The patients with scores 1-5, 6-10, and >10 had 4.923, 23.143, and 112.0 higher odds of mortality, respectively. Conclusions: This scoring system predicts the severity of illness and outcome with a sensitivity of 71.19% and specificity of 72.14%, respectively, in the ED. Higher scores predict unfavorable outcomes in these children. [ABSTRACT FROM AUTHOR]

Background: Patients admitted to intensive care units (ICUs) with severe coronavirus disease (COVID-19) are associated with high mortality. The present retrospective, multicenter study describes the predictors and outcomes of COVID-19 patients requiring ICU admission from COVID-19 Registry of Indian Council of Medical Research (ICMR), India. Materials and methods: Prospectively collected data from participating institutions were entered into the electronic National Clinical Registry of COVID-19. We enrolled patients aged >18 years with COVID-19 pneumonia requiring ICU admission between March 2020 and August 2021. Exclusion criteria were negative in RT-PCR report, death within 24 hours of ICU admission, or incomplete data. Their demographic and laboratory variables, ICU severity indices, treatment strategies, and outcomes were analyzed. Results: A total of 5,865 patients were enrolled. Overall mortality was 43.2%. Non-survivors were older (58.2 ± 15.4 vs 53.6 ± 14.7 years; p = 0.001), had multiple comorbidities (33.2% vs 29.5%, p = 0.001), had higher median D-dimer (1.56 vs 1.37, p = 0.015), higher CT severity index (16.8 ± 5.2 vs 13.5 ± 5.47, p = 0.001) and longer median hospital stay (10 vs 8 days, p = 0.001) and ICU stay (5 vs 4 days, p = 0.001), compared with survivors. On multivariate analysis, high CRP (HR 1.008, 95% CI: 1.006-1.010, p = 0.001) and high D-dimer (HR 1.089, 95% CI: 1.065-1.113, p < 0.001) were associated with invasive mechanical ventilation while older age (HR 1.19, CI: 1.001-1.038, p = 0.039) and high D-dimer (HR-1.121, CI: 1.072-1.172, p = 0.001) were independently associated with mortality and while the use of prophylactic low molecular weight heparin (LMWH) (HR 0.647, CI: 0.527-0.794, p = 0.001) lowered mortality. Conclusion: Among 5,865 COVID-19 patients admitted to ICU, mortality was 43.5%. High CRP and D-dimers were independently associated with the need for invasive mechanical ventilation while older age and high D-dimer were associated with higher mortality. The use of prophylactic LMWH independently reduced mortality. [ABSTRACT FROM AUTHOR]

Background: A serious problem in cirrhosis is acute renal injury. The study aimed to examine the urinary neutrophil gelatinase-associated lipocalin (uNGAL) as a diagnostic and prognostic marker of acute kidney injury (AKI) in cirrhotic patients. Methods: A prospective study was carried out over a period of 1 year. A total of 490 patients suffering from cirrhosis who visited an indoor hospital were screened, and after the exclusion, a total of 90 subjects admitted to the medicine intensive care unit (MICU) fulfilling inclusion criteria were enrolled. Those having a history of renal diseases, on nephrotoxic drugs, in septic shock, peritonitis, UTI, and no urine output were excluded. On admission, for the estimation of uNGAL, urinary levels of sodium, creatinine, fresh urine samples were obtained, and blood samples were taken for serum creatinine estimation. Results: Out of 90 patients, 33.3% did not develop AKI, and 66.7% developed AKI. Urinary neutrophil gelatinase-associated lipocalin levels were six times higher in patients with acute tubular necrosis (259.08 ± 118.41 ng/mL) and three times higher in Hepatorenal syndrome (HRS)-AKI (124.97 ± 16.38) as compared with patients with normal kidney function (39.76 + 5.7). Those who died had a higher uNGAL (171.6 ng/mL) in comparison to those who survived (133.7 ng/mL). At a cutoff value of ≥114.9 (ng/mL), urinary NGAL represents a sensitivity of 86.92% and specificity of 100% to diagnose AKI and AUC 0.966 (95% CI: 0.919-0.990) in cirrhotic patients. Conclusion: Urinary NGAL is good for diagnosing AKI and is a marker to distinguish the types of AKI in liver cirrhosis. [ABSTRACT FROM AUTHOR]

Background: Snakebite remains a significant public health problem worldwide, particularly in rural areas with unexpected morbidity and mortality. This study evaluated the clinical, laboratory profile and outcomes in children with snake bites from Eastern India. Methods: This was a retrospective case record-based study between January 2017 and December 2021. The clinical features, complications, laboratory profiles and outcomes were analysed. Results: Thirty children with snake bites were admitted during this study period. There was a male predominance with a ratio of 2.3:1. The mean age of presentation was 10.4 years. About 60% of bites occurred during the rainy season between July and September. Most bites (96%) were on lower limbs, predominantly showing vasculotoxic features followed by neurotoxic and a combined presentation. In this study, around 53% received anti-snake venom (ASV) before reaching our centre; the median time to reach our centre was 13 h. Complications such as acute kidney injury (AKI), cellulitis, shock and coagulation abnormalities were common in those who arrived early (before 6 h) than in those who reached late (after 6 h). Similarly, the mean duration of hospital stay was less for those seeking medical attention early as compared to those reaching late for treatment (4.7 days vs. 7.2 days). Twenty-six out of 30 (86.7%) were discharged without any sequelae, 3 (10%) children were left against medical advice and one died. Conclusions: Snakebite remains a major health problem in children causing significant morbidity and mortality. Children, in general, especially males, are particularly vulnerable because of their playful and explorative nature and considerable time spent in outdoor activities. Preventive measures, education about avoiding traditional first aid methods and early administration of ASV reduce complications, duration of hospital stay and avoid the use of antibiotics. [ABSTRACT FROM AUTHOR]

