Christian Medical College & Hospital

Study question: Can a core outcome set be developed through a global consensus to standardize outcome selection, collection, comparison, and reporting in future male infertility trials? Summary answer: A minimum dataset, known as a 'core outcome set', has been developed for randomized controlled trials (RCTs) and systematic reviews evaluating potential interventions for male infertility. What is known already: Numerous factors, including a failure to consider the perspectives of men with lived experiences of infertility or their partners when developing and conducting RCTs can limit their clinical utility. Selection of outcomes, variations in outcome definitions, and the selective reporting of outcomes based on statistical analysis make the results of infertility research challenging to interpret, compare, and implement. For male infertility, this is further compounded by there being potentially three participants, the male, their female partner, and any offspring born, all with outcomes to be reported. This has led to significant heterogeneity in trial design and reporting. While a core outcome set for general infertility trials has been developed, there is no such outcome set for male infertility trials. Study design, size, duration: A two-round Delphi survey (334 participants from 39 countries) and consensus development workshops (44 participants from 21 countries). Participants/materials, setting, methods: Healthcare professionals, researchers, and men and women with infertility were brought together in a transparent process using formal consensus science methods. Main results and the role of chance: The core outcome set for male infertility trials has been developed by the inclusion of specific male-factor outcomes in addition to the general infertility core outcome set. These outcomes include assessment of semen using the World Health Organization recommendations for semen analysis; viable intrauterine pregnancy confirmed by ultrasound (accounting for singleton, twin, and higher multiple pregnancies); pregnancy loss (accounting for ectopic pregnancy, miscarriage, stillbirth, and termination of pregnancy); live birth; gestational age at delivery; birthweight; neonatal mortality; and major congenital anomaly. Although not a requirement as part of the core outcome set, other outcomes were identified as potentially useful in certain study settings. Limitations, reasons for caution: We used consensus development methods in this work, which have inherent limitations, including the representativeness of the participant sample, Delphi survey attrition, and an arbitrary consensus threshold. Wider implications of the findings: Embedding the core outcome set within RCTs and systematic reviews should ensure the comprehensive selection, collection, and reporting of core outcomes, which are inconsistently reported at present. Research funding bodies, the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) statement, and over 80 specialty journals, including the Cochrane Gynaecology and Fertility Group, Fertility and Sterility and Human Reproduction, have committed to implementing this core outcome set for male infertility trials

This case report describes Hepatitis A and typhoid infections in a child hailing from an urban site in India within 4 weeks, thereby highlighting systemic issues with water quality and public health. The case sheds light on the broader public health challenges faced by low- and middle-income countries, including inadequate WASH (water, sanitation and hygiene) facilities, contributing to high incidences of faecal-orally transmitted diseases. In 2016, poor WASH was responsible for 60% of diarrhoeal deaths. The Sustainable Development Goals aim to improve global water and sanitation by 2030, emphasising the need for equitable access. Interim solutions like vaccination and point-of-use water treatment are vital. Vaccination against typhoid and hepatitis is especially crucial in areas with high disease prevalence and rising antimicrobial resistance. We must advocate for these vaccines to be included in the National Immunisation Schedules to ensure widespread, equitable coverage and support public health.

