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AbstractObjectiveMethodsResultsConclusion\nKEY POINTSESKALE is a French, multicentre, observational study of adults with treatment-resistant depression (TRD) treated with esketamine. This interim analysis describes baseline demographic and clinical characteristic evolution in patients included and treated from early access program to post-marketing launch.Data were collected from medical records and included patient characteristics, disease history at esketamine initiation, use of neurostimulation, the patient’s care pathway, and the number of antidepressant treatment lines prescribed prior to esketamine initiation. Descriptive statistics were used for each cohort: the early access program ‘Temporary Authorisation for Use’ (ATU), post-ATU, and post-launch cohorts.The overall ESKALE cohort (N = 160 included; n = 157 treated with esketamine; average age 49.0 years; 66.2% female) demonstrated moderate-to-severe depression according to clinical assessment and a mean Montgomery-Åsberg Depression Rating Scale score of 32.6 (8.0); however, severity, subtype, and comorbidities were heterogeneous across the cohorts. Earlier use of esketamine and prior to alternative treatments occurred during the later cohorts.These findings demonstrated a high burden of TRD in these patients and that esketamine is used in TRD treatment regardless of their disease severity, subtype, or existing comorbidities. These results also suggest that esketamine is potentially a clinically useful alternative treatment, particularly with healthcare professionals gaining greater familiarity with and easier access to esketamine.ESKALE is a long-term, French, multicentre, observational study based on secondary data in adult patients with treatment-resistant depression (TRD) who initiated esketamine treatment in one of three mutually exclusive cohorts: the Temporary Authorisation for Use (ATU), post-ATU, and post-launch cohorts.ESKALE is one of the largest European real-world studies investigating the profiles of more than 150 patients and their treatment with esketamine before and after marketing authorisation.A majority of patients had moderate to severe TRD, with multiple treatment failures with medications and/or neurostimulation prior to esketamine initiation.Esketamine nasal spray administration was undertaken more frequently in an outpatient setting, with the post-administration period monitoring being undertaken mostly by nurses.Esketamine was used in patients with TRD in real-world conditions regardless of their disease severity and subtype or existing comorbidities.These results highlight both the need for an effective treatment for TRD and the adoption of esketamine by multidisciplinary teams that are involved in esketamine prescription and administration.ESKALE is a long-term, French, multicentre, observational study based on secondary data in adult patients with treatment-resistant depression (TRD) who initiated esketamine treatment in one of three mutually exclusive cohorts: the Temporary Authorisation for Use (ATU), post-ATU, and post-launch cohorts.ESKALE is one of the largest European real-world studies investigating the profiles of more than 150 patients and their treatment with esketamine before and after marketing authorisation.A majority of patients had moderate to severe TRD, with multiple treatment failures with medications and/or neurostimulation prior to esketamine initiation.Esketamine nasal spray administration was undertaken more frequently in an outpatient setting, with the post-administration period monitoring being undertaken mostly by nurses.Esketamine was used in patients with TRD in real-world conditions regardless of their disease severity and subtype or existing comorbidities.These results highlight both the need for an effective treatment for TRD and the adoption of esketamine by multidisciplinary teams that are involved in esketamine prescription and administration. [ABSTRACT FROM AUTHOR]

Introduction: Infections associated with orthopaedic implants, especially prosthetic joint infections (PJIs) are increasing with advancement in joint arthroplasty. The reported prevalence of PJI out to 2 years after hip replacement is 1.63% and after knee replacement is 1.55%. PJI for the individual patient is devastating with increased rate of mortality, increased risk of morbidity, decreased quality of life, and potential for decreased level of mobility and ambulation. Rapid detection of infection is of paramount importance because delaying the start of treatment of PJI may result in the loss of the device. The consequence of PJI is quite severe at the patient as well as the healthcare system level. Hence this study was done to understand clinical profile, risk factors, and treatment outcome which can guide clinicians in appropriate management. Methodology: A retrospective study was done in cohort of patients in a tertiary care diagnosed as periprosthetic joint infections as per guidelines by infectious disease society of America. All the patients’ records holding diagnosis as PJIs during January 2021 to December 2023 were included. After obtaining permission from institutional ethical committee clearance, data from patient’s medical records were collected and analysed. Data on patients’ socio-demographic characteristics, clinical profile, investigations, treatment modalities and outcome were retrieved. A total of 50 such patients’ records were analysed. The data were analyzed using statistical package for the social sciences (SPSS) version 20. Chi square test and students t test was used with P<0.05 considered as statistically significant. Results: Commonest symptom was joint swelling in 100%, followed by pain in joint in 86%, erythema in 84% and fever in 40%. Other symptoms were outflow around the scar and fistula in 8% and 16% respectively. PJIs were early onset, delay onset and late onset in 64%, 24% and 12% respectively. Culturally positive PJIs were 80%. On culture microbes identified were staphylococcus aureus in 44%, pseudomonas in 16%, Gram negative organisms in 16% and Enterococci in 4%. Management done with debridement, antibiotics, implant retention (DAIR), 1 stage implant exchange, 2 stage implant exchange, arthrodesis and amputation in 78%, 8%, 4%, 4% and 6% patients respectively. Function was restored in 76% and death seen in 4% of patients respectively. Conclusion: Mean haemoglobin, mean serum albumin, mean serum calcium was found to be significantly less in patients with delayed or late onset PI when compared to early onset PJI. Leucocyte count of synovial fluid and mean CRP was significantly higher in patients with delayed or late onset PJI when compared to early onset PJI. [ABSTRACT FROM AUTHOR]

Aim: To study the clinical profile of geriatric emergencies presenting to the emergency department. Material And Methods: This study was conducted in the Emergency Department of Rajmata Vijaya Raje Scindia Government Medical College, Bhilwara, Rajasthan among patients aged >65 years who presented to the Emergency Department of the Hospital, both males and females, and had given written informed consent, were included in the study. Details of history and physical examination findings of all the patients were recorded on a standard data collection sheet. Diagnosis was made based on the clinical history, vitals, systemic examination, and the initial and/ or relevant investigations. Data was collected and subjected to statistical analysis using SPSS software version 24. Results: The maximum participants belonged to the age group of 65-70 years (53.5%).Most common symptom was shortness of breath (37%), followed by fever (23.5%). Most common cause was respiratory (33.5%) followed by metabolic (14%), cardiovascular (13.5%) and neurological (12.5%) and infectious (12.5%), followed by gastrointestinal (7%), and then trauma (6%). Among 200 patients, 58% patients required Hospital Admission (ICU or Ward), 27% went back home from the ED itself on oral medicines, and 15 % patients suffered death. Conclusion: Respiratory Emergencies were the most common, followed by Metabolic, Cardiovascular, Neurological and Infectious, Gastrointestinal, Trauma and minor causes included Renal, Genitourinary, Anaphylactic and Neoplasm. ED of India should be aware of this demographic profile, and should be sensitised to it. ED should consider taking on the role of a tertiary injury prevention centre, and provide opportunistic screening for the at-risk elderly. [ABSTRACT FROM AUTHOR]

Guillain–Barré syndrome (GBS) is an acute autoimmune polyneuropathy with substantial geographic variations in demography, antecedent events, clinical manifestations, electrophysiological sub-types, diagnostic findings, treatment modalities, and prognostic indicators. However, there is limited contemporary data on GBS patient profiles and prognostic factors from low-resource settings like Ethiopia. The objective of this study is to investigate the clinical profile, factors associated with mortality, and hospital outcomes among GBS patients admitted to Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa, Ethiopia. A retrospective cross-sectional study was conducted among 60 GBS patients admitted to TASH from January 2018 to December 2022. Data on demographics, clinical features, treatments, complications, and outcomes were extracted from medical records. Bivariate and multivariate logistic regression analyses identified factors associated with mortality and poor hospital outcomes. The cohort had a mean age of 28.5 years, with 76.7% aged 14–34 years. Males comprised 61.7% of cases. Ascending paralysis (76.7%) was the predominant presentation. Absent or reduced reflexes were seen in 91.7% of patients. The most common antecedent event was gastroenteritis (26.7%), followed by upper respiratory tract infection (URTI) (15%) and vaccination (11.7%). The mean interval from symptom onset to hospital presentation was 8.77 days, and the peak symptom severity was 4.47 days. The axonal variant (75.5%) was the most common subtype, followed by the demyelinating variant (24.5%). Intravenous immunoglobulin was administered to 41.7% of patients. Respiratory failure requiring invasive mechanical ventilator (MV) support occurred in 26.7% of cases. The mortality rate was 10%, with mechanical ventilation being the only factor significantly associated with mortality (95% CI 2.067–184.858; P < 0.010). At discharge, 55% had a good outcome, and 45% had a poor outcome, according to the Hughes Functional Disability Scale (HFDS). Mechanical ventilation (AOR 0.024, 95% CI 0.001–0.607) and a GBS disability score > 3 (AOR 0.106, 95% CI 0.024–0.467) were factors significantly associated with poor hospital outcomes. GBS in this cohort primarily affected individuals of young age, commonly preceded by gastroenteritis and characterized by a high frequency of the axonal variant. Mechanical ventilation was found to be significantly linked to mortality. Alongside mechanical ventilation requirements, severe disability upon presentation emerged as a crucial determinant of poor outcomes upon discharge, underscoring the importance of early identification of high-risk patients and prompt interventions. [ABSTRACT FROM AUTHOR]