Introduction: Posterior circulation stroke (PCS) is often diagnosed late and long-term outcomes have not been described in South India. We wished to study clinical features, long-term outcomes, and independent predictors of the same. Materials and Methods: We conducted a prospective cohort study in PCS patients from January 2014 to May 2017. Morbidity and mortality at discharge, at 3 months and 6 months was studied. Univariate and multivariate analysis of predictors of poor outcome as well as the survival analysis was computed. Results: We recruited 291 PCS during the study period; prevalence of PCS among all strokes was 12.9% in 2014. The mean age was 53.34 years (standard deviation 13.34). Young strokes constituted 28.8%. The common comorbidities were hypertension 72%, diabetes mellitus 52.6%, smoking 38.5%, and dyslipidemia 32.6%. The common presenting symptoms were giddiness 79%, unsteadiness 75.35%, ataxia 56%, motor deficits 48.8% and nausea and vomiting 43%. Most were Ischemic strokes (86.5%); 10.3% gave a history of preceding TIAs. Common arteries involved were posterior cerebral 45%, posterior inferior cerebellar 38%, and basilar artery 19.2%. Among ischemic strokes, large artery atherosclerosis was 50.8%. Dysphagia was seen in 32.6% and sepsis in 19.2%; post stroke pain in 23%, followed by cognition decline in 10.3%. Bad outcome (modifies Rankins score 4-6) was 16.8% at discharge, 16.4% at 1 month, 14.4% at 3 months, and 13.8% at 6 months. Independent predictors of bad outcomes at 6 months were baseline National Institute of Health Stroke Scale (NIHSS) score (Odds ratio [OR] 1615.59 confidence interval [CI] 27.64-94447.7), invasive ventilation (OR 7.77 CI 1.57-38.43), sepsis (OR 17.22 CI 1.45-204.08), and basilar artery involvement (OR 19.98 CI 1.67-238.81). Baseline NIHSS scores between 0 and 5 suggest a good outcome while scores more than 13 suggest a bad outcome at 6 months. At 6 months, half are unemployed. Conclusions: The prevalence, clinical features, and comorbidities were also similar to previous studies. There was good survival at 6 months. NIHSS score is useful in predicting poor outcomes. [ABSTRACT FROM AUTHOR]

Background: Peripherally inserted central catheters (PICCs) are central venous catheters inserted peripherally but terminate in great vessels. PICCs are widely used for patients requiring long-term intravenous therapy in both in-patient and out-patient settings. Aim: This study was carried out to understand PICC-related complications, specifically infections and causal pathogens, in a tertiary care hospital in Kerala, South India. Methods: A retrospective analysis of PICC insertions and follow-up during a 9 years period to look at patient demographics and infections related to PICC was carried out. Results: The overall PICC-related complication rate is 28.1% (4.98 per 1000 PICC days). Commonest complication was thrombosis followed by infection, either PICC-associated bloodstream infection (PABSI) or local infection (LI). PABSI noted in this study was 1.34 per 1000 catheter days. The majority (85%) of PABSI were due to Gram-negative rods. The average duration of PICC days for occurrence of PABSI was 14 days and the majority occurred in in-patients. Conclusion: Thrombosis and infection were the commonest PICC-related complications. PABSI rate was comparable to that of previous studies. [ABSTRACT FROM AUTHOR]

Background: Duration of untreated psychosis (DUP) is an important modifiable factor affecting schizophrenia outcomes. A dearth of research in India on untreated versus treated schizophrenia warrants further research. Methods: This was a longitudinal study in a tertiary hospital over 2 years. Inpatients diagnosed with schizophrenia (N = 116), aged 18–45, were divided into untreated and treated groups. Diagnostic confirmation, severity assessment, and clinical outcome were done using ICD-10 criteria, Positive and Negative Syndrome Scale (PANSS), and Clinical Global Impression (CGI) scale. Follow-up was done at 12 and 24 weeks. DUP was measured, and its association with the outcome was assessed. Results: Final analysis included 100 patients, 50 each of previously untreated and treated. Untreated patients had lower age and duration of illness (DOI), but higher DUP (p <.001). Treated patients showed much improvement on CGI-I at 12 weeks (p =.029), with no difference at 24 weeks. PANSS severity comparison showed no difference, and both groups followed a declining trend. In untreated patients, age of onset (AoO) was negatively correlated with severity (except general symptoms at baseline) at all follow-ups (' r ' range = −0.32 to –0.49, p <.05), while DOI showed a positive correlation with negative and general symptoms at 12 weeks (r ~ 0.3, p <.05). Treated patients showed inconsistent and lower negative correlation between AoO and PANSS, with no correlation between severity and DOI. The mean sample DUP was 17.9 ± 31.6 weeks; it negatively correlated with education (r = –0.25, p =.01) and positively with PANSS severity (' r ' range = 0.22 to 0.30, p <.05) at all follow-ups, especially negative symptoms. Patients with no or minimal improvement on CGI at 24 weeks had higher DUP (Quade's ANOVA F[1,98] = 6.24, p =.014). Conclusion: Illness variables in untreated schizophrenia affect severity, which has delayed improvement than treated schizophrenia. Higher DUP is associated with negative symptoms of schizophrenia. [ABSTRACT FROM AUTHOR]