Introduction According to WHO long COVID is defined as a continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation. We followed up patients after an episode of acute COVID-19 for 1 year after hospital discharge from different parts of India. Methods This was a multi-centric study among patients ≥18 years hospitalized with COVID-19, which recruited patients at 6 weeks after hospital discharge (baseline). Quantitative data on demographics, pre-existing co-morbidities, risk factors, signs and symptoms and hospital parameters during acute COVID-19 infection were noted at baseline. They were followed up and data collected telephonically thereafter at 3–6, 6–9 and 9–12 months regarding self-reported persistence of symptoms. A qualitative component included face to face in-depth interviews to elicit information on perceived health problems, quality of life and financial burden due to COVID-19. Results A total of 315 patients were enrolled, with the majority being males (59.4%). The median age was 52 years (IQR 40, 63). The prevalence of long COVID was 16.5%. At 6 weeks and 12 months, 35.2% and 25.9% of patients, reported more than one new symptom that affected their quality of life. Shortness of breath was common at each time point, persistent muscle pain and weakness waxed and waned. Variables at 6 weeks post discharge (baseline) such as shortness of breath (OR 2.22 CI 1.06–4.65, p = <0.05), cough (OR 6.93, CI 2.36–20.30, p = <0.05), fatigue (OR 2.34, CI 1.05–5.23, p = <0.05), and weight loss (OR 2.90, CI 1.30–6.49, p = <0.05) were significantly associated with long COVID. Conclusion We found that long COVID was noted in 16.5% patients who self reported non – recovery at 1 year. Physical symptoms, mental health issues and mobility were persistent in a significant number of patients following an initial recovery from an acute COVID-19 infection. In 25.9% of patients more than 1 symptom was reported at 1 year after COVID-19. We urgently need therapeutic interventions which can improve the quality of life in these patients.

Rationale Melioidosis is a serious opportunistic infection caused by Burkholderia (B.) pseudomallei, primarily affecting immunocompromised individuals, particularly in endemic regions. Timely diagnosis and appropriate treatment are crucial to prevent fatal outcomes. Patient concerns Case 1 was a 34-year-old male kidney transplant recipient who presented with a 15-day history of intermittent fever, accompanied by liver and spleen abscesses. Case 2 was a 37-year- old female kidney transplant recipient who presented with acute febrile illness and developed leucopenia. Blood cultures for both patients grew B. pseudomallei. Diagnosis Both patients were diagnosed with melioidosis caused by B. pseudomallei , with the diagnosis confirmed through pus culture from the liver abscess in Case 1 and blood culture in Case 2. Interventions Both patients were treated with an intensive regimen of meropenem (renal-adjusted doses), followed by a 3-month course of oral cotrimoxazole for eradication therapy. Outcomes Case 1 experienced resolution of liver and spleen abscesses after 3 months of treatment and continued to recover well. In Case 2, blood cultures became sterile after 4 weeks, with no further complications observed. Lessons Melioidosis should be suspected in immunocompromised patients, especially kidney transplant recipients, who present with unexplained fever and sepsis-like symptoms. Early diagnosis through aspiration of abscesses and prompt treatment are critical for preventing relapses and improving patient outcomes.

Ovarian Sertoli Leydig cell tumours (SLCTs) are rare and occur predominantly in young females. Categorised as less common ovarian cancers, they have a favourable prognosis, and fertility preservation is an option in early-stage disease, where fertility is desired. Here, we describe a case of a late adolescent girl, who presented after tumour excision of left ovarian mass. Her initial histopathology report showed mucinous adenocarcinoma of left ovary. Slide review and immunohistochemistry suggested stage IC, intermediate grade Sertoli Leydig cell tumour and the patient was kept on observation. Six months later, she underwent re-surgery with fertility preservation for suspected recurrence. Final histopathology showed no residual tumour. The girl has been disease-free for 4 years. This case highlights the importance of immunohistochemistry and extensive pathology review for diagnosis of this rare tumour. It emphasises that SLCT can masquerade as other poor-grade malignancies owing to histopathological overlap.