Background: The incidence of Hodgkin's lymphoma (HL) in people living with HIV (PLWHA) and on HAART is approximately 20–30 times higher than in HIV-negative individuals. Most patients with HIV-HL present at an advanced stage (III-IV) have 'B' symptoms and extranodal involvement. The natural history and risk stratification of HIV-HL has undergone a significant change as a result of HAART's rollout. This study investigated the differences in clinicopathological and survival patterns of HL among individuals with and without HIV disease in Tanzania during the HAART era. Methodology: This hospital-based retrospective cohort study was conducted at the ORCI, Dar-Es-Salaam, Tanzania. Chi-square and Fisher’s exact tests were used to compare proportions. The student t-test was used to compare means. To determine factors that predict survival, we used the log-rank test to analyze the variables in univariate analysis. A Cox regression model was used to analyze the significant factors from univariate analysis in multivariate analysis. Results: Eighty-three patients with HL were recruited, and the prevalence of HIV-positive status was 27.7%. Most of the patients with HIV-HL had an age of > 30 years (73.9%), while most of the non-HIV-HL patients had an age of ≤ 30 years (63.3%) (P = 0.02). The 2-year OS rate for HIV-HL was 34%, while that for non-HIV-HL was 67%. Among the HIV-HL patients, predictors of a poorer outcome were a CD4 count ≤ 200 cells/mm3 (P = 0.05), lack of HAART use (P = 0.00), and the use of HAART for ≤ 10 months (P = 0.00). Conclusion: The prevalence of HIV-HL was 27.7% among HL patients. HIV positivity is still a poor prognostic factor in our setting, especially for patients not on HAART, on HAART for ≤ 10 months, or with a low CD4 count below 200 cells/mm3. Patients with HIV-HL were older and had higher LDH levels, whereas patients with non-HIV-HL were younger and had low LDH levels. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer is associated with HPV infection. In India, it is 2nd leading cause of female cancer taking a huge toll on human life. This study explores the socio-demographic and clinical profile of cervical cancer patients at a tertiary care hospital in Kolkata. Methods: A cross-sectional study was undertaken for 2 months with 41 cervical cancer patients using a questionnaire for socio-demographic details, gynecological history, and details of the cancer and its treatment. Results: The mean age of the respondents was 54.80 ± 2.17 years, with majority belonging to lower socio-economic status. 69.44% presented with post-menopausal per vaginal bleeding and 45.45% of the patients were in stage IIB. 51.85% had symptoms for 2-6 months before visiting a doctor. Conclusions: Delay in seeking medical help has significant association with per capita monthly family income (p=0.004). Cervical cancer is a major public health problem in India majority of patients belonging to lower socioeconomic status. [ABSTRACT FROM AUTHOR]

Background Diphtheria cases continue to be reported in Indonesia, which has long been one of the countries with the highest number of diphtheria cases worldwide. One of Indonesia's province with the highest annual diphtheria cases is West Java. Dr. Hasan Sadikin General Hospital (RSHS) is one of the tertiary referral hospitals in Bandung, West Java, that treats several diphtheria cases annually. No study focused on the clinical characteristics of diphtheria cases in children admitted to RSHS between 2017 and 2021 yet. Therefore, this study sought to analyze that. Objective To find out the profiles of children < 18-year-old with diphtheria admitted in RSHS between 2017-2021. Methods This descriptive, cross-sectional study reviewed the medical records of diphtheria patients 0 to 18-year-old who were admitted to RSHS between year 2017 and 2021. Results Out of 45 subjects, 76% were males. The median of age was eight years old, ranging from 2 to 17 years. Most patients lived in urban areas and had normal anthropometry status, although some showed abnormal findings. The data showed that 44% had more than 3 days of onset until admission to the hospital, and the median length of stay was 9 days. The clinical characteristics showed that 91% of patients had pseudomembrane, also present with cough, common cold, hoarseness, stridor, and bull’s neck. As many as 44% of patients did not have complete basic immunization status. Complications found were airway obstructions, myocarditis, and sepsis, and 2 deaths were reported. Conclusion Pseudomembrane was found in the majority of patients. Most patients were over five years of age, and almost half number of the patients did not have complete basic immunization status, indicating the need for improved immunization and booster coverage.

Abstract Ocular trauma, a preventable public health issue, is one of the common causes of ophthalmic morbidity and monocular blindness worldwide. It can occur in almost any setting and at any age in either sex but largely affects males. The mechanism and type of injury, the extent of damage, and the time-lapse between the occurrence of injury and eye care are among the factors that determine the visual outcome of ocular injuries. This study is designed to assess the clinical profile and visual outcome of patients presenting with penetrating ocular injury. A prospective hospital-based study was conducted among penetrating ocular trauma patients who visited UOG tertiary eye care and training center during the study period. All patients with penetrating ocular trauma who fulfilled the inclusion criteria were included in the study. Data on demography, initial and final visual acuity, type of injury, as well as management, were included in a structured questionnaire. The collected data were processed and analysed using Statistical Packages for the Social Sciences (SPSS) version 25.0. The study included 91 cases of penetrating ocular injuries. The majority of the patients 81.2% were males. The male-to-female ratio was 4.3:1. The left eye was involved in 52.7% of the patients. The median age was 20 years, with an IQR of 10–35. The majority (31.9%) of the cases were in the age range of 5–10 years. nearly half of the study participants (45.1%) sustained the injury at home. The commonest source of injury was wooden sticks 49.5%. Six patients were lost to follow-up at three-month visits. Traumatic cataracts (p = 0.001), and poor initial visual acuity were poor prognostic factors. Still ocular injury is a common cause of monocular blindness. We recommend that more has to be done on the primary prevention and control measures.

Abstract Guillain–Barré syndrome (GBS) is an acute autoimmune polyneuropathy with substantial geographic variations in demography, antecedent events, clinical manifestations, electrophysiological sub-types, diagnostic findings, treatment modalities, and prognostic indicators. However, there is limited contemporary data on GBS patient profiles and prognostic factors from low-resource settings like Ethiopia. The objective of this study is to investigate the clinical profile, factors associated with mortality, and hospital outcomes among GBS patients admitted to Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa, Ethiopia. A retrospective cross-sectional study was conducted among 60 GBS patients admitted to TASH from January 2018 to December 2022. Data on demographics, clinical features, treatments, complications, and outcomes were extracted from medical records. Bivariate and multivariate logistic regression analyses identified factors associated with mortality and poor hospital outcomes. The cohort had a mean age of 28.5 years, with 76.7% aged 14–34 years. Males comprised 61.7% of cases. Ascending paralysis (76.7%) was the predominant presentation. Absent or reduced reflexes were seen in 91.7% of patients. The most common antecedent event was gastroenteritis (26.7%), followed by upper respiratory tract infection (URTI) (15%) and vaccination (11.7%). The mean interval from symptom onset to hospital presentation was 8.77 days, and the peak symptom severity was 4.47 days. The axonal variant (75.5%) was the most common subtype, followed by the demyelinating variant (24.5%). Intravenous immunoglobulin was administered to 41.7% of patients. Respiratory failure requiring invasive mechanical ventilator (MV) support occurred in 26.7% of cases. The mortality rate was 10%, with mechanical ventilation being the only factor significantly associated with mortality (95% CI 2.067–184.858; P 3 (AOR 0.106, 95% CI 0.024–0.467) were factors significantly associated with poor hospital outcomes. GBS in this cohort primarily affected individuals of young age, commonly preceded by gastroenteritis and characterized by a high frequency of the axonal variant. Mechanical ventilation was found to be significantly linked to mortality. Alongside mechanical ventilation requirements, severe disability upon presentation emerged as a crucial determinant of poor outcomes upon discharge, underscoring the importance of early identification of high-risk patients and prompt interventions.

