Role of fine needle aspiration cytology (FNAC) in diagnosing Pancreatic lesions in a tertiary care institution

OBJECTIVE- FNAC is an accurate and rapid technique for diagnosing pancreatic masses. Pancreatic carcinoma represents the seventh leading cause of cancer death in the world, responsible for more than 300,000 deaths per year.[1] Worldwide, both the incidence and death rates of pancreatic cancer are increasing. The aim of this study was early diagnosis of these lesions and to evaluate its burden and study the global, regional, and national patterns. These would further aid in policy making , better resource allocation for controlling pancreatic cancer risk factors and formulating more effective treatments.[2] METHODS- This was a retrospective observational study performed at a tertiary care hospital over a period of one and a half year. A total of 86 patients with pancreatic lesions were subjected to image guided FNA . 35 of these patients underwent diagnostic histopathology in addition to FNA. RESULTS- The 86 cases analyzed were in the age group of 61-70 years with mean age distribution of 57.34 years. Male predominance was seen with M:F ratio of 2.18:1. Head was the most common area to be aspirated followed by tail and least number of lesions were in body of pancreas. Maximum cases were found to be malignant (55) in etiology. Only 2 were non diagnostic because one of them had insufficient cellularity and other had necrosis mainly on histopathology. Adenocarcinoma was the most common malignancy found followed by one case each of lymphoma and solid pseudo papillary neoplasm of pancreas. Histo pathological correlation was obtained in 91.42% cases proving that FNA is a very useful tool in early diagnosing pancreatic lesions.

Cosmetic outcomes of grafted tubularized incised plate urethroplasty in primary distal penile hypospadias: prospective comparative study with the classic Snodgrass repair

Background To compare the outcomes between classic tubularized incised plate (C-TIP), known as Snodgrass urethroplasty, and grafted TIP (G-TIP) in the repair of primary distal penile hypospadias. Methods Parents of all children presented to our tertiary care institution with primary distal penile hypospadias were asked to participate in this study. Patients were equally randomized using closed envelope method into two groups; Group A underwent repair using G-TIP and Group B underwent repair using the C-TIP. Circumcised cases and/or cases with penile chordee > 30 degrees were excluded from this study. Urethral catheter was kept for 7 to 10 days after surgery. The success rate and cosmetic outcomes assessed by HOSE score were evaluated at 6-month postoperatively. Results A total of 55 patients were recruited in each group. One hundred and seven patients of the 110 patients (54 and 53 in groups A and B, respectively) were evaluated at 6-month postoperatively using HOSE score. All preoperative data were comparable in both groups. Success was documented in 49/54 patients (90.7%) in group A. The five failures were secondary to two cases of glans dehiscence and three cases of residual postoperative chordee. Whereas, success was documented in 48/53 patients (90.5%) in group B. Complications were: a case of meatal stenosis, three cases of fistula, and a case of combined meatal stenosis and fistula. The HOSE score was comparable between the two groups (15.4 ± 1.09 vs. 15.6 ± 0.55; p = 0.29). However, the operative time was statistically longer in the G-TIP compared with the C-TIP (91.4 ± 6.2 min vs. 85.2 ± 6.3 min; p < 0.001), respectively. Conclusion The G-TIP urethroplasty provided comparable results with C-TIP in terms of cosmoses, success rate, and complications. However, G-TIP was accompanied with significantly longer operative time.

Effect of COVID-19 Pandemic Restructuring on Surgical Volume and Outcomes of Non-COVID Patients Undergoing Surgery

