Publications

BACKGROUND: The intensive care unit (ICU) is an area within a medical facility equipped with advanced technologies such as ventilators and personnel trained to provide intensive, advanced life-supportive care to critically ill patients. These units can be general or specialized. Intensive care beds are always in demand in any tertiary care center. Getting ICU beds is a challenging task. In 2008, the cost of critical care was 17-39% of hospital costs and 5.2-11% of the total healthcare budget. On one hand, where needy patients do not get ICU beds, there are instances when patients are kept just for observation in intensive care. So, we planned this study to analyze our status regarding the effective utilization of medical intensive care beds.

AIMS AND OBJECTIVES: To audit our admissions and discharges on the grounds of the criteria laid by the American Critical Care Medicine (ACCM) in the year 2016, and to strengthen our admission and discharge policies with standard protocols to make the best utilization for society.

MATERIALS AND METHODS: Retrospectively, we analyzed the medical records of 