Abstract Background The incidence of Hodgkin's lymphoma (HL) in people living with HIV (PLWHA) and on HAART is approximately 20–30 times higher than in HIV-negative individuals. Most patients with HIV-HL present at an advanced stage (III-IV) have 'B' symptoms and extranodal involvement. The natural history and risk stratification of HIV-HL has undergone a significant change as a result of HAART's rollout. This study investigated the differences in clinicopathological and survival patterns of HL among individuals with and without HIV disease in Tanzania during the HAART era. Methodology This hospital-based retrospective cohort study was conducted at the ORCI, Dar-Es-Salaam, Tanzania. Chi-square and Fisher’s exact tests were used to compare proportions. The student t-test was used to compare means. To determine factors that predict survival, we used the log-rank test to analyze the variables in univariate analysis. A Cox regression model was used to analyze the significant factors from univariate analysis in multivariate analysis. Results Eighty-three patients with HL were recruited, and the prevalence of HIV-positive status was 27.7%. Most of the patients with HIV-HL had an age of > 30 years (73.9%), while most of the non-HIV-HL patients had an age of ≤ 30 years (63.3%) (P = 0.02). The 2-year OS rate for HIV-HL was 34%, while that for non-HIV-HL was 67%. Among the HIV-HL patients, predictors of a poorer outcome were a CD4 count ≤ 200 cells/mm3 (P = 0.05), lack of HAART use (P = 0.00), and the use of HAART for ≤ 10 months (P = 0.00). Conclusion The prevalence of HIV-HL was 27.7% among HL patients. HIV positivity is still a poor prognostic factor in our setting, especially for patients not on HAART, on HAART for ≤ 10 months, or with a low CD4 count below 200 cells/mm3. Patients with HIV-HL were older and had higher LDH levels, whereas patients with non-HIV-HL were younger and had low LDH levels.

Abstract Background The emergence of Drug Resistant Tuberculosis (DR-TB) is one of the main public health and economic problems facing the world today. DR-TB affects mostly those in economically productive years and prevents them from being part of the workforce needed for economic growth. The aim of this study was to determine the Clinical Profile and Outcomes of DR-TB in Central Province of Zambia. Methods This was a retrospective cross sectional study that involved a review of records of patients with confirmed DR-TB who were managed at Kabwe Central Hospital’s Multi-Drug Resistant TB (MDR-TB) Ward from the year 2017 to 2021. 183 patients were managed during this period and all were recruited in the study. Data was collected from DR-TB registers and patient files and then entered in SPSS version 22 where all statistical analyses were performed. Results The study revealed that the prevalence of DR-TB among registered TB patients in Central Province was 1.4%. Majority of those affected were adults between the ages of 26 and 45 years (63.9%). The study also found that more than half of the patients were from Kabwe District (60.7%). Other districts with significant number of cases included Kapiri Mposhi 19 (10.4%), Chibombo 12 (6.6%), Chisamba 10 (5.5%), Mumbwa 7 (3.8%) and Mkushi 7 (3.8%). Furthermore, the analysis established that most of the patients had RR-TB (89.6%). 9.3% had MDR-TB, 0.5% had IR-TB and 0.5% had XDR-TB. RR-TB was present in 93.8% of new cases and 88.9% of relapse cases. MDR-TB was present in 6.2% of new cases and 10% of relapse cases. With regard to outcomes of DR-TB, the investigation revealed that 16.9% of the patients had been declared cured, 45.9% had completed treatment, 6% were lost to follow up and 21.3% had died. Risk factors for mortality on multivariate analysis included age 36–45 years (adjusted odds ratio [aOR] 0.253, 95% CI [0.70–0.908] p = 0.035) and male gender (aOR 0.261, 95% CI [0.107–0.638] p = 0.003). Conclusion The research has shown beyond doubt that the burden of DR-TB in Central Province is high. The study recommends putting measures in place that will help improve surveillance, early detection, early initiation of treatment and proper follow up of patients.

Introduction: Pancytopenia in the peripheral smear and hypocellularity in the bone marrow characterise aplastic anaemia (AA). It is far less common in Western countries. The Asian continent has a greater prevalence rate. Aplastic anemia carries a high mortality rate if it is not treated. Hence early diagnosis and treatment is important to reduce the mortality rate. Only few Indian studies are conducted to assess the epidemiology of AA. Aims and Objectives: To evaluate clinical and pathological profile of patients with aplastic anemia. Materials and Methods: This cross sectional observational study was done over a period of 1.5years in department of medicine, St johns medical college, Bangalore. A detailed clinical history, physical examination and available previous investigations were recorded. Results: In our study aplastic anemia had bimodal peak in age distribution noted in groups of 21-30 & 51-60yrs .Male preponderance of 1.33:1 .Most common presenting complaint was Fatigue. Severe (37.6%) and Very severe aplastic anemia (37.6%) were more common.Most common 1st line agent was Cyclosporine and 2nd line agent was Danazol. Out the 35 only 4 (11.4%) showed Complete Response, 19 (54.3%) showed Partial Remission, 10 were transfusion dependent (28.6%) and 2 (5.8%) expired. Conclusion: ATG and Cyclosporine showed significant improvement in most parameters. Many patients in the study were unwilling for ATG and bone marrow transplantation due to the cost factor. Many are still requiring frequent transfusions, thus probing us to search for newer novel forms of treatment to reduce the cost of treatment and mortality in aplastic anemia patients.

Background: Infertility is a prevalent medical issue that can arise from challenges in male or female or both partners. Pivotal contributing factors to female infertility include dysfunction, tubal issues, and peritoneal factors. Hysterosalpingography (HSG) holds significant importance in assessing abnormalities associated with the uterus and fallopian tubes. Aims and Objectives: This study aimed to assess the clinical profile and hysterosalpingographic findings of women with infertility who visited the department of radiodiagnosis for HSG. Materials and Methods: This is a cross-sectional study, where consecutive convenience-based sampling was used, with ethical clearance in place. Sixty-three infertile women of reproductive age were recruited for the study and were referred for HSG by the Department of Obstetrics and Gynecology. Results: The majority of the participants had primary infertility (71.88%) and was in the 31–35-year age group with the majority having 3–6 years of infertility and endometriosis. On HSG uterine pathology was found in 9.37% of participants and unilateral and bilateral tubal blocks were seen in 18.75% and 14.06% of cases approximately. Conclusion: HSG is a minimally invasive procedure, secure, and plays a crucial role in diagnosing uterine and tubal factors contributing to infertility.

Introduction: Infection-related glomerulonephritis, IRGN in adults is increasing in prevalence in India. However, there are only a few prospective studies from south India on the long term prognosis of this disease. Materials and Methods: This is a prospective observational study on patients above 18 years of age, with biopsy proven IRGN, at a tertiary care centre in south India with a minimum follow up of 6 months. Results: A total of 100 patients were included in the study. Peak incidence was in the age group of 40-60 years (n=45, 45%) with a male preponderance (n=56,56%). The most common co-morbidities were diabetes mellitus (n=27, 27%) and alcohol intake (n=13,13%). The most common source of infection was skin and soft tissues (n=41, 41%). Streptococcus and Staphylococcus were the most common isolated organisms. One patient had IRGN following SARS C0V-2 virus infection. Twenty three (n=23, 23%) required dialysis initiation. The mean follow up was 31.4 weeks. 3 patients died within 1 month of illness. At the end of 6 months, out of the 97 surviving patients, 34 (n=34,35%) patients had chronic kidney disease, CKD (eGFR 40 years, associated diabetes mellitus,underlying CKD, dialysis requiring renal failure at presentation,presence of crescentric GN and moderate to severe Interstitial Fibrosis and Tubular Atrophy in renal biopsy were identified as risk factors for development of CKD by univariate analysis. Conclusion: Adult IRGN is as an important cause of CKD and end stage renal disease in Indian adults especially in diabetics and those above 40 years of age.