Objectives COVID-19 has caused significant surgical delays as institutions minimize patient exposure to hospital settings and utilization of health care resources. We aimed to assess changes in surgical case mix and outcomes due to restructuring during the pandemic. Methods Patients undergoing surgery at a single tertiary care institution in the Deep South were identified using institutional ACS-NSQIP data. Primary outcome was case mix. Secondary outcomes were post-operative complications. Chi-square, ANOVA, logistic regression, and linear regression were used to compare the control (pre-COVID, Mar 2018-Mar 2020) and case (during COVID, Mar 2020-Mar 2021) groups. Results Overall, there were 6912 patients (control: 4,800 and case: 2112). Patients were 70% white, 29% black, 60% female, and 39% privately insured. Mean BMI was 30.2 (SD = 7.7) with mean age of 58.3 years (SD = 14.8). Most surgeries were with general surgery (48%), inpatient (68%), and elective (83%). On multivariable logistic regression, patients undergoing surgery during the pandemic were more likely to be male (OR: 1.14) and in SIRS (OR: 2.07) or sepsis (OR: 2.28) at the time of surgery. Patients were less likely to have dyspnea with moderate exertion (OR: .75) and were less dependent on others (partially dependent OR: .49 and totally dependent OR: .15). Surgeries were more likely to be outpatient (OR: 1.15) and with neurosurgery (OR: 1.19). On bivariate analysis, there were no differences in post-operative outcomes. Conclusion Surgeries during the COVID-19 pandemic were more often outpatient without differences in post-operative outcomes. Additional analysis is needed to determine the impact of duration of operative delay on surgical outcomes with restructuring focusing more on outpatient surgeries.

Recovery of Screening Mammogram Cancellations During COVID-19

Background In response to the COVID-19 pandemic, the American Society of Breast Surgeons and American College of Radiology released a joint statement recommending that all breast screening studies be postponed effective March 26, 2020. Study Design A retrospective review of all canceled mammograms at a single tertiary care institution from January 1-August 31, 2020 was performed to evaluate the effect of this recommendation by quantifying both the number and reason for mammogram cancellations before and after March 26, 2020. Utilization of the electronic patient portal for appointment cancellation as a surrogate for telehealth uptake was noted. Results During the study period, 5340 mammogram appointments were kept and 2784 mammogram appointments were canceled. From a baseline of 30 (10.8%) canceled mammograms in January, cancellations peaked in March (576, 20.6%) and gradually decreased to a low in August (197, 7%). Reasons for cancellations varied significantly by month ( P < .0001) and included COVID-19 related (236, 8.5%), unspecified patient reasons (1,210, 43.5%), administrative issues (147, 5.3%), provider requests (46, 1.7%), sooner appointments available (31, 1.1%), and reasons not given (486, 17.5%). In addition, compared to a baseline in January (51, 16.5%), electronic patient portal access peaked in August (67, 34.0%). Conclusion Screening mammogram cancellations have gradually recovered after early COVID-19 restrictions were lifted and increasing use of electronic patient access appears to be sustained. Consequences for future staging at the time of diagnosis remain unknown. Understanding to what extent the pandemic affected screening may help surgeons plan for post-pandemic breast cancer care.

A Record-based Analysis of Profile, Pattern and Outcomes of Geriatric Fractures in a Tertiary CareHospital, Chandigarh

Introduction: Older people with diseased conditions are more prone to fracture irrespective of gender. Osteoporosis is the most common cause of elderly fractures. Objectives: 1) To ascertain the profile and pattern of geriatric fracture cases reporting a tertiary care institution, 2) To ascertain the extent of mortality and complications in geriatric fracture cases, and 3) To ascertain the functional outcomes of geriatric fracture cases discharged from the tertiary care institute. Methodology: A list of geriatric fracture inpatients of an institution was made for 2014 - 2018. The data on the profile of patients, type of fracture, treatment received, the lag time between the reporting and the surgery, comorbidities, past medical history, cause/ place of fracture, length of stay, and status at the time of the phone-based interview were analysed through SPSS software. Results: The highest range of the age for fracture occurrence was 60-70 years. Female patients were more than the male ones. Femur fracture was the most common. The most common direct cause of the fracture was fall (indoor). Open reduction, internal fixation and arthroplasty were the commonest treatment performed. The lag time between the patient arrival to the health care and surgery was 0-5 days. The highest length of stay by the patients in the hospital was 0-10 days. Conclusion: The possible direct causes of the fracture reported in the study were falls, roadside accidents, trauma etc.

