Physicians’ Knowledge, Attitudes, Practices and Perceived Needs Regarding Specialised Geriatric Healthcare: A Nation-wide Survey in India

Background: The OSA is commonly found in ILD with overall incidence varying from 17 to 88 %. The morbidity and mortality of OSA are high when it occurs with chronic respiratory diseases like ILD. There is lack of data on sleep breathing disorder in ILD patients from India. The present study aims is to assess the occurrence of OSA in ILD patients and its correlation with other parameters. Method: Prospective observational study of 41 ILD patients of one year duration. All patients underwent detailed clinical examination, radiological, laboratory investigations and Type 1 diagnostic polysomnography according to AASM guideline. The severity of OSA was defined as per AHI and the correlation of OSA with other parameters were assessed.

Binocular summation in comitant exotropia: Change after surgery

Purpose: To assess the change in binocular summation (BiS) in comitant exotropia (XT) after strabismus surgery. Methods: This is a prospective study on 20 patients who underwent surgery for comitant XT over a one year period. Patients with sensory exotropia and nystagmus were excluded. Best?corrected visual acuity (VA) and contrast sensitivity (CS) of both eyes separately and together (binocularly) were recorded. BiS score was calculated as binocular score minus better eye score. BiS score at the end of 3 months was compared with the preoperative data. Results: The mean ± SD of BiS score increased from 2.95 ± 0.88 to 4.55 ± 0.68 (P?value < 0.0001) for VA (on ETDRS letters) and from 2.75 ± 0.44 to 4.5 ± 0.76 (P?value < 0.001 for CS (on Pelli–Robson chart) after surgery. Conclusion: There is significant improvement in BiS in XT after strabismus surgery. Authors recommend its inclusion in evaluation of functional outcome of XT surgery

Comprehensive Geriatric Assessment (CGA) Screening of Geriatric Patients in a Tertiary Care Hospital: a Cross-sectional Study in India

Background: Within the next few decades, India will witness a staggering increase in its elderly population owing to advancements in health care. However, an increase in life span is not mutually inclusive with high quality of living. Old age is associated with multiple ailments which decreases functionality and increases dependency, several of which go undiagnosed while catering to primary complaints. This prompts the need for a comprehensive approach to the healthcare of the elderly for which Comprehensive Geriatric Assessment (CGA is widely practiced in the west. Objectives: This study was conducted to estimate the prevalence of undiagnosed medical problems by Comprehensive Geriatric Assessment (CGA) Screening and explore its applicability in Indian tertiary healthcare setup. Methodology: Following ethical approval of the institute, a cross-sectional study was conducted among 262 geriatric patients with age over 60 years, from seven out-patients departments. A Comprehensive Geriatric Assessment (CGA) inventory was prepared by compiling screening instruments for Visual acuity, Hearing acuity, Dependency, Functionality, Depression, Cognitive impairment, Fall risk, Urinary incontinence, Nutritional Status and Insomnia. The participants were administered the screening inventory once they had already undergone a normal check-up in the OPDs. Results: Overall, 262 geriatric patients underwent CGA screening (Female: 57.3%, Male: 42.7%). There was a high prevalence of problems going undiagnosed ranging from 58.65% to 95.45% in various OPDs. Some problems had a significantly greater overall prevalence and were also prevalent in going undiagnosed in particular OPDs (urinary incontinence in Gynaecological OPD, p=0.003; insomnia in surgical OPD, p<0.005). Many patients who screened positive for certain problems were found to have a few other problems as well (dependency and cognitive impairment, p=0.003; insomnia and depression, p=0.0001). Conclusion: This study showed a high prevalence of problems going undiagnosed along with their associations with particular OPDs and other problems. Participants of this study showed a considerable acceptability for CGA. This reaffirmed the need for CGA in every geriatric patient in our tertiary care setup.

An observational single-center study of nivolumab in Indian patients with recurrent advanced non-small cell lung cancer