Background: An increasing incidence of colorectal cancer (CRC) is being reported in developing countries, including India. Most Indian studies on CRC are retrospective and single-centered. The present study is an attempt to understand the current clinical profile and stage of newly diagnosed CRCs across multiple centers in Tamil Nadu, India. Methods: A multi-centric observational survey was conducted between September 1, 2021, and August 31, 2022, under the aegis of the Indian Society of Gastroenterology - Tamil Nadu chapter. Patients 18 years of age and older with a recent diagnosis of CRC fulfilling the inclusion criteria were prospectively recruited at the participating centers. Their demographic, clinical, biochemical, endoscopic, histopathologic, radiologic and risk factor details were systematically collected and analyzed. Results: Across 23 centers in Tamil Nadu, 1208 patients were recruited. The male:female ratio was 1.49:1, while mean (SD) age was 57.7 (13.5) years. A majority (81.9%) were Tamils and 78.5% belonged to lower socioeconomic classes. The predominant symptoms were hematochezia (30.2%) and a change in bowel habits (27.5%). The most common locations were the rectum (34.3%) and rectosigmoid (15.1%). Synchronous CRCs were seen in 3.3% and synchronous colorectal polyps in 12.8%. Predisposing factors for CRC were seen in 2%. A past history of any cancer among CRC patients was obtained in 3.1% and a family history of any cancer was found in 7.6%. Patients who were either overweight or obese constituted 46.4% of the study population. At presentation, the predominant stages were stage III (44.7%) and stage IV (20.8%). Conclusions: A majority of patients with newly diagnosed CRC in Tamil Nadu belonged to the lower socioeconomic classes. About 60% had CRCs located within the reach of the flexible sigmoidoscope. Two-thirds of the patients exceeded stage II disease at presentation. Trial registration: Not applicable [ABSTRACT FROM AUTHOR]

This observational study aimed to delineate the clinical profile of stroke in young women, utilizing a sample size of 61 patients admitted to a tertiary care center. The age distribution indicated that 37.70% of strokes occurred in women aged 40-45 years. The clinical presentation varied, with 91.81% experiencing neurodeficit, 34.42% altered sensorium, and 29.50% headaches. Significant risk factors identified included hypertension (37.70%) and diabetes mellitus (18%). The primary etiology was arterial thrombosis (49.18%), highlighting distinct pathophysiological underpinnings in this population. The study observed a high survival rate (90.16%), yet the presence of a 9.8% mortality rate underscores the critical nature of stroke in young women. The findings advocate for an increased focus on risk factor management and the importance of recognizing diverse clinical presentations to improve stroke outcomes in young women. The study's insights into the etiological factors emphasize the need for specific preventative and therapeutic strategies tailored to this demographic. [ABSTRACT FROM AUTHOR]

The aim of this analysis was to investigate the socio-demographic and clinical profile, the effectiveness, and the association of pharmacological treatment in patients who underwent electroconvulsive therapy during the last 10 years in the largest psychiatric hospital in Romania. This study includes 249 patients aged between 18 and 73 years old. Recurrent depression was the most frequent diagnosis for which ECT was performed (T = 96, 38.55%), followed by schizophrenia (T = 72, 28.91%). The most frequent indication for ECT was treatment resistance (T = 154, 61.84%), followed by persistent suicidal ideation (T = 54, 21.68%) and catatonia (T = 42, 16.86%). In 111 (44.60%) cases included in this study, re-hospitalization was required after performing ECT, while 138 (55.40%) participants did not require any further hospital readmissions. Significant differences were found between these groups in terms of socio-demographic data, diagnosis, number of ECT sessions performed, and association of psychotropic medication during and after the procedure, therefore two separate patient profiles were found based on these characteristics. Patients necessitating re-hospitalization post-ECT were mainly males aged 25–44 diagnosed with schizophrenia and underwent a greater number of ECT sessions (7–12), whereas those not requiring re-hospitalization were predominantly females aged 45–64 with recurrent depressive disorder for which 4–6 ECT sessions were performed. [ABSTRACT FROM AUTHOR]

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Introduction: Spontaneous pneumothorax (SP) commonly presents as continuous, sharp, unilateral chest pain exacerbated by deep inspiration and change of posture. The present study has been undertaken to study the clinical profile of SP among in-patients of a tertiary care hospital in South India. Methodology: A prospective hospital-based study of 100 consecutive cases diagnosed with SP from January 2019 to September 2020. Every patient underwent comprehensive history taking, in-depth clinical examination, and investigations. Data were entered into Excel spreadsheets in 2019. Data were presented using frequency and percentage and descriptive statistics were used. Results: SP was more common in males, Smoking can be considered a significant risk factor for SP, as 54% of all cases had a history of smoking. Dyspnea, accompanied by unilateral chest pain is the most common SP symptom. Tuberculosis is the most common etiological component of SP. Eighty-five percent of cases were successfully treated by tube thoracostomy. Conclusion: SP was more common in males and during the third and fifth decades of life. Secondary SP was more common than primary SP. Smoking history is an important risk factor for SP. Evaluating the clinical profile helps in assessing the etiology of SP. Early screening for risk factors and detection of comorbidities helps in the prevention of SP. [ABSTRACT FROM AUTHOR]

The introduction of inhaled corticosteroids (ICSs) changed over a few decades the treatment focus of mild-to-moderate asthma from bronchodilation to reduction in inflammation. This was achieved by inhaling a suitable corticosteroid (CS), giving a high, protracted airway concentration at a low total dose, thereby better combining efficacy and tolerance than oral therapy. Successful trials with the potent, lipophilic "skin" CS beclomethasone dipropionate (BDP) paved the way, suggesting that ICSs require a very low water solubility, prolonging their intraluminal dissolution within airways. The subsequent ICS development, with resulting clinical landmarks, is exemplified here with budesonide (BUD), showing that a similar efficacy/safety relationship is achievable by partly alternative mechanisms. BUD is much less lipophilic, giving it a 100-fold higher water solubility than BDP and later developed ICSs, leading to its more rapid intraluminal dissolution and faster airway and systemic uptake rates. In airway tissue, a BUD fraction is reversibly esterified to intracellular fatty acids, a lipophilic conjugate, which prolongs airway efficacy. Another mechanism is that the rapidly absorbed bulk fraction, via short plasma peaks, adds anti-inflammatory activity at the blood and bone marrow levels. Importantly, these plasma peaks are too short to provoke systemic adverse actions. Controlled clinical trials with BUD changed the use of ICS from a last resort to first-line treatment. Starting ICS treatment immediately after diagnosis ("early intervention") became a landmark for BUD. An established dose response made BUD suitable for the treatment of patients with all degrees of asthma severity. With the development of the budesonide/formoterol combination inhaler (BUD/FORM), BUD contributed to the widely used BUD/FORM maintenance and reliever therapy (MART). Recent studies demonstrated the value of BUD/FORM as a generally recommended as-needed therapy for asthma ("anti-inflammatory reliever", AIR). These abovementioned qualities have all influenced international asthma management and treatment guidelines. [ABSTRACT FROM AUTHOR]

Background: The emergence of Drug Resistant Tuberculosis (DR-TB) is one of the main public health and economic problems facing the world today. DR-TB affects mostly those in economically productive years and prevents them from being part of the workforce needed for economic growth. The aim of this study was to determine the Clinical Profile and Outcomes of DR-TB in Central Province of Zambia. Methods: This was a retrospective cross sectional study that involved a review of records of patients with confirmed DR-TB who were managed at Kabwe Central Hospital's Multi-Drug Resistant TB (MDR-TB) Ward from the year 2017 to 2021. 183 patients were managed during this period and all were recruited in the study. Data was collected from DR-TB registers and patient files and then entered in SPSS version 22 where all statistical analyses were performed. Results: The study revealed that the prevalence of DR-TB among registered TB patients in Central Province was 1.4%. Majority of those affected were adults between the ages of 26 and 45 years (63.9%). The study also found that more than half of the patients were from Kabwe District (60.7%). Other districts with significant number of cases included Kapiri Mposhi 19 (10.4%), Chibombo 12 (6.6%), Chisamba 10 (5.5%), Mumbwa 7 (3.8%) and Mkushi 7 (3.8%). Furthermore, the analysis established that most of the patients had RR-TB (89.6%). 9.3% had MDR-TB, 0.5% had IR-TB and 0.5% had XDR-TB. RR-TB was present in 93.8% of new cases and 88.9% of relapse cases. MDR-TB was present in 6.2% of new cases and 10% of relapse cases. With regard to outcomes of DR-TB, the investigation revealed that 16.9% of the patients had been declared cured, 45.9% had completed treatment, 6% were lost to follow up and 21.3% had died. Risk factors for mortality on multivariate analysis included age 36–45 years (adjusted odds ratio [aOR] 0.253, 95% CI [0.70–0.908] p = 0.035) and male gender (aOR 0.261, 95% CI [0.107–0.638] p = 0.003). Conclusion: The research has shown beyond doubt that the burden of DR-TB in Central Province is high. The study recommends putting measures in place that will help improve surveillance, early detection, early initiation of treatment and proper follow up of patients. [ABSTRACT FROM AUTHOR]