A study on adverse effect following immunization COVID-19 vaccination Covishield among MBBS student s of a tertiary care institution in a rural area of Chhattisgarh, India

Background: India has granted emergency use authorization to two COVID-19 vaccines, Pune based Serum Institute of India’s Covishield and Hyderabad- based Bharat Biotech International Ltd.’s Covaxin, for the vaccination drive. Once a vaccine is in use, it must be continuously monitored to make sure it continues to be safe. These data will add on in policy making and also help vaccine to be safely tracked throughout its use. In view of above background present study has been conducted to determine adverse effect following immunization.Methods: A cross sectional observational study was conducted among 400 MBBS students of a rural medical college in Chhattisgarh, India from January 2021 to March 2021. Approval was taken from institutional ethical committee and written informed consent was obtained from participants. A semi-open questionnaire was used to estimate the adverse effect following Covishield administration. Data was processed, analysed using SPSS software and information was obtained.Results: Study shows most common adverse effect was pain at injection site (86%), followed by fever (76%). Female received more (69%) treatment compared to male (31%). Almost 100% of subject experienced adverse effect following immunization (AEFI) following first dose administration whereas about 20% only experienced adverse effect following administration of second dose.Conclusions: Pain at injection site was most common adverse effect followed by fever. Adverse effect was four times more with first dose compared to second dose. Female received more treatment compared to male. Majority had fever and pain for 1-2 days only. Thus, it was concluded that vaccine have no serious side effect.

Ten years risk assessment of cardiovascular events among adult population visiting urban health and training centre of a tertiary care institution, Farrukhabad, Uttar Pradesh, India

Background: Cardiovascular diseases (CVDs) are the number one cause of death globally, four out of five CVDs deaths are due to heart attacks and strokes, and one third of these deaths occur prematurely in people under 70 years of age. In view of above background study conducted with the aim and objective to determine Ten years risk assessment of cardiovascular events (myocardial infarction or stroke) among adult population visiting UHTC of a tertiary care Institution, Farrukhabad, UP, India.Methods: A cross-sectional study was conducted using World Health organisation (WHO)/International Society of Hypertension (ISH) tool at urban health and training centre (UHTC) of a tertiary care institution at Farrukhabad, UP from August 2017 to January 2018. Sample size was 400 (n=4pq/l2). Ethical clearance was obtained from institutional ethical committee and written informed consent obtained from the participants. Data analysed using SPSS Software. Chi-square test used to observe level of significance at p<0.05.Results: Majority (69.5%) have less than 10% risk for CVD whereas 10.5% have 10-20% risk, 8% people have 20-30% risk, 6.25% have 30-40% risk and 5.75% people have ≥ 40% risk. Majority (58.75%) belong to young adult. About 7.75% people were diabetic and 11.25% were smoker. Concerning serum cholesterol, 49% had 5 mmol/l, 42% had 4 mmol/l, 0.75% had ≥8 mmol/l. Statistically significant association observed between socio-economic status (SES) and cardiovascular event when chi-square is 95.344, and p<0.00001.Conclusions: About 1/3 population have risk above 10%. Mostly middle-income group are on risk.

Covid-19 and Co-Infection in Children: The Indian Perspectives

BACKGROUND AND OBJECTIVES Assessing the co-infections with COVID-19 is crucial to delineate its true clinical impact. Pediatric information in this aspect is limited. Our study aims to analyze the spectrum of co-infections in pediatric COVID-19 patients and determine the clinical as well as laboratory parameters predicting co-infection. METHODOLOGY In this prospective observational study conducted from June to December, 2020 in a single tertiary care institution, data pertaining to demographic, illness and treatment-related variables were analyzed among two subsets of pediatric patients of age 1 month -12 years with RTPCR-confirmed COVID-19 infection-Group A: those with confirmed co-infection and Group B: moderate to severe disease without co-infection. Among Group A, etiology of co-infection was characterized through relevant microbiological examination within 48 hours admission. RESULT Among our study population, 15.03% and 20.6% had co-infections and moderate to severe disease respectively. Among those with confirmed co-infection, 32.5%, 11.6% and 6.97% recorded blood culture, respiratory secretion and CSF growth respectively, the picture being dominated by Methicillin resistant and sensitive Staph. Aureus. Serum serology demonstrated Scrub typhus infection to be most prevalent. Concurrent respiratory viral infections were seen in 11.6%. Children with co-infection had significantly higher morbidity and need for supportive therapy. Predictors of co-infection were localization of infection, Neutrophil count &gt;/= 10 x 109, age specific lymphopenia, CRP &gt; 100 mg/dL and hyper-ferritinemia. CONCLUSION Co-infections are an important factor prognosticating pediatric Covid infection .Their early detection, prompt and appropriate treatment is of paramount importance.