Background Hypopigmented mycosis fungoides (HMF) is a rare cutaneous T-cell lymphoma seen in children with persistent hypopigmented patches, histopathology showing epidermotropism of atypical lymphocytes, and immunohistochemistry being predominantly CD8+. Methodology A cross-sectional retrospective study on patients with HMF between June 2009 and January 2024 at a tertiary care center in South India was done. The clinical profile of the patients, serology, and histopathology with immunohistochemistry were reviewed. Results Of 34 patients included in the study, the mean age at presentation was 32.65 ± 13.25 years, duration of symptoms was 5.33 ± 0.83 years, and the mean age at onset was 27.29 ± 2.73 years. All but one patient had multiple patches, 18(53%) with both covered and photo-exposed sites and 14(41%) having only over covered sites. Nine patients presented with mixed morphology of lesions along with hypopigmented patches. Seventeen (50%) patients had more than 10% body surface area involved, none had systemic disease. Histopathology revealed epidermotropism (100%) and lymphocyte tagging (82%). Immunohistochemistry showed CD8 predominance in 56%. Of the patients with only hypopigmented lesions, 64% showed CD8+ predominance, and 67% of patients with mixed morphology had CD4+ predominance. Conclusions HMF should be considered in patients with persistent hypopigmented patches predominantly over covered areas. Usually, HMF has an earlier age of onset, but our study had a mean age at onset of 27 years. Hypopigmented lesions were mostly CD8+ and mixed morphology of lesions were mostly CD4+ on immunohistochemistry.

Remdesivir was widely used in India during the peak of the COVID-19 pandemic, and several guidelines recommended it for hospitalized hypoxic adult and pediatric patients. However, well-designed studies reported inconsistent results, and many international guidelines changed their recommendations with each emerging COVID-19 variant. This rapid review was done as part of living evidence synthesis (previous versions available in https://indicovidguidelines.org) to assess the effectiveness of various interventions in COVID-19 infection contextualizing to the current Indian context. We conducted a systematic review of randomized controlled trials (RCTs) evaluating remdesivir in COVID-19 infection (current to September 29, 2023). Two reviewers independently evaluated the eligibility of search results and extracted data for predefined outcomes. The risk of bias (RoB) was assessed using the Cochrane RoB v2.0 tool and meta-analysis using RevMan 5.4. We used hazard ratios for continuous outcomes, risk ratios (RRs) for dichotomous outcomes, and Grading of Recommendations, Assessment, Development, and Evaluation methodology to determine the certainty of evidence, which was then documented in the “ Table 2. summary of findings using GRADEpro Guideline Development Tool. In total, nine RCTs with 12,984 COVID-19 patients were included. Low certainty of evidence revealed that remdesivir when compared to standard care/placebo may reduce progression to noninvasive ventilation or high-flow nasal oxygen (RR = 0.70; 95% confidence interval [CI] = 0.51–0.98) but makes little to no difference on all-cause mortality at 28–30 days (RR = 0.92; 95% CI = 0.84–1.01) and progression to oxygen therapy (RR = 0.81; 95% CI = 0.54–1.22). The effect of remdesivir on progression to invasive mechanical ventilation (RR = 0.73; 95% CI = 0.51–1.06), adverse effects requiring interruption of therapy (RR = 1.18; 95% CI = 0.41–3.21), and hospitalization (RR = 0.14; 95% CI = 0.03–0.59) was unclear due to the very low certainty of evidence. This review suggests that remdesivir has an unclear benefit in the current context of COVID-19 variants which have a low propensity for severe disease, as well as widespread immunization in the country.

Paediatric Emergency Medicine (PEM) in India has witnessed remarkable growth over the past two decades. Initially, emergencies involving children were predominantly managed by paediatricians and family physicians in homes, walk-in clinics, or general hospital settings. From these beginnings, PEM has evolved into a dynamic and specialized field, driven by dedicated physicians committed to improving access, training, and the quality of emergency care for children. With increasing recognition of the critical role of specialized paediatric emergency care, the field is set for continued expansion. This article offers an overview of the journey and development of PEM in India.

Simulation can be an effective teaching strategy for developing psychomotor skills, especially for trainee doctors and nurses. In this article we give a detailed account on designing and assembling a model that can be used in training of securing an airway (this was initially used for training during the covid pandemic) and its various uses. To impart the training of securing an emergency airway by a tracheostomy to the ENT trainees and surgeons, anaesthesiologist, intensivists and related health care workers, an inexpensive teaching and training model for tracheostomy was designed. Material easily available in all hospitals was used to fabricate this inexpensive (< 1$) training model. The sessions using this simple model during the Covid pandemic was very effective in imparting the knowledge and the training the health personnel in the steps to be followed during the tracheostomy procedure to reduce aerosol generation. Simulation can be an effective teaching strategy for developing psychomotor skills, especially for trainee doctors and nurses. This low cost, easily available and reusable training model for airway procedures may be considered as a tool to learn and train on how to secure an emergency airway.