Background: Infertility is a prevalent medical issue that can arise from challenges in male or female or both partners. Pivotal contributing factors to female infertility include dysfunction, tubal issues, and peritoneal factors. Hysterosalpingography (HSG) holds significant importance in assessing abnormalities associated with the uterus and fallopian tubes. Aims and Objectives: This study aimed to assess the clinical profile and hysterosalpingographic findings of women with infertility who visited the department of radiodiagnosis for HSG. Materials and Methods: This is a cross-sectional study, where consecutive convenience-based sampling was used, with ethical clearance in place. Sixty-three infertile women of reproductive age were recruited for the study and were referred for HSG by the Department of Obstetrics and Gynecology. Results: The majority of the participants had primary infertility (71.88%) and was in the 31-35-year age group with the majority having 3-6 years of infertility and endometriosis. On HSG uterine pathology was found in 9.37% of participants and unilateral and bilateral tubal blocks were seen in 18.75% and 14.06% of cases approximately. Conclusion: HSG is a minimally invasive procedure, secure, and plays a crucial role in diagnosing uterine and tubal factors contributing to infertility. [ABSTRACT FROM AUTHOR]

Background: Upper aero-digestive tract emergencies (UADTEs) are common in our setting and can be life-threatening and challenging to otolaryngologists. However, there is a paucity of clinical studies on these emergencies. This study aimed to determine the clinical profile, treatment modalities and outcomes of upper aero-digestive tract emergencies at Bugando Medical Centre (BMC), Mwanza, Tanzania. Methods: Between January and May 2019, a cross-sectional study involving patients presenting with a clinical diagnosis of UADTEs was conducted at BMC. Results: Of 487 ENT emergencies seen during the study period, 128 (26.3%) patients had UADTEs. Males outnumbered females by a ratio of 1.5: 1. Their median age at presentation was 5 [range, 2-40] years. The major causes of UADTEs were foreign body ingestion, head and neck tumours, foreign body aspiration and cut-throat injuries that were seen in 56(43.8%), 33(25.8%), 25(19.5%) and (3.9%), respectively. The most frequent presentations were dysphagia 81(63.3%), difficulty in breathing 61(47.7%) and odynophagia 56(43.8). Age = 40 years (p=0.02), prolonged duration to treatment (p=0.04) and low blood oxygen saturation (SPO2) (p=0.04) were significantly associated with poor outcomes following esophagoscopy. In addition, delayed duration to treatment (p=0.01) and foreign body ingestion (p=0.001) were significantly associated with prolonged hospital stay. Conclusion: UADTEs are common at BMC and constitute a significant cause of otorhinolaryngological admission with foreign bodies in the aerodigestive tract, which is the most typical cause of these emergencies. Most of these injuries can be prevented through public enlightenment campaigns. Early detection and management of UADTEs is essential to reduce morbidity and mortality associated with these emergencies. [ABSTRACT FROM AUTHOR]

Background: The clinical profile varies in patients with Wilson's disease (WD). There is paucity of data regarding adult and pediatric patients with hepatic WD. Methods: As many as 140 consecutive patients diagnosed with hepatic WD between December 2006 and January 2021 were included in the study. Data was collected regarding the demographic parameters, clinical presentation, extrahepatic organ involvement, liver histology and laboratory investigations. Adult and children (0–14 years) with hepatic WD were compared regarding these features. Result: Eighty-eight adults and 52 children were included in the study. The median age of presentation was 17 years (range: 1.1–42 years). Male preponderance was seen (adult 68/88, 69%; children 40/52, 77%). Adults as compared to children presented more commonly as cirrhosis (52/88 vs. 15/52, p = 0.0005) and with hepatic decompensation (35/88 vs. 9/52, p = 0.005). Presentation with acute-on-chronic liver failure (ACLF) was more common in children (10/52 vs. 2/88, p = 0.0005). Twenty-eight-day mortality was 50% (5/10) in children and none in adults presenting with ACLF. Nazer's Prognostic Index (≥ 7) and New Wilson Index were more accurate in predicting mortality among children with ACLF with AUROC 1, while AARC (APASL ACLF Research Consortium) was less accurate with AUROC 0.45. Liver histology findings were similar in adults and children. Extrahepatic involvement was also similar. (8/88 in adults vs. 3/52 children, p value 0.48). Conclusion: Most patients with WD present as cirrhosis in adulthood. ACLF is more common in children. Nazer's prognostic index and new Wilson Index score are accurate in predicting mortality in children with ACLF. [ABSTRACT FROM AUTHOR]

Objectives: To study epidemiological characteristics, clinical features, laboratory findings, and clinical outcomes in cases of scrub typhus. Additionally, the study aims to identify the predictors of disease severity. Methods: This cross-sectional study was conducted in the Department of General Medicine at Dr PDM Medical College in Amaravati, India. The study duration was 6 months, from July 2023 to December 2023. All clinically confirmed patients with scrub typhus were evaluated through history, clinical examination, and appropriate laboratory investigations. The clinical and laboratory profiles, hospital course, and outcomes were analyzed. Organ dysfunction upon admission was assessed using the sequential organ failure assessment (SOFA) score. Results: A total of 200 cases were included in the study. The majority of the cases were in the age range of 31-40 years, and most of them were males. The highest number of scrub typhus cases occurred in September. The most common presenting symptoms were fever (81%), followed by nausea (37.5%), generalized weakness (34%), abdominal pain, eschar (21.5%), breathlessness, and cough (21% each), headache (19%), vomiting (15%), and altered sensorium (4.5%). The majority of patients (72.5%) did not experience any complications, while 55 patients (27.5%) developed multi-organ dysfunction syndrome (MODS) as a complication. The mortality rate was 1%. Conclusion: Scrub typhus is a significant cause of acute febrile illness in the Vidarbha region of Maharashtra. It can present with various clinical manifestations, with or without an eschar. Early diagnosis and appropriate treatment of these cases can lead to minimal complications.

Background: Scrub typhus, caused by Orientia tsutsugamushi, is an acute febrile illness with symptoms such as fever, chills, and organ failure. The similar clinical presentation in other common diseases such as malaria, dengue fever, and typhoid fever creates difficulty and delay in the clinical diagnosis of scrub typhus. This delay may increase the risk of scrub typhus complications. In India, it is a public health issue with a paucity of data. Aims and Objectives: This study aims to evaluate the clinical characteristics, outcomes, and prognostic factors of patients with scrub typhus. Materials and Methods: This institutional-based observational, cross-sectional study was conducted among consecutively selected 154 adult patients suffering from scrub typhus at a Medical College Hospital situated in the southern part of West Bengal, India. All data were collected according to a pre-designed proforma. At the end of the study, results were analyzed statistically. Results: Younger, females, and homemakers are more susceptible to scrub typhus, mostly in the post-monsoon season from July to November. The incidence of scrub typhus complications is high in the southern part of West Bengal. The case fatality rate of scrub typhus is 6.5%. Male sex, pre-hospitalization duration of illness more than 7 days, presence of diabetes mellitus, serum creatinine (Scr) more than 1.5 mg/dL, serum bilirubin more than 3 mg/dL, systolic blood pressure below 90 mmHg, altered sensorium, and acute respiratory distress syndrome were associated with poor prognosis. Conclusion: A high degree of clinical suspicion is required for the early diagnosis of scrub typhus and the factors associated with poor prognosis must be considered to reduce morbidity and mortality.

BACKGROUND: To evaluate the clinical profile, risk factors, and ophthalmic diagnostic and monitoring tools in Omani patients with idiopathic intracranial hypertension (IIH) using optical coherence tomography (OCT). METHODS: A retrospective single institutional cohort study on Omani patients with a fulfilled diagnosis of IIH from January 1, 2014, to January 1, 2020, was conducted. The data obtained from the neuro-ophthalmic clinic contained age of onset of the disease, gender of patients, body mass index (BMI), presence of other associated conditions, and medication use. RESULTS: Our study group comprised 21 patients with IIH with an annual incidence rate of 2.8 per 100,000 population. Female-to-male ratio was 9.5:1 with a mean age of 27.24 ± 7.1. Headaches appeared to be the most prevalent symptom in 21 (100%) patients, followed by transient obscuration of vision in 9 (42.9%) patients and diplopia in 3 (14.3%) patients, and the least common symptom was pulsatile tinnitus in 2 (9.5%) patients. Increased BMI was seen in 19 (90.5%) patients and noted to be the most prevalent predisposing factor among our study group. The use of oral contraceptive pills was documented in 4 (19%) patients and 1 (4.8%) patient was noted to have polycystic ovary syndrome. All patients (100%) had a best-corrected visual acuity of 1.0 in both eyes pre- and postrecovery and 7 (33.3%) patients had an enlarged blind spot on visual field testing. All patients had papilledema on presentation and an average of 14.1 months to resolve to normal clinically and on OCT monitoring. All patients were treated with medications and only 1 (4.8%) continued to have intractable headaches that did not respond to maximum medical therapy and required surgery. CONCLUSION: The incidence of IIH in the Omani population was found to be less than neighboring countries but comparable worldwide. OCT is considered a useful tool to confirm and document papilledema and more importantly monitor recovery.