Purpose: Limited treatment options are available for patients with advanced non-small cell lung cancer (NSCLC) after failure of first-line platinum-based chemotherapy. The treatment of recurrent advanced NSCLC progressed with the arrival of nivolumab and other immunotherapeutic agents. Our single-center prospective study aimed to present the effectiveness and safety of nivolumab in second-line setting after first-line platinum doublet in Indian patients with advanced NSCLC. Patients and Methods: Twenty-nine adult patients with stage IV NSCLC treated with nivolumab after failure of first-line platinum-based chemotherapy at Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, India, between October 2016 and January 2018, were included in the study. Overall survival (OS), hematological, and nonhematological toxicities were evaluated. Results: A total of 29 patients (mean age of 59.6 years at enrollment) were evaluated. Histological evaluation revealed adenocarcinoma (44.8%) and squamous (55.2%) type of cancer. The Eastern Cooperative Oncology Group performance score was II in 7 patients (24.1%) and I in 22 (75.9%) patients. Patients received an average of four cycles of nivolumab. The median survival duration was 101 days, and OS rate in the study was 51.7%. Six patients (20.7%) had stable disease response, five patients (17.2%) had partial response, and three patients (10.3%) were lost to follow-up. Asthenia and cough were the most common nonhematological toxicities. Only three patients developed hematological toxicities (anemia and thrombocytopenia). Conclusion: Data from our study suggest nivolumab is well-tolerated and effective in Indian patients with recurrent advanced NSCLC after failure of the multiple first lines of platinum-based combination chemotherapy.

Outcome analysis of a newly setup pediatric intensive care unit in a teaching hospital of northern India

Background: Pediatric intensive care units (PICU) have brought about dramatic increase in the survival of critically ill children. The aim of pediatric intensive care is not just to save lives but also to maximise the quality of those lives. Evaluation of the outcome of an intensive care unit is necessary as a measure of quality improvement in patient care.Methods: A retrospective observational study was done in a PICU of a teaching hospital between February 2017 to August 2018. Records of all admissions, transfer outs, discharges and deaths were collected along with age, sex, diagnosis, length of stay, and outcome.Results: Mean age of the 601 patients admitted over a period of nineteen months was 4 years. 36% patients were between 1-5 year and 32% were infants. Major indication for admission to the PICU was respiratory (30%) followed by neurological illnesses (25%) and infections (22%). Increased length of stay (LOS) (>5 days) was seen in respiratory, neurological diseases and infections. A significant relation (p value <0.05) was found between outcome and patients admitted with sepsis and the group classified as others. Patients admitted with involvement of nephrology system had a significant relation with LOS (p value <0.05). The mortality rate was 2%.Conclusion: The outcome analysis of our newly setup PICU is comparable with other studies in the Indian subcontinent. Active surveillance or audit of PICU admissions help capture lapses in management and bring a better outcome with available resources.

An IoT Equipped Hospital Model: A New Approach for E-governance Healthcare Framework

Internet of things (IoT) is an emerging technology that helps in reducing the human efforts. IoT refers to the physical objects connected to each other over the internet. In reference to the healthcare sector various equipment and gadgets like a thermometer, ECG, blood pressure measuring machine, heart rate monitor etc. are interconnected via various sensors. People are becoming more inclined towards the use of the Internet of things. The growing elderly population and the increase in chronic diseases generate a need for the healthcare sector to find ways to provide services at the convenience of the patient. Many people in India do not have access to proper medical services due to which the health of these people suffers. Nowadays the government is taking so many initiatives to support and provide help to the people living in the rural area. This paper proposes a model e-governance healthcare framework of IoT equipped hospital that helps in treating critical healthcare requirements.

Pigmented Purpuric Dermatoses.

Pigmented purpuric dermatoses (PPD) are a group of histopathologically similar conditions that are primarily differentiated based on morphology. The basic pathological finding is a lymphocytic perivascular infiltrate with hemorrhage limited to the papillary dermis without fibrinoid necrosis of the vessels. The etiology is unknown; they run a chronic course and are fairly resistant to treatment. We present this review for the physicians to kindle interest in this not-so-uncommon entity.

Leprosy Scenario at a Tertiary-level Hospital in Navi Mumbai: A Four-year Retrospective Study.

Introduction: India was among the last few countries in the world to achieve leprosy elimination in 2005. However, wide variations in prevalence rates continue to exist across the states and regions in the country. Aims: The purpose of the study is to determine the current clinical profile of leprosy from a tertiary-level hospital in Navi Mumbai. Materials and methods: A retrospective study was done to determine the epidemiological and clinical profile of leprosy patients in a tertiary care center, MGM Medical College & Hospital, Navi Mumbai (September 2011 to August 2015). Data regarding demographic details, clinical features, investigations, treatment, and complications were analyzed. Results: In total, 207 patients were registered over a 4-year period, with male:female ratio of 2.4:1 and children (≤ 14 years) constituting 7.2%. As per Ridley Jopling classification, borderline tuberculoid leprosy was the most frequent morphologic type, seen in 45.8%, followed by borderline lepromatous (28%), lepromatous leprosy (10.1%), and other forms in 11.5%. Multibacillary leprosy was the most common clinical type (81.1%). About 32.8% patients presented in reaction (type I in 22.7% and type II in 10.1%). World Health Organization (WHO) grade 2 deformities were diagnosed in 32.8%, with claw hand being the most common paralytic deformity (18.8%). Conclusion: The study shows that despite statistical elimination, multibacillary disease, leprosy reactions, and deformities are commonly seen as presenting manifestations. Large population of migrant workers in Navi Mumbai could be a possible contributing factor towards these findings. It highlights the need to sustain and provide high-quality leprosy services to all patients through general health services, including good referral system. Investigations, such as slit skin smear and biopsy must be carried out for all newly diagnosed patients.