Background: Diagnosing anaphylactic deaths is a challenging task for forensic pathologists. Although serum tryptase is considered to be a reliable biomarker, there are limitations to it. Thus, there is an urgent need to explore various other potential biomarkers which could be of diagnostic value, along with Tryptase, to diagnose anaphylactic shock at autopsy. Aim: We want to systematically review the accuracy of newer postmortem biomarkers for anaphylaxis, such as chymase or eosinophilic cationic protein. Before embarking on this project, we intend to assess the feasibility of conducting systematic reviews on this topic. and identify any deficiencies in the existing literature to guide research priorities. Methodology: We followed PRISMA guidelines and conducted the search in four databases, namely Medline, Scopus, EBSCO-CINAHL, and TRIP. Rayyan AI software was used to screen the articles. Results: A total of 6112 articles were retrieved from the search, and 5079 articles were screened after removing duplicates. Only 25 articles were finally available as per our inclusion criteria. Studies pertaining to post-mortem tryptase levels were found in large numbers, with two recently done systematic reviews on this topic. The number of studies available on other newer biomarkers was too few. More clinical studies are needed before a metaanalysis can be done. Hence, we could perform only a narrative review on the topic. Discussion: There is a scarcity of literature with definite cutoff levels for markers other than Tryptase. Based on the available studies, it is not possible to do diagnostic accuracy reviews at the moment. Hence, we narrate the usefulness of biomarkers like Immunoglobulin E, Chymase, Carboxypeptidase A3, Diamine Oxidase, Histamine and Eosinophilic Cationic Protein. Conclusion: Based on the available evidence, serum tryptase is recognized as the primary biomarker for the postmortem diagnosis of anaphylactic death, with elevated levels strongly indicating anaphylaxis. Additionally, serum IgE, particularly allergen-specific IgE, is a valuable complementary biomarker. Further research is needed to understand the performance of other biomarkers.

This article aims to assess the presence of skeletal and soft tissue infections before or after treatment and to assess treatment response in Ga-68 citrate positron emission tomography/computed tomography (PET/CT) scan positive patients. A prospective study was conducted for 43 patients. The eligibility criteria included those patients clinically suspected of infections who underwent a Ga-68 citrate PET/CT. Exclusion criteria were pregnancy and lactation. Patients with suspicion of infection or treatment failure underwent a Ga-68 citrate PET/CT between January 2020 and November 2021. Among these, eight patients underwent a follow-up scan posttreatment to assess their treatment response. The Institutional Review Board (IRB No.12511) approved the study. Forty-three patients underwent a diagnostic Ga-68 citrate PET/CT scan. The scan interpretation was based on visual comparison of uptake of Ga-68 citrate in the region of interest, which was compared with the normal side/adjacent soft tissue/blood pool. The semiquantitative parameter maximum standardized uptake value was retrospectively analyzed as well. PET/CT findings were correlated with tissue diagnosis, clinical symptoms, biochemical parameters like C-reactive protein (CRP), erythrocyte sedimentation rate, and total leukocyte count, and other imaging modalities with a statistically significant association with CRP (p = 0.001). Tissue diagnosis was considered the gold standard and out of the 43 patients included in the study, 27 had a tissue diagnosis. Sensitivity, specificity, negative predictive value, positive predictive value, and accuracy were calculated at 100, 87.5, 100, 95, and 96.3%, respectively. Ga-68 citrate is a promising tool to assess the presence of bone and soft tissue infections before or after treatment.