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has disrupted multiple health services, including human immunodeficiency virus (HIV) testing, care, and treatment services, jeopardizing the achievement of the Joint United Nations Programme on HIV/AIDS 90-90-90 global target. While there are limited studies assessing the impact of the COVID-19 pandemic on people living with HIV (PLHIV) in Latin America, there are none, to our knowledge, in Venezuela. This study aims to assess the impact of the COVID-19 pandemic among PLHIV seen at the outpatient clinic of a reference hospital in Venezuela. Methods We conducted a cross-sectional study among PLHIV aged 18 years and over seen at the Infectious Diseases Department of the University Hospital of Caracas, Venezuela between March 2021 and February 2022. Results A total of 238 PLHIV were included in the study. The median age was 43 (IQR 31–55) years, and the majority were male (68.9%). Most patients (88.2%, n = 210) came for routine check-ups, while 28 (11.3%) were newly diagnosed. The majority of patients (96.1%) were on antiretroviral therapy (ART), but only 67.8% had a viral load test, with almost all (95.6%) being undetectable. Among those who attended regular appointments, 11.9% reported missing at least one medical consultation, and 3.3% reported an interruption in their ART refill. More than half of the patients (55.5%) had received at least one dose of the COVID-19 vaccine, while the rest expressed hesitancy to get vaccinated. Most patients with COVID-19 vaccine hesitancy were male (65.1%), younger than 44 years (57.5%), employed (47.2%), and had been diagnosed with HIV for less than one year (33%). However, no statistically significant differences were found between vaccinated patients and those with COVID-19 vaccine hesitancy. Older age was a risk factor for missing consultations, while not having an alcoholic habit was identified as a protective factor against missing consultations. Conclusion This study found that the COVID-19 pandemic had a limited impact on adherence to medical consultations and interruptions in ART among PLHIV seen at the University Hospital of Caracas, Venezuela.

AIM: To provide a comprehensive and more representative national data on the disease, especially on treatment options and outcomes, and to determine access of retinoblastoma patients from Luzon, Visayas and Mindanao to eye care, and determine if access is associated with delay in consultation, staging and outcomes. METHODS: Cohort study of retinoblastoma patients seen in eleven institutions located in the three major areas of the Philippines namely Luzon, Vizayas and Mindanao from 2010-2020. RESULTS: Totally 636 patients, involving 821 eyes, were included. Majority (57%) were from Luzon and were seen in institutions in Luzon (72%). Annually, 58±10 new cases were seen with 71% having unilateral disease. Median delay of consultation remained long at 9 (3, 17)mo, longest in patients with unilateral disease (P

Background Nontuberculous Mycobacterial (NTM) diseases present unique clinical challenges and are increasingly recognised as significant contributors to respiratory and extrapulmonary morbidity. This study protocol outlines an observational and cross-sectional investigation aiming to comprehensively understand the clinical profile of NTM disease, including its prevalence, risk factors, and clinical features, in patients at a tertiary care hospital in central India. Methods Over two years, from July 2022 to June 2024, a convenience sample size will be recruited from TB suspects meeting inclusion criteria. Comprehensive data collection will be conducted, including demographic information, clinical history, radiological findings, microbiological test results, and risk factor assessments. Statistical methods will be applied to the collected data, including descriptive statistics, comparative analysis, risk factor assessments, and multivariate analyses. Expected Results The study aims to provide valuable insights into the prevalence and clinical manifestations of NTM disease, shedding light on the risk factors contributing to its occurrence. The statistical analyses will identify key factors associated with NTM disease and characterise its clinical and radiological features.

Background & Objectives: Charcot-Marie-Tooth (CMT) disease is a group of hereditary sensorimotor neuropathies with a great variability of genotypes and phenotypes. The aims of the study were to provide a general perspective of the clinical manifestations and the frequency of genetic subtypes in CMT patients from a medical center in Taiyuan, northern China. Methods: Twenty-eight unrelated CMT patients were enrolled from a research center in northern China according to the CMT diagnosis criteria formulated by De Jonghe et al. in 1998. Then multiplex ligation-dependent probe amplification (MLPA) testing combined with next-generation sequencing (NGS) were performed among 18 of these patients. Results: PMP22 duplications were identified in 8 patients. In addition, 2 novel mutations were detected in the GJB1 gene (c.236T>C and c.464T>C). According to the American College of Medical Genetics and Genomics (ACMG) standards and guidelines, both two GJB1 mutations were assigned as 'likely pathogenic'. PMP22 and GJB1 were the most common causative genes in CMT1 and intermediate CMT, respectively. In addition, the first CMTX6 patient with a p.R158H mutation in the PDK3 gene was confirmed in China. Our study further shows that the p.R158H of PDK3 is likely to be a recurrent mutation. Conclusions: The results have broadened the genetic and clinical spectrums of CMT patients, which can help facilitate the diagnosis of CMT. Despite the increasing popularity of NGS, genetic screening of large cohorts of CMT patients using NGS is still rarely performed in the Chinese population. In CMT we suggest having MLPA for PMP22 as the first tier of study followed by target NGS for those with negative MLPA findings. The deciphering of the target gene candidates can further be guided by electromyographic data. [ABSTRACT FROM AUTHOR]

Background This study was conducted to evaluate the clinical profile and predictive markers for the development of spontaneous bacterial peritonitis, as well as the frequent etiological reasons producing it in patients with decompensated liver disease. Methods In the general medicine wards of Government Stanley Hospital in Chennai, 82 patients with a history of decompensated chronic liver disease and ascites diagnosed as spontaneous bacterial peritonitis participated in this hospital-based prospective observational study. The study was conducted from June 2019 to June 2020 and was approved by the institutional ethics committee. The participants written informed consent was obtained. Results When previous SBP and outcome are compared using Pearson's chi-squared test, a statistically significant correlation is found between the two. It was statistically significant to compare total bilirubin with the outcome using the unpaired t-test. Serum albumin and the outcome by unpaired t-test comparison were statistically significant. Serum creatinine and outcome were compared using an unpaired t-test, and the results were statistically significant. According to the unpaired t-test, serum sodium and the outcome were highly statistically significant. The INR and unpaired outcome comparisons show a statistically significant difference. The unpaired t-test comparison of the ascitic fluid PMN and the outcome reveals a highly statistically significant difference. Ascitic protein and outcome are compared using an unpaired t-test, which reveals statistical significance. A statistically significant comparison was made between Child Pugh and the outcome using Pearson's chi-squared test. High statistical significance was seen when the HE grade and Pearson's chi-squared outcome were compared. Conclusion In the study population, alcoholic cirrhosis was the most common cause of cirrhosis, followed by Budd-Chiari syndrome. Abdominal distension was the most frequent clinical presentation, and it was followed by GI bleeding, fever, hepatic encephalopathy, and abdominal discomfort. [ABSTRACT FROM AUTHOR]

Introduction: Behcet's disease (BD) is classified among inflammatory vascular diseases, affecting vessels of all kinds and sizes thus affecting every tissue and organ, with unknown aetiology. Considering low frequency with which this condition occurs, variation with the signs of symptoms, lack of specific test for diagnosis, this study was done to understand the clinical behaviour of patients with BD, which will aid in diagnosing and managing patients with BD and also relapses and other associated conditions. Methodology: A hospital-based study was done in 50 adult patients of either sex, diagnosed with BD in a tertiary care hospital after obtaining ethical committee clearance during February 2020 to January 2023. The diagnosis was based on the diagnostic criteria laid down by the International Team for the Revision of the International Criteria for Behçet's Disease (ITR-ICBD). Results of laboratory tests, including HLA-B5, HLA-B51, and HLA-B27, were recorded. NSAIDS, steroids and immunomodulating drugs were prescribed, either individually or in combination, to treat the disease. Data analysis was done using SPSS 20. Data represented as frequency percentage and bar diagrams. Results: Majority of the patients with BD belong to age group of 41 - 60 years (84%) with mean age of the patients being 42.3±8.4. BD was seen more in males (68%). Oral apthous (94%) ulcers were the most common manifestations followed by skin lesions (52% includes erythema nodosum, pseudo folliculitis and others) and ocular involvement (50% includes anterior uveitis, posterior uveitis, pan uveitis and retinal vasculitis). Pathergy test was positive in 62% of patients. Out of 50 patients 62% had positive HLA B5, followed by HLA B51 (40%) and HLA B27 (8%). Conclusion: BD is more common in younger age group with mean age 42.3 years and in males. Most of the patients were positive for HLAB5. [ABSTRACT FROM AUTHOR]