Aim: To study the profile of paediatric blunt abdominal trauma and to assess the correlation of grade of injury with the outcome. Materials and Methods: It is a prospective observational study from January 2015 to December 2020. Children below 12 years with blunt abdominal trauma were included. Patient demographic data, treatment given and the final outcome were recorded. All patients were followed up for a minimum of 6 months to maximum 5 years. Results: A total of 68 patients were included in the study. Fall from height was the most common mode of injury (62%) followed by road traffic accidents (35%) and the other causes included in the miscellaneous group (hit by animal and fall of heavy object on the abdomen; 3%). Most commonly injured organ was liver (n = 28, 41%) followed by spleen (n = 18, 26%) and kidney (n = 15, 22%). Other injuries were bowel perforations (jejunal [n = 4], ileal [n = 1] and large bowel [n = 1]; 9%), pancreaticoduodenal (n = 5, 7%), urinary bladder (n = 3, 4%), abdominal vascular injury (iliac vein-1, inferior vena cava-1;3%), adrenal haematoma (n = 2,3%) and common bile duct (CBD) injury (n = 1, 1%). More than one organ injury was seen in 13 cases (19%). Non-operative management was successful in 84% (n = 27) and laparotomy was done in 16% (n = 11). Most of the patients sustained Grade IV injury (n = 36, 53%) and majority of the patients (n = 60, 88%) had good outcome without any long-term complications. Conclusion: Profile of paediatric blunt abdominal trauma include solid organ injuries such as liver, spleen, kidney, pancreas, adrenal gland and others like bowel injury, CBD, urinary bladder and abdominal vascular injury. The grade of injury does not correlate with the outcome in a higher grade of injury and these children had good outcome. [ABSTRACT FROM AUTHOR]

Objectives: Using data from a hospital-based cancer registry (HBCR) in the private sector in Northern India, we provide overall survival (OS) and event-free survival (EFS) for childhood cancer patients. Methods: All newly diagnosed childhood (age <18 years) cancer patients in our HBCR registered between March 1, 2013 till July 31, 2021 were eligible. 3-year and 5-year OS (death was an event), EFSc (death, progression/relapse was an event), and EFSa (death, progression/relapse, abandonment of treatment was an event) were calculated using the Kaplan-Meier method. Regression analysis was done to see their association with demographic, diagnostic and treatment variables. Results: 705 newly diagnosed children (36.2% female) with cancer were registered. Common cancers were leukemias (26%), CNS tumors (20%) and bone tumors (16%). 202 (28.6%) had experienced an event at median follow up of 1.95 years (range 0–8.14 years), which included 23 (3.3%) who abandoned treatment. The 3-year OS, EFSc, EFSa were 70.8%, 64.4% and 63.6%, respectively. Correspondingly, 5-year OS, EFSc, EFSa were 66%, 58.6% and 57.5%, respectively. There was no significant difference by age group, gender, nationality, and if cancer directed treatment initiated elsewhere. The OS, EFSa and EFSc by the main and the extended International Childhood Cancer Classification categories varied significantly (P<0.001). Conclusion: We add more recent registry-based OS data on childhood cancer in India and present the first estimates on EFS. [ABSTRACT FROM AUTHOR]

Trauma is a global challenge and India has one of the highest trauma deaths in the world. Despite the United Nations' target to halve the global number of deaths and injuries from road traffic crashes by 2030, death tolls from road traffic injuries (RTI) are rising in India. In the pediatric age group, falls from height add to the burden of trauma. Uncontrolled bleeding from exsanguination on scene is estimated to account for nearly 40% of RTI trauma related mortality. Stopping the bleeding in the first few minutes is crucial for meaningful survival and hence the role of training lay public who can reach the scene in minutes. Active bleeding control (ABC) pilot research project to simulation train the bystanders to stop the bleed showed promising outcomes in Hyderabad, India. This paper describes the ABC project and discusses the role of pediatricians in training the public to reduce morbidity and mortality from uncontrolled bleeding at the trauma scene. [ABSTRACT FROM AUTHOR]

Objectives: To describe the clinical presentation, phenotype and outcome of multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) from a tertiary care center in southern India. Methods: 257 children fulfilling the inclusion criteria of MIS-C were prospectively enrolled from June, 2020 to March, 2022. Results: Median (range) age at presentation was 6 year (35 day to 12 years). Presenting features were fever (98%), vomiting (75.8%), red eyes (63%), rashes (49%), pain abdomen (49%), shock (45.9%), lymphopenia (73%, thrombocytopenia (58.3%) and anemia (45%). 103 (39.7%) children required intensive care admission. Shock phenotype, Kawasaki-like phenotype and no specific phenotype were diagnosed in 45.9%, 44.4%, and 36.6% children, respectively. Left ventricular dysfunction (30.3%), acute kidney injury (13%), acute liver failure (17.4%), and hemophagolymphohistiocytosis (HLH) (13.6%) were the major system involvement in MIS-C. Mitral regurgitation (P=0.029), hyperechogenic coronaries (P=0.006), left ventricular dysfunction (P=0.001) and low ejection fraction (P=0.007) were significantly associated with shock. Overall mortality was 11.7%. Conclusions: Kawasaki-like and shock-like presentation were common in MIS-C. Coronary abnormalities were seen in 118 (45.9%) children. Children with acute kidney injury, HLH, need for mechanical ventilation, and echocardiogram evidence of mitral regurgitation in MIS-C have a poor outcome. [ABSTRACT FROM AUTHOR]