Peeling Palmar Skin.

A 20-year-old male presented with asymptomatic peeling of palmar skin of 1 month duration ( Fig. 1). He gave history of similar episodes since 3 years, all of which occurred during the winter season and subsided without treatment in a period of 2 to 3 months. He also complained of excessive sweating over palms. There was no personal or family history of atopy. Cutaneous examination revealed exfoliation of skin over the volar aspect of the palms and fingers. Soles were spared. Palmar hyperhidrosis was also noted. Onset in adulthood, absence of itching and/ or fluid-filled blisters, and negative KOH mount excluded dyshidrotic eczema, acral peeling skin syndrome, epidermolysis bullosa simplex, and dermatophytid and convened the diagnosis of keratolysis exfoliativa. Keratolysis exfoliativa is characterized by annular erythema with an air-filled blister arising in the center, followed by superficial collarette and lamellar peeling of glabrous palmoplantar skin. Synonyms include dyshidrosis lamellosa sicca and lamellar dyshidrosis. Emollients, urea, and lactic acid may be used; however, treatment is not necessary as the condition is asymptomatic.

Acquired Cold Urticaria: An Under-reported Entity.

Acquired cold urticaria (ACU) is a subtype of physical urticaria which may be primary (idiopathic) or secondary to underlying infections or cryoproteins. In addition to complete history and thorough physical examination, the diagnosis is dependent on a positive cold stimulation time test (CSTT) which is the minimum time of cold contact stimulation required to induce an immediate coalescent wheal. Although idiopathic type is seen in 96% of the cases, it is important to rule out cryoprotein by an intricate yet simple test for cryoprecipitate. The identification of cold exposure as the likely trigger for urticaria is vital because systemic anaphylactic reactions are common in patients with cold urticaria, occurring in roughly 1 in 3 patients. In addition to preventive counseling and avoidance of critical cold exposure, H1-receptor antagonists form the first line of treatment. However resistant cases may require cyclosporine, danazol or omalizumab. No individual case reports of ACU appear in Indian literature. Therefore, the authors attempt to highlight the diagnostic work-up and therapeutic options for this not so uncommon cause of chronic urticaria.

Non-mycosis Peripheral T-Cell non-Hodgkin Lymphoma involving the Skin.

A 64 years old male presented with reddish lesions all over the body of 1 month duration, high grade fever with evening rise of temperature and chills. No lymphadenopathy or hepatosplenomegaly were noted. Multiple infiltrated erythematous and hyperpigmented patches and plaques were present on the face, trunk and extremities along with few oral erosions. Histopathology from skin showed features of mycosis fungoides (MF). A further workup with Immunohistochemistry was suggestive of peri pheral T-cell lymphoma, not otherwise specified diag nosis (PTCLNOS). We report a case of PTCLNOS in a man mimicking MF clinically and histopathologically.

Metabolic and Cardiovascular Comorbidities in Psoriasis: Revisited.

There is increasing awareness that psoriasis, as a disease, is more than ‘skin deep’ and associated with comorbidities that potentially increase morbidity and mortality, and lower quality of life. The consistency of association and the diversity of comorbidities reported in psoriasis warrants it to be labeled as a complex syndrome. Merely finding an association between psoriasis and comorbidities is not going to suffice until this evidence is put into clinical practice. The pathogenesis of psoriasis and its comorbidities is complex but several studies have revealed certain mechanisms and factors which are common to both. These shared pathogenic mechanisms solve the mystery to this comorbid association, especially with metabolic syndrome and cardiovascular disease. Studying these pathogenic links may reveal certain parameters which can be utilized as potential biomarkers in the presumptive screening of patients for the presence of comorbidities. These shared pathogenic mechanisms hold the key toward establishing a novel biomarker which can monitor both the disease severity and the associated comorbidity. Psoriasis patients with comorbidities also incur more healthcare costs, than those without comorbidities. Cardiovascular comorbidity in psoriasis incurs the greatest increase in healthcare resource use. Early detection of cardiovascular and other comorbid conditions in psoriasis can possibly reduce the morbidity, mortality, and economic burden associated with the disease. We attempt to review the pathogenic links between psoriasis and its metabolic and cardiovascular comorbidities.