The optimal management of large tuberculous mass lesions (LTML) involving the central nervous system remains unclear. We conducted a single-center, retrospective, observational study that assessed the outcomes of patients with LTML from January 2010 to February 2023. An LTML was defined as a tuberculoma or tubercular abscess exceeding or equal to 3 cm. The primary outcome was independence in activities of daily living, as assessed by the modified Rankin Scale (mRS) at a follow-up of 6 months. Forty-six patients were identified during the study period. Their mean age was 27.6 ± 12 years, the median duration of antituberculous therapy (ATT) was 18 months, and the median duration of follow-up was 20 months (interquartile range 15.7–40). The favorable outcomes were 76.9% (10/13) for ATT alone, 62.5% (10/16) for ATT with steroids, 87.5% (7/8) for ATT with surgery, and 66.9% (6/9) for ATT, steroids, and surgery. The median mRS at baseline in the study was 2 (1–3), and at the 6 month follow-up, it was 1 (0–2). Adding steroids or surgical intervention to ATT did not significantly improve primary outcomes ( P = 0.637). Further large-scale studies are necessary to confirm these preliminary observations.

Background Occupational therapy (OT) is a client-centered healthcare profession aimed at restoring or adapting compromised body functions, to attain the maximum level of achievable functional independence and to ameliorate substandard occupational performance. To achieve this, OT makes use of the therapeutic benefits of everyday life activities. Although OT plays a crucial role within the multidisciplinary healthcare team, existing literature indicates that healthcare professionals often have an unclear comprehension of its function. Particularly considering that OT in India relies on referral-based access, the limited awareness of the OT profession may result in inaccurate referrals. As a result, the job satisfaction of OT practitioners could potentially suffer adverse effects. Objectives This study aimed to explore the awareness, attitude, and knowledge regarding OT among medical and allied health science stream undergraduate (UG) students. Study Design: A cross-sectional survey. Methods This is a cross-sectional study using a descriptive study design. The “Knowledge and Attitude toward OT Practice” Tool, developed in the Middle East, was modified for the Indian context. The revised questionnaire, the “Awareness, Attitude, and Knowledge of OT” Tool, was then electronically distributed among 96 UG students pursuing medical and allied health science degrees after obtaining electronic informed consent. Results This study found that 56 (58.3%) UG students became aware of OT only after joining the institution for their UG studies. Only 50 (52.0%) considered OT to be irreplaceable within the multidisciplinary team. While the students exhibited a reasonable comprehension of the overall scope of OT, there was confusion regarding the roles of OT and physiotherapy. Conclusion The results point to the need for further knowledge and awareness among the multidisciplinary rehabilitation team members. There is also scope for attitudinal change regarding the profession, which will streamline referral pathways and improve the visibility of OT as a profession.

In accordance with World Health Organization guidelines, the school-based deworming for soil-transmitted helminths (STH) is being implemented in India since 2015 through teachers on National Deworming Day (NDD). This study aimed to assess teachers’ knowledge levels and perception of STH and NDD programmes in southern India using a cross-sectional study design with purposive sampling of teachers involved in the NDD programme. Data from 402 teachers across 221 schools were analysed using STATA 16.0 software. Overall, 37% of the teachers from 52% of schools had attended an NDD training programme. Of a maximum possible score of 32, the knowledge levels were categorised as low (<50%), average (at least 50%), and adequate (70% and above). While 84% of the teachers had an average level of knowledge, only 33% had an adequate level of knowledge. The results showed significant knowledge gaps regarding important aspects of the STH programme including, helminths species being treated, age eligibility of children for treatment, and the name of and side-effects of the deworming tablet distributed. Adequate level of knowledge was more likely among teachers from government schools than those from government-aided/private schools (OR: 3.74; CI: 1.80 – 7.74; p<0.001); those who attended an NDD training programme than those who never attended (OR: 2.69; CI: 1.73 – 4.19; p<0.005); and female teachers compared to male teachers (OR: 1.94; CI: 1.22 - 3.08; p<0.005). A weak but significant positive correlation was observed between knowledge levels and perception (Spearman’s rho=0.2075; p=0.002). Teachers from all schools must be encouraged to participate in formal STH training programmes coordinated by the government, and these programmes should be evaluated periodically for effectiveness.