Introduction: The main objective of the study was to evaluate, compare and correlate clinical, biochemical and Radiological [Computerized Tomography (CT) scan/Magnetic Resonance Imaging (MRI)] findings in patients with intracerebral haemorrhage (ICH) with their outcomes at least 15 days in a hospital-based prospective study. Material and methods: This was a prospective study carried out at the Department of Medicine at KPC medical college and hospital among 128 patients having haemorrhagic CVA based on CT/MRI findings. After proper ethical clearance from the Institutional Ethics Committee of KPC Medical College & Hospital (No: KPCMCH/IEC/470), informed consent was taken from all patients. Pre-designed, pre-tested and semi-structured proforma with a checklist was used to collect data regarding demographic and clinical variables. Random blood sugar, total cholesterol, HDL, LDL, TRIGLYCERIDE and VLDL were performed in each participant from the hospital laboratory. CT Scan/ MRI findings were used to calculate the site of the haematoma, the side of the haematoma and the volume of the haematoma. In this study, 67 (52%) patients had left-SIDED HAEMATOMA and 61(48%) patients had right-SIDED HAEMATOMA. Results: In this study, 4 (8.0%) patients were < 40 years old, 11 (22.0%) patients were forty-one to fifty years old, 19 (38.0%) patients were fifty-one to sixty years old, 5 (10.0%) patients were sixty-one to seventy years old and 11 (22.0%) patients were more than seventy-one years old. In this study, 33 (26%) patients had APHASIC SPEECH, 36 (28%) patients had DYSARTHIC SPEECH, 32 (25%) patients could not be examined (ENP) and 27 (21%) patients had NORMAL SPEECH. In this study, 10 (8%) patients had BILATERAL, 56 (44%) patients had COMPLETE, 6 (4%) patients had NORMAL and 56 (44%) patients had VARIABLE motor weakness. In this study, 18 (14%) patients had decreased DTR OF AFFECTED SIDE and 110 (86%) patients had Exaggerated DTR OF AFFECTED SIDE. In this study, 18 (14%) patients had Extensor B/L, 51 (40%) patients had Extensor Left and 59 (46%) patients had Extensor Right. Conclusions: It was found that a longer duration of a stroke at the time of initial evaluation was associated with higher mortality which was statistically significant. It was found that altered sensorium, level of consciousness at presentation, hypertension and h/o stroke were significantly associated with mortality. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality. India suffers the highest loss in potentially productive years of life, due to deaths from CVD. There are various investigations that have been utilised for diagnosis and management of acute coronary syndrome such as troponin, CK-MB and 2D echo. There are few expensive investigations such as NT pro BNP that have been used as the prognostic factor in acute coronary syndrome. There is thus need of an investigation that can be done in peripheral setting which can be done easily and and has good prognostic value in acute coronary syndrome. Objective: To study of neutrophil to lymphocyte ratio in acute coronary syndrome and its correlation with outcome Methods: This cross-sectional observational study was conducted in tertiary care hospital in Central India. Patients who were admitted to tertiary care centre with a diagnosis of ACS fulfilling the inclusion criteria were included in the present study. The study was conducted from June 2020 to Nov 2022. Results: Among the patients with N/L=4, 36.1% had Killip class 1, 36.1% had Killip class 2, 19.4% had Killip class 3 and 8.3% had Killip class 4. Among the patients with N/L>4, 11.1% had Killip class 1, 30.6% had Killip class 2, 29.2% had Killip class 3 and 29.2% had Killip class 4. There was statistically significant difference. The mean CK MB of the patients with N/L=4 was 570.90±36.29 and the mean CK MB of the patients with N/L>4 was 177.42±107.76. There was statistically significant difference. The mean 2D ECHO EF of the patients with N/L=4 was 44.16±6.39 and the mean 2D ECHO EF of the patients with N/L>4 was 34.58±5.45. There was statistically significant difference. Among the patients with N/L=4, all of them survived (100.0%); among the patients with N/L>4 15.3% died and 84.7% survived. There was statistically significant difference. Conclusions: The results of this study revealed that NLR is the strong predictive marker of ACS, so the study recommends using NLR as a good prognostic indicator for predicting short-term MACE and death in ACS patients. [ABSTRACT FROM AUTHOR]

Backgroud: Pulmonary thromboembolism (PE) is a common and potentially lethal condition. Despite significant advancements in diagnosis and management, there is limited reporting of this condition from India. Objective: To study the clinical profile and outcomes in patients of pulmonary thromboembolism. Methodology: This was a prospective observational study, conducted at the Department of Medicine, which includes the Medicine wards and MICU, in a tertiary care hospital located in central India. The study period was from November 2020 to October 2022, with a sample size of 43 participants. Results: The mean age of the cases was 50.86 years. Hypertension was the most common risk factor and Diabetes was the most common comorbidity. Palpitation was the most common symptom seen in 100% of cases and most common sign at the time of presentation was Tachycardia. ECG finding was Sinus tachycardia in 69.8% of the cases, the chest x-ray finding was dilated MPA/R in 34.9% of the cases, Right Ventricular (RV) dysfunction was seen in 30.2% of the cases on Echocardiography, DVT was seen in 9.3% of the cases in doppler and Pulmonary thromboembolism was seen 100% of the cases on CT pulmonary angiography. Heparin was given in 32.6% of cases and LMW Heparin was seen in 37.2% of the cases. Oral anticoagulation was given in 18.6% of the cases. New-oral anticoagulants were given in 37.2% of the cases. Thrombolytic therapy, Streptokinase was given in 30.2% of the cases. The outcome was discharge in 72.1% of the cases and death in 27.9% of the cases. Conclusion: Pulmonary thromboembolism (PTE) remains a major cause of morbidity and mortality all over the world. Risk factors are present in a majority of patients with confirmed venous thromboembolic disease. This condition is unrecognized and underdiagnosed clinically despite its high mortality. [ABSTRACT FROM AUTHOR]

Justification: The diagnosis of Down syndrome (DS) is easily made clinically but the management is multi-disciplinary and life-long. There is no standard protocol available for its management in India. Process: A committee was formed under the Indian Academy of Pediatrics (IAP) chapter of Neuro developmental pediatrics consisting of 20 experts working in the related field. The various aspects of the condition were discussed and allotted to the concerned experts related for preparing the guidelines. The material received was collated to form a set of guidelines, which were reviewed by the committee, and a consensus statement made. The guidelines were then approved by the chapter, and by the IAP. Objectives: To define the condition and to look into the various aspects of antenatal and postnatal diagnosis. To explain briefly about the involvement of the various systems that are involved and formulate recommendations for management. To recommend early and sustained interventional therapies to enable children with DS lead an independent life. Recommendations: The stress on bio-psycho-social strategy for the management of children with DS is reiterated, and the need for a medical, social and rights model is recommended after each section. The age-wise recommendations are also highlighted in addition to the recommendations under each system. [ABSTRACT FROM AUTHOR]

The present study evaluated the clinical presentation and outcome of COVID-19 patients with underlying hypercreatinemia at the time of hospitalization. A retrospective observational study was conducted from the 23rd of March 2020 to the 15th of April 2021 in 1668 patients confirmed positive for COVID-19 in the Chest Disease Hospital in Srinagar, India. The results of the present study revealed that out of 1668 patients, 339 with hypercreatinemia had significantly higher rates of admission to the intensive care unit (ICU), severe manifestations of the disease, need for mechanical ventilation, and all-cause mortality. Multivariable analysis revealed that age, elevated creatinine concentrations, IL-1, D-Dimer, and Hs-Crp were independent risk factors for in-hospital mortality. After adjusted analysis, the association of creatinine levels remained strongly predictive of all-cause, in-hospital mortality (HR-5.34; CI-4.89–8.17; p ≤ 0.001). The amelioration of kidney function may be an effective method for achieving creatinemic targets and, henceforth, might be beneficial for improving outcomes in patients with COVID-19. [ABSTRACT FROM AUTHOR]

Introduction: Delay in diagnosis and treatment initiation often lead to poorer outcomes in rheumatoid arthritis (RA). Most of the data on delay in diagnosis and management are from western population with no data from India. Additionally, with improved health care services, whether the delay has changed over years is not known. In this longitudinal observational study, we investigated delay to diagnosis and disease-modifying antirheumatic drugs (DMARDs) initiation over past 9 years. Methods: Patients aged ≥ 18 years having RA fulfilling 2010 ACR/EULAR criteria were enrolled from January to June in years 2012, 2017 and 2021. Diagnoses received before presenting to clinic, socioeconomic status, educational level and other demographic variables were recorded. Results: Each year, 323 patients (mean age 49.5–52.01 years) were enrolled. There was a significant reduction in delay in diagnosis from a median (IQR) of 36 (12–84, range 1–288) months in 2012 to 12 (4–36, range 1–180) months in 2017 and 10 (5–24, range 1–120) months) in 2021 (p < 0.0001). A significant improvement in time to initiating DMARDs from 2012 [48 (24–96) months] to 2017 [12 (6–36) months] (p < 0.0001) and from 2017 to 2021 [12 (5–24) months] (p = 0.03) was seen. Higher education, more patients opting for treatment from rheumatologists, and urbanisation contributed significantly to improvement in delay. There was no impact of age or gender on delay. Conclusion: Delay in diagnosis has improved significantly between 2012 and 2021. However, delay still remains long as most patients miss the 3-month therapeutic window. Future work focussing on reasons for delays in the patient pathway could help improve consultation pathways in India. [ABSTRACT FROM AUTHOR]

Objective: To compare the risk of early childhood obesity (BMI z-score of ≥+2SD) among children of more than 7 years of age with a birth weight of more than 3500 g to a birth weight of 2500–2999 g. Methods: Retrospective birth cohort study among children of 7 to 10 years of age in 22 villages of Himachal Pradesh with not-exposed (birth weight: 2500 to 2999 g) and exposed (> 3500 g) group. Results: A total of 379 and 377 participants were enrolled in not-exposed and exposed group, respectively. Adjusted relative risk (aRR) between exposed and high BMI (>+2SD) was 4.9 (95%CI: 1.3–17.5) adjusted for mean age, gender, mean years of schooling, consumption of butter, fruits, vegetables, and indoor playing. Conclusion: High birth weight (>3500 g) increases and normal birth weight decreases the risk of childhood obesity up to five times in rural India. [ABSTRACT FROM AUTHOR]

There is little information available about neurological manifestations in paediatric COVID-19 patients from around the world, including India. This study aimed to identify characteristics of paediatric COVID-19 cases with neurologic involvement who were hospitalized in IMS & SUM Hospital, Odisha. This retrospective cross-sectional study included hospitalized patients with confirmed SARS-CoV-2 from January 2020 to December 2022 aged 0 to 14 years. The necessary information was obtained from the patients' medical records. There were 21 cases in total. The studied group's median ages, those with neurological manifestations and those without, were 6.5, 11.0, and 5.0 years, respectively. Five COVID-19 patients experienced neurological manifestations, with headache and decreased consciousness being the most common recorded manifestations. The majority of patients, both with and without neurological manifestations, survived. In hospitalized paediatric COVID-19 cases, neurological manifestations were common. However, most of the neurological manifestations were mild and nonspecific, with headache being the most common. Although specific neurological manifestations were uncommon, paediatric COVID-19 patients, especially young infants, were at risk of developing severe encephalopathy with a fatal outcome. [ABSTRACT FROM AUTHOR]

Introduction: With the advent of direct-acting antivirals (DAAs), the past decade has seen a paradigm shift in the management of hepatitis C (HCV) infection in children. In this review, we summarize the various treatment options for pediatric HCV infection, highlighting the recent changes in the management. Methods: A literature search was performed using the PubMed database with the relevant keywords. Filters included were human, ages 0–18 years, and the English language. Results: Initial phase of HCV treatment using conventional or pegylated interferon and ribavirin combination regimens yielded poor outcomes in children, especially in genotypes 1 and 4, with an overall sustained virologic response of 58%. Also, treatment with interferon and ribavirin combination was associated with significant side effects in up to 52% of those treated. Presently, various combinations of direct-acting antivirals (DAAs) have been approved in children above three years of age with documented evidence of high efficacy (SVR12 of 92% to 100%) and excellent safety, and the current standard of care. Conclusion: With various DAA regimens now being approved for children above three years of age, the treatment of active HCV infection (HCV-RNA positive) in children has become simple. Besides the effectiveness of DAA therapy, public awareness about HCV transmission, better screening, and making the DAAs available at a subsidized price in the public sectors are necessary to eliminate HCV infection in India. [ABSTRACT FROM AUTHOR]

Background and Objectives: Complex soft-tissue injuries are one of the leading causes of morbidity and mortality following road traffic accidents (RTA). This article is regarding the pattern, management, and outcome of complex soft-tissue injuries. Methods: This observational study was conducted on 519 patients, from January 01, 2010, to April 30, 2013, at a tertiary care center in southern India. We analyzed the demographic profile, mechanism of injuries, management, and outcome of complex soft-tissue injuries during this study. Results: Of 519 patients with soft-tissue injury, blunt and penetrating injuries were seen in 81.7% and 18.3% of all cases, respectively. The most common cause of injury was RTA 74.3%. Isolated moral Lavelle injuries without associated neurovascular injuries occurred in 26.3% of patients. Soft-tissue injury was associated with bony, vascular, nerve, and tendon injuries in 52.0%, 44.7%, 20.0%, and 16.3% of all the cases, respectively. Patients who presented early (within 6 h of injuries) and patients with bone-only injuries had higher limb salvage rates. The overall morbidity rate among adults was 16.3% and the mortality rate was 1.9% and the most common cause of death was hemorrhagic shock. Mortality and morbidity in the pediatric group are higher than in the adult group. Conclusions: In summary, health education about road safety and proper safety protocol for two-wheelers and four-wheelers will reduce the incidence of RTA, thereby reducing the incidence of complex soft-tissue injury. The early and aggressive intervention will prevent a high amputation rate in bony injuries combined with vascular injury. A low threshold of blood transfusion and early aggressive treatment in the pediatric population will reduce the high mortality rate. [ABSTRACT FROM AUTHOR]

Introduction Hearing loss following a head injury is common and well known. The numbers of road traffic accidents have increased recently, with minor head injuries being very common, and usually go unreported. Hearing loss after a minor head injury is often unnoticed. Available literature is limited in this regard. Objective This study was done to assess hearing loss in patients with minor head injuries and to define its natural history and progression/regression by a serial assessment of hearing. Methods This prospective study was done in the Department of Neurosurgery, AIIMS, Bhubaneshwar, Odisha, India, for a period of 24 months to look at the profile of hearing levels of patients presenting with history suggestive of minor head injury. Results This study has shown that some form of hearing loss is common after a minor head injury and should be evaluated in all patients to detect subclinical hearing loss. A significant number of patients having minimal or a mild degree of hearing loss, if managed properly, improve to preinjury status. Distortion product oto-acoustic emission testing should be used as the screening and follow-up tool. Conclusion This study highlights the importance of hearing assessment in minor-head-injury patients and the prognosis of recovery as per the severity of hearing loss and head injury. [ABSTRACT FROM AUTHOR]

Apart from the regular respiratory symptoms, neurological manifestations like headache, encephalopathy, encephalitis, seizure, coma, demyelinating disorders, and aseptic meningitis has been seen in paediatric Coronavirus Disease-2019 (COVID-19) positive cases. The present case series is about three children, of age range 9 to 15 years, who presented with encephalitis between January 2022- February 2022. All the children tested positive for COVID-19, either by Rapid Antigen Test (RAT) or by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). One patient had necrotising encephalitis like changes in the MRI neuroimaging of the brain, but negative Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Ribonucleic Acid (RNA) PCR in Cerebrospinal Fluid (CSF). The second patient's Magnetic Resonance Imaging (MRI) brain was suggestive of acute encephalopathy, but with normal CSF analysis. The third patient presented with clinical findings suggestive of encephalitis with normal CSF study and normal MRI. The children were managed with antipyretics, antiepileptics, antibiotics, and antiviral, injection mannitol, and steroids. After the completion of the treatment, all the children were alive and were discharged from the hospital. [ABSTRACT FROM AUTHOR]

Background: Despite tremendous advances and new guidelines for the management of pediatric septic shock, the mortality and morbidity associated with it remain unacceptably high. This study was conducted to evaluate the impact of adherence to the American College of Critical Care Medicine (ACCM) guidelines in the management of septic shock in pediatric intensive care units (PICU). Subjects and Methods: This was a hospital-based prospective observational study conducted in the 15-bedded PICU of a tertiary care hospital in Utter Pradesh, India. Children from 1 month to 18 years of age admitted to the PICU with septic shock were included in the study as per definitions given by ACCM guidelines. The children who were managed strictly adhering to ACCM guidelines were labeled as the adherent group and those who were managed with any deviation from these guidelines were considered as the nonadherent group. The two groups were compared with respect to outcome. Results: In this study, the prevalence of septic shock was 54.4% in PICU. Out of 124 cases of septic shock, 93 were from the adherent group and 31 were from the nonadherent group. Recovery was significantly higher (p-0.012) in children among the adherent group (56 [60.21%] vs. 11 [35.48%]) than in the nonadherent group. The hemodynamic stability achieved within 48 h among the adherent group was higher in comparison to the nonadherent group (39 [56%] vs. 6 [8.5%]) making this a significant (P = 0.007) observation. Conclusions: Strict adherence to the ACCM guidelines was associated with favorable outcomes in the management of septic shock in children. [ABSTRACT FROM AUTHOR]

Introduction: Though many scoring systems for prognostication of sepsis are available in the intensive care set-up, predisposition, insult, response, and organ dysfunction (PIRO) score helps to assess each patient and evaluate response to therapy. There are few studies comparing the efficacy of PIRO score with other sepsis scores. Hence, our study was planned to compare PIRO score with acute physiology and chronic health evaluation IV (APACHE IV) score and sequential (sepsis-related) organ failure assessment (SOFA) score in predicting the mortality of intensive care patients with sepsis. Materials and methods: This prospective cross-sectional study was done in the medical intensive care unit (MICU) from August 2019 to September 2021 among patients above 18 years of age with the diagnosis of sepsis. Predisposition, insult, response, and organ dysfunction score, SOFA score, and APACHE IV score on admission and at day 3 were calculated and statistically analyzed in the terms of outcome. Results: A total of 280 patients fulfilling the inclusion criteria were included in the study, the mean age was 59.38 ± 15.9 years. There was a significant association of PIRO score, SOFA score, and APACHE IV score on admission and at day 3 with mortality (p-value <0.05). Among all three parameters, the PIRO score on admission and at day 3 was the best predictor of mortality at cut-off points of >14 and >16 with 92.50% and 96.50% chances of correctly predicting mortality, respectively. Conclusion: Predisposition, insult, response, and organ dysfunction score can be considered as a strong predictor of prognostication of patients with sepsis admitted to the intensive care unit (ICU) and predict mortality. It should be routinely used as it is a simple and comprehensive score. [ABSTRACT FROM AUTHOR]

Introduction: Endoscopic retrograde cholangiopancreaticography (ERCP) is an essential therapeutic procedure with a significant risk of complications. Data regarding the complications and predictors of adverse outcomes such as mortality are scarce, especially from India and Asia. We aimed to look at the incidence and outcome of complications in ERCP patients. Materials and Methods: This study is a retrospective analysis of prospectively collected data of all the patients who underwent ERCP and had a complication from January 2012 to December 2018. Data were recorded in predesigned pro forma. The data analysis was done by appropriate statistical tests. Results: A total of 17,163 ERCP were done. A total of 570 patients (3.3%) had complications; perforation (n = 275, 1.6%) was most common followed by pancreatitis (n = 177, 1.03%) and bleeding (n = 60, 0.35%). The majorities of perforations were managed conservatively (n = 205, 74.5%), and 53 (19%) required surgery. Overall, 69 (0.4%) patients died. Of these, 30 (10.9%) patients died with perforation. Age (odds ratio [OR]: 1.04, 95% confidence interval [CI]: 1.005–1.07) and need of surgery (OR: 5.11, 95% CI: 1.66–15.77) were the predictors of mortality in patients with perforation. The majority pancreatitis were mild (n = 125, 70.6%) and overall mortality was 5.6% (n = 10). Conclusion: ERCP complications have been remained static over the years, with perforation and pancreatitis contributing the most. Most perforations can be managed conservatively with good clinical outcomes. [ABSTRACT FROM AUTHOR]

Human–elephant conflicts (HECs) are becoming a disturbing public health concern in eastern India. This study highlights the pattern of injuries, epidemiological factors, and outcomes among the victims who survived an elephant attack (EA). This retrospective observational study was conducted in a tertiary care hospital. Data were retrieved from the medical records of EA victims who presented to the emergency department of the hospital over five years (January 2019–January 2024). Data regarding sociodemographic characteristics, injury mode, injury pattern, radiological findings, emergency procedures, and outcome variables (admission, length of intensive care unit and hospital stay, and death) were collected. In total, 45 EA victims were included in this study. The mean participant age was 45.8 ± 14.57 years. Of the total participants, 35 (78 %) were men. Most EAs [ n = 18 (40 %)] occurred in the forest area and during the early morning hours between 4am and 8am [ n = 18 (40 %)] of the winter season [ n = 37 (82 %)] and were unprovoked [38 (84 %)]. Of the total injuries, 26 (67 %) injuries were due to the direct mode of EA and 13 (33 %) were due to the indirect mode. The most common mechanism of EA was using the trunk and foot [20 (51 %)], followed by the tusk [6 (15 %)]. The median ISS in victims was 20 (13–29). The median AIS score of chest injuries was 1 (0–3). Thirteen (29 %) patients were positive on e-FAST. Of the total EA victims, 12 (26 %) were admitted to the intensive care unit (ICU) and 17 were admitted to the wards. Severe chest injury (AIS score ≥ 3) (p = 0.003), direct mode of injury, and polytrauma (ISS > 16) were identified as significant factors contributing to ICU admission. The median ICU stay of the victims was 6 (3–8) days, and the median length of hospital stay was 7 (0.5–11) days. One inpatient mortality was noted. Middle-aged men were the most common victims of EA occurring during the early morning hours. Extremity and soft tissue injuries were most common, followed by chest and abdominal injuries. Severe chest injury resulted in ICU admission and extended hospitalization. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19 in kidney transplant recipients (KTR) had been associated with high incidence of acute kidney injury and higher mortality. Management of these patients is still evolving. Methods: A retrospective observational study was done that included all KTR aged ≥18 years and ≤65 years who had COVID-19 diagnosis via RTPCR test between 1 June 2020 and 30 May 2021. Severity of COVID-19 was determined as per the guidelines given by Government of India. Acute kidney injury was defined according to KDIGO guideline. Data was collected and analyzed using SPSS version 16.0 (Chicago, SPSS Inc.). Results: Out of 34 patients, 29 were men. Median age of patients was 39.9 years and median time since transplantation was 34 months. Presenting symptoms were fever (100%), cough (79.4%), gastrointestinal symptoms (23.5%), and dysgeusia/anosmia (23.5%). COVID-19 was severe in 17.6%, moderately severe in 32.4%, and mild in 50% of patients. Time since transplantation, duration of symptoms, hospital stay and inflammatory markers like CRP, LDH, ferritin and d-dimer were significantly associated with disease severity (P < 0.05). Steroids were increased in 55%, antiproliferative agents stopped in 97%, and calcineurin inhibitors stopped in 26% of patients. 70.6% of the patients were managed in home isolation. Acute kidney injury occurred in 58.8% cases. 75% of the AKI patients recovered by 28 days after discharge. Conclusion: Our study showed that outcome of COVID-19 in kidney transplant patients was reasonably good. [ABSTRACT FROM AUTHOR]

Children with underlying cancer are often immunocompromised. Data on severity of coronavirus disease 2019 (COVID-19) in children with cancer and its outcomes is emerging. Treatment protocols of specific cancers are decided based on the infrastructure, availability of supportive-care, and logistic issues of the locality. The purpose of the study was clinical analysis of COVID-19 in children and adolescents with cancer. The retrospective observational study was conducted at a tertiary healthcare-center in East India. Children and adolescents (aged 0–19 years) with cancer and under treatment with reverse-transcriptase-polymerase-chain-reaction (RT-PCR) confirmed COVID-19 between 5-July-2020 and 5-December-2020 were studied. Median age of the 68 identified patients was six years. Acute leukemia was the most common (66%) diagnosis. COVID-19 was asymptomatic/mildly symptomatic in 91% and moderate to severe in only 9% of patients. Fever (87%) was the commonest symptom, followed-by cough/coryza (75%). Three patients with acute myeloid leukemia (AML) and severe/critical COVID-19 and associated neutropenic sepsis were required transfer to the intensive-care-unit (ICU) for management. Three (4.4%) patients succumbed with COVID-19. Delay in treatment was observed in 63.2% of patients, and the median duration of delay was 28 days after acquiring COVID-19. Median time to attain negative COVID-19 RT-PCR was 16 days, and eight patients were repeat positives. While pediatric and adolescent cancer patients on active treatment may have a higher risk of mortality from severe COVID-19 than their healthy counterparts, the risk may be much lower than deemed. It is essential to continue cancer therapy in these children. Delay in treatment remains a concern. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19 disease is more prevalent and severe in people who are more likely to be deficient in vitamin D, people with obesity and diabetes mellitus, and people who live in higher latitudes. Materials and methods: The study was an ambispective, analytical, observational study conducted at a tertiary care teaching hospital in New Delhi, India. The study population consisted of adults with a confirmed diagnosis of COVID-19. Results and conclusion: Eighty eight patients diagnosed with COVID-19 between February and July 2021 were enrolled, with mean (SD) age being 40(2) years and there were 55 (62.5%) males. The most common co-morbidities were hypertension, diabetes mellitus, and chronic obstructive pulmonary disease (COPD) and the most common symptoms were fever, cough, and myalgia. Twelve (13.6%) patients had severe disease. Seven (7.9%) patients died. Sixty one (69.3%) patients had vitamin D levels <30 ng/mL and had severe disease, more symptoms, and increased oxygen requirement, but did not affect laboratory parameters and mortality. [ABSTRACT FROM AUTHOR]

Introduction: Intracerebral Haemorrhage (ICH) is less frequent than ischemic stroke, but has higher mortality and morbidity, it being one of the first causes of severe disability. Hypertension is the most common cause of ICH but Non Hypertensive Intracerebral Haemorrhages (NHICH) are not rare. Hence, the importance of recognizing these conditions and need for urgent specific therapy which may play a vital role in therapeutic planning and prevention of ICH. Hence this study was performed to study. Aim: To study the clinical and radiological profile in NHICH, to identify risk factors, and to determine whether clinical/neuronradiological parameters would predict the prognosis of ICH. Materials and Methods: The present prospective observational study was conducted in the Department of General Medicine Mahadevappa Rampure Medical College Gulbarga, Karnataka, India, from January 2016-January 2017. It involved 50 subjects with NHICH. Demographic details, clinical and radiological data were collected in patients presenting with signs and symptoms of stroke and confirmed by Computed Tomography (CT) scan/ Magnetic Resonance Imaging (MRI) brain as ICH, who were non hypertensive and with age more than 18 years. Clinical outcome of the patients was measured based on Glasgow Coma Scale (GCS), site and volume of haemorrhage. Descriptive statistics of the explanatory and outcome variables were calculated by mean, Standard Deviation (SD) and Chi-square test was applied for qualitative variables. Results: In the present study 31 (62%) were males, and 19 (38%) were females. The age of patients ranged from 18-85 years. The most common risk factor associated with intracerebral haemorrhage was alcohol consumption 16 (32.0%), followed by smoking 13 (26%), and anticoagulant intake 13 (26%). Most common clinical presentation were hemiplegia/hemiparesis, speech defect, vomiting, convulsion, pupillary defect and cranial nerve involvement, in decreasing frequency. High ICH score and low GCS were poor prognostic factors for outcome of intracerebral haemorrhage patient in the present study. In hospital mortality rate was 28%. During 30 days follow-up, there was 22.2% mortality among the discharged patient. Conclusion: Although hypertension remains as a most common risk factor for intracerebral bleed, other risk factors such as significant alcohol consumption, coagulopathy should also be kept in mind especially in young. Non hypertensive haemorrhage usually occurs at sites not typical for hypertensive bleed. All efforts should be directed to establish the aetiological factors for intracerebral bleed, so that appropriate timely therapy can be provided to prevent further morbidity and mortality. [ABSTRACT FROM AUTHOR]

Pediatric B-cell lymphoblastic lymphoma (LBL) is a rare entity, and appropriate treatment for pediatric B-cell LBL is not well defined. While intensive ALL type regimens achieve long term survival of 90% across Western co-operative group trials, published data from Asian studies on long term outcomes are scarce. We retrospectively analyzed the data of pediatric B-cell LBL patients treated between January 2010 and December 2017 on a uniform protocol (modified BFM 90). Kaplan-Meier method was used to estimate the survival and Cox regression models to identify prognostic factors. Of 21 patients who received treatment on the modified BFM-90 protocol, 17(81%) were alive in remission, 3(14%) had relapse, and 1(4%) had treatment-related mortality (TRM) while in remission. Two of 3 relapsed patients subsequently expired. With a median follow-up of 66 months (range 6–114), 5-year event free survival (EFS) and overall survival (OS) were 80% (95% CI:71–89%) and 91% (95% CI:85–97%), respectively. While delayed presentation from symptom onset (p=0.030), and partial response at early (D35) interim assessment (p=0.025) had inferior EFS, patients with elevated baseline LDH had a worse OS (p=0.037). Outcomes of pediatric B-cell LBL patients treated on a modified BFM-90 protocol at a single center in India were excellent. In our study, higher disease burden manifested by elevated baseline LDH and delayed presentation (≥3months) and partial interim response portend poorer survival. Supplemental data for this article is available online at https://doi.org/10.1080/08880018.2021.2005725 [ABSTRACT FROM AUTHOR]