This document summarizes a study conducted in a tertiary care center in South India on children with congenital adrenal hyperplasia (CAH). The study found that growth was more compromised in children with salt wasting (SW) CAH compared to simple virilizing (SV) CAH, and higher doses of hydrocortisone were associated with greater growth faltering. The study emphasizes the importance of accurate growth assessment and optimizing steroid therapy for children with CAH. The document also mentions that diagnosis is often delayed in male infants, leading to increased morbidity and mortality, and acknowledges the need for further research due to limitations in sample size. [Extracted from the article]

Diphtheria is a re-emerging disease with a changing epidemiology. It is thus essential to recognize diphtheria's clinical profile, patterns of morbidity and mortality, and the level of immunization. This study aimed to analyze the clinical-epidemiological profile of patients with diphtheria at the Infectious Disease Hospital, New Delhi, India. The present study was a cross-sectional investigation conducted on 94 patients diagnosed with diphtheria. The data collection tool was a questionnaire that had questions eliciting details such as socio-demographic characteristics, clinical history, examination findings, and vaccination history. The case fatality rate was calculated. Means and proportions were also measured, and the significance level was set at P <0.05. The mean±SD age of the participants was 9±4.4 years. Laryngeal involvement was found in 10 (11%) participants. Complete diphtheria vaccination doses were taken by 6 (6.4%) participants. The case fatality rate was 13%, and complications such as neuropathy were found in 21 (22%) cases, cardiac problems in 12 (13%), and respiratory problems in 13 (14%). Longer duration of the illness, delayed presentation, and complications were associated with poor clinical outcomes (P<0.05). The majority of diphtheria cases were 6-10 years old and had a low socioeconomic status. Most of them had a partial vaccination against diphtheria. Around one-third of the patients had complications related to diphtheria, and the case fatality rate was also high. Key preventive measures for controlling the deadly diphtheria disease include specialized immunization programs for areas with poor immunization coverage, as well as the early detection and treatment of suspected cases. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) is the most common form of arthritis and one of the leading causes of disability. This degenerative and progressive joint disease affects around 250 million people worldwide and more than 27 million people in the United States. Elderly (approximately 35% of patients over 65 years old) females, patients with obesity and African Americans are the population with the highest risk of developing OA. The study was hospital based prospective randomized controlled trail. The patients were subjected to a standardized injection protocol and are assessed on variables such as pain, stiffness and physical function using WOMAC scale, & for pain, using visual analog scale at pre injection, 6 wks post injection, 3 months & 6 months post injection. 19 (23.75%) patients (9 in PRP group & 10 in steroid group) were between 41-50 years, 23 (28.75%) patients (15in PRP group & 8 in steroid group) were between 51-60 years, 38(47.5%) patients (16 in PRP in group & 22 in steroid group) were more than 60 years. [ABSTRACT FROM AUTHOR]

Background: Scrub typhus, caused by Orientia tsutsugamushi, is an acute febrile illness with symptoms such as fever, chills, and organ failure. The similar clinical presentation in other common diseases such as malaria, dengue fever, and typhoid fever creates difficulty and delay in the clinical diagnosis of scrub typhus. This delay may increase the risk of scrub typhus complications. In India, it is a public health issue with a paucity of data. Aims and Objectives: This study aims to evaluate the clinical characteristics, outcomes, and prognostic factors of patients with scrub typhus. Materials and Methods: This institutional-based observational, cross-sectional study was conducted among consecutively selected 154 adult patients suffering from scrub typhus at a Medical College Hospital situated in the southern part of West Bengal, India. All data were collected according to a pre-designed proforma. At the end of the study, results were analyzed statistically. Results: Younger, females, and homemakers are more susceptible to scrub typhus, mostly in the post-monsoon season from July to November. The incidence of scrub typhus complications is high in the southern part of West Bengal. The case fatality rate of scrub typhus is 6.5%. Male sex, pre-hospitalization duration of illness more than 7 days, presence of diabetes mellitus, serum creatinine (Scr) more than 1.5 mg/dL, serum bilirubin more than 3 mg/dL, systolic blood pressure below 90 mmHg, altered sensorium, and acute respiratory distress syndrome were associated with poor prognosis. Conclusion: A high degree of clinical suspicion is required for the early diagnosis of scrub typhus and the factors associated with poor prognosis must be considered to reduce morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID-19) pandemic has disrupted multiple health services, including human immunodeficiency virus (HIV) testing, care, and treatment services, jeopardizing the achievement of the Joint United Nations Programme on HIV/AIDS 90-90-90 global target. While there are limited studies assessing the impact of the COVID-19 pandemic on people living with HIV (PLHIV) in Latin America, there are none, to our knowledge, in Venezuela. This study aims to assess the impact of the COVID-19 pandemic among PLHIV seen at the outpatient clinic of a reference hospital in Venezuela. Methods: We conducted a cross-sectional study among PLHIV aged 18 years and over seen at the Infectious Diseases Department of the University Hospital of Caracas, Venezuela between March 2021 and February 2022. Results: A total of 238 PLHIV were included in the study. The median age was 43 (IQR 31–55) years, and the majority were male (68.9%). Most patients (88.2%, n = 210) came for routine check-ups, while 28 (11.3%) were newly diagnosed. The majority of patients (96.1%) were on antiretroviral therapy (ART), but only 67.8% had a viral load test, with almost all (95.6%) being undetectable. Among those who attended regular appointments, 11.9% reported missing at least one medical consultation, and 3.3% reported an interruption in their ART refill. More than half of the patients (55.5%) had received at least one dose of the COVID-19 vaccine, while the rest expressed hesitancy to get vaccinated. Most patients with COVID-19 vaccine hesitancy were male (65.1%), younger than 44 years (57.5%), employed (47.2%), and had been diagnosed with HIV for less than one year (33%). However, no statistically significant differences were found between vaccinated patients and those with COVID-19 vaccine hesitancy. Older age was a risk factor for missing consultations, while not having an alcoholic habit was identified as a protective factor against missing consultations. Conclusion: This study found that the COVID-19 pandemic had a limited impact on adherence to medical consultations and interruptions in ART among PLHIV seen at the University Hospital of Caracas, Venezuela. [ABSTRACT FROM AUTHOR]

Background: Acne vulgaris, a prevalent skin condition, significantly impacts the quality of life, especially during adolescence. This study aimed to investigate the clinical profile of acne vulgaris, including its prevalence, severity, scarring, relationship with androgenicity, seasonal variation, and association with smoking in a South Indian population. Methodology: The study, conducted from July 2019 to May 2020, included 300 acne vulgaris patients attending the dermatology outpatient department. Patient demographics, lesion characteristics, and associated factors were assessed. Acne vulgaris severity was graded, and statistical analyses were performed using SPSS 15 software. Results: The study revealed a prevalence of 1.068% among new dermatology patients. Male predominance (57%) and an increased likelihood of severe acne in patients aged 20 years or older were noted. Closed comedones were the most common lesion type, and postacne scarring was observed in 39.4% of patients. No significant correlation was found between acne severity and markers of androgenicity. Seborrheic dermatitis was the most common comorbidity, and seasonal variation was observed in 25.8% of patients. Discussion: The study's findings align with global acne epidemiology, with unique insights into the South Indian population. Notably, post-acne scarring incidence was relatively high, suggesting population-specific characteristics. The study provides valuable data on lesion types, severity distribution, and associated factors, contributing to the understanding of acne vulgaris in this region. Conclusion: This hospital-based study contributes to the limited literature on acne vulgaris in South India, emphasizing the need for larger, population-based studies. Understanding regional variations in acne presentation and associated factors is crucial for tailored management strategies. Further research should explore hormonal abnormalities in female patients exhibiting androgenic markers. [ABSTRACT FROM AUTHOR]

BACKGROUND: To evaluate the clinical profile, risk factors, and ophthalmic diagnostic and monitoring tools in Omani patients with idiopathic intracranial hypertension (IIH) using optical coherence tomography (OCT). METHODS: A retrospective single institutional cohort study on Omani patients with a fulfilled diagnosis of IIH from January 1, 2014, to January 1, 2020, was conducted. The data obtained from the neuro-ophthalmic clinic contained age of onset of the disease, gender of patients, body mass index (BMI), presence of other associated conditions, and medication use. RESULTS: Our study group comprised 21 patients with IIH with an annual incidence rate of 2.8 per 100,000 population. Female-to-male ratio was 9.5:1 with a mean age of 27.24 ± 7.1. Headaches appeared to be the most prevalent symptom in 21 (100%) patients, followed by transient obscuration of vision in 9 (42.9%) patients and diplopia in 3 (14.3%) patients, and the least common symptom was pulsatile tinnitus in 2 (9.5%) patients. Increased BMI was seen in 19 (90.5%) patients and noted to be the most prevalent predisposing factor among our study group. The use of oral contraceptive pills was documented in 4 (19%) patients and 1 (4.8%) patient was noted to have polycystic ovary syndrome. All patients (100%) had a best-corrected visual acuity of 1.0 in both eyes pre- and postrecovery and 7 (33.3%) patients had an enlarged blind spot on visual field testing. All patients had papilledema on presentation and an average of 14.1 months to resolve to normal clinically and on OCT monitoring. All patients were treated with medications and only 1 (4.8%) continued to have intractable headaches that did not respond to maximum medical therapy and required surgery. CONCLUSION: The incidence of IIH in the Omani population was found to be less than neighboring countries but comparable worldwide. OCT is considered a useful tool to confirm and document papilledema and more importantly monitor recovery. [ABSTRACT FROM AUTHOR]

Objective: This study was conducted to characterize the clinical presentation, results of serological and immunological tests and sociodemographic factors in the Pakistani Lupus population. Methods: This prospective, cross-sectional study was undertaken at the Clinic for Arthritis and Rheumatic Diseases, Rawalpindi Teaching Hospital, Rawalpindi, Pakistan between January 2020 and June 2023, involving adult patients with SLE (classified based on 1997 revised ACR criteria). Demographic data, clinical and laboratory features, auto-antibody profile, disease duration, treatment history and organ damage (calculated by SLICC/ACR-DI) were recorded for all patients. Descriptive statistics and logistic regression analysis were performed for statistical assessment. Results: A total of 98 patients (94.9% females and 5.1% males) were enrolled in the study. The mean age of patients was 30.93±11.09 years while the mean duration of illness was 3.27±3.01years. The most commonly observed clinical manifestations were neuropsychiatric systemic lupus erythematosus in 84% of patients and mucocutaneous involvement (photosensitivity, mucosal ulcers, facial rash, alopecia and discoid lupus in 63.92%, 56.70%, 48.45%, 37.11% and 13.40% patients respectively). They were followed by serositis, arthralgias and renal involvement in 60.42%, 33.67% and 25% of patients respectively. Antinuclear antibody by indirect immunofluorescence was positive in all while anti-dsDNA was positive in 50% of patients. Conclusions: Fatigue was the most commonly recorded symptom while Neuropsychiatric SLE was the most commonly observed systemic manifestation in the Pakistani population followed by mucocutaneous involvement, serositis, arthralgias and renal involvement. Reasons for serious manifestations at initial presentation include deficiency of healthcare professionals trained in the field of Rheumatology and lack of awareness among patients. [ABSTRACT FROM AUTHOR]

It is estimated that nosocomial and other health-care associated infections affect >2 million patients and contribute to 88,000 deaths in U.S. hospitals annually. The fact that 25-50% or more of nosocomial infections are due to the combined effect of the patient's own flora and invasive devices, highlights the importance of improvements in the use and design of such devices. Data was entered into Microsoft excel data sheet and was analyzed using SPSS 22 version software. Categorical data was represented in the form of frequencies and proportions. Continuous data was represented as mean and standard deviation. In our study the mean insertion day of life was 2.44 days, neonates in whom PICC line was inserted between 1-3days of life (11) 14.29% had CLABSI, (4)13.33% of neonates had CLABSI in whom PICC line was inserted between 3-7 days, (1) 33.33% of neonates had CLABSI in whom PICC line was inserted between 7-12 days of life. [ABSTRACT FROM AUTHOR]

Introduction: Typhoid fever is a life-threatening systemic infection of variable severity caused by Salmonella serotypes that occurs in developing countries such as India. The signs and symptoms of typhoid fever in children differ from those in adults. Few studies suggest renewed sensitivity of Salmonella to chloramphenicol. Method: 88 children aged 2-10 years with suspected enteric fever were admitted in pediatric ward and pediatric ICU (as per their clinical conditions) were included in the study. Enteric fever was diagnosed in 52 of these patients, and the clinical features were compared in the different age groups. In patients with positive blood cultures, the sensitivity profile to antibiotics was also investigated. Results: Abdominal distension, sepsis and encephalitis were significantly more common in children younger than 5 years, whereas nausea, constipation, and blood in stool were rare in this age group. Abdominal pain, headache and intestinal perforation were significantly more common in children older than 5 years than in the younger group. Sensitivity to the classical drugs chloramphenicol and ampicillin was 73.33% and 60%, respectively. Conclusion: the clinical profile of enteric fever in children differs according to age. There is a recurrence of Salmonella typhus sensitivity to chloramphenicol and ampicillin in blood cultures. [ABSTRACT FROM AUTHOR]

Background: Hepatitis Delta represents a greater risk in the progression of advanced liver disease and HCC compared with HBV. The exact mechanism that determines the spontaneous clearance of delta virus or its progression to cirrhosis remains unknown. Therefore, this study aimed to analyze the clinical profile of HBV and HBV/HDV individuals in the Western Amazon. Methods: The study was carried out at the Specialized Outpatient Clinic for Viral Hepatitis belonging to the Centro de Pesquisa em Medicina Tropical de Rondônia/CEPEM. 100 individuals were included, stratified into two groups: 50 with hepatitis B virus and 50 with hepatitis Delta virus. Results: The overall mean age was 48 years. For the HBV and HDV groups, 66 % (33/50) and 54 % (27/50) were men and 56 % (28/50) and 58 % (29/50) were on antiviral treatment, respectively. Patients with detectable HDV-RNA demonstrated high levels of ALT and AST compared to individuals with undetectable HDV-RNA. Comparative analysis between HBV carriers and infected with HDV shows significant differences in terms of age, HBV-DNA levels, albumin, hepatomegaly and splenomegaly. Conclusion: Several markers were important for differentiating HBV and HDV infections. HDV-RNA detectable showed significant changes in biomarkers compared to undetectable patients, suggesting a possible worse prognostic effect in this group.

Introduction: Spontaneous bacterial peritonitis (SBP) is a critical complication in patients with chronic liver disease (CLD). Understanding the clinical features and bacterial profile of SBP is essential for its effective management. To study the clinical and bacteriological profile and the factors influencing the outcome of SBP in patients with CLD. Materials and Methods: We retrospectively analyzed the medical records of 113 patients diagnosed with SBP between January 2018 and December 2022 at a tertiary care hospital. We assessed the clinical features, laboratory parameters, causes of cirrhosis, and bacterial profiles. Statistical analyses were performed to identify associations between these parameters and the clinical outcomes. A p value of

Background: Malaria remains a leading cause of human morbidity and mortality due to inability of the insecticide and chemotherapeutic agents to eliminate the vector and the agent of the disease. The present study is aimed to study the clinical profile, laboratory profile, species identification and line of treatment of the patients as per the species. Material & Methods: Present study was conducted on 100 confirmed cases of Malaria admitted in Medicine department of Sanjeevan super-specialty hospital, Satara, Maharashtra. All patients were interviewed followed by clinical examination and relevant investigations. Data was entered in MS Excel and statistical analysis was done using EPI-5. Results: There was male preponderance in my study and incidence was more (84%) in middle age 16-50 years. 100% cases showed fever as the major symptom followed by nausea (36%), vomiting (36%), headache (22%). Anemia is common (56%) followed by thrombocytopenia (30%). Spleen was palpable in 50% patients. Hyperbilirubinemia was 28% in my study predominantly of conjugated variety. 72% cases were P. falciparum, 22 % were p. vivax and 6 % were mixed. In the diagnosis, QBC was found to be more sensitive 98% than PBS 78%. for uncomplicated vivax malaria Tab chloroquine showed 60% sensitivity, tab artemether + lumefantrine showed 75% sensitivity, those who were not responding were added with quinine, doxycycline. In falciparum inj. artesunate76 % was more sensitive than quinine 69%. Artemether showed 57% response in falciparum in my study. Conclusion: Incidence of malaria was more in males than females due to their outdoor stay, travelling and more expose part of the body. Splenomegaly is the most common elicitable sign. Anemia, thrombocytopenia are found in falciparum malaria. Multidrug therapy like artemisinin combination therapy has more response in complicated and non-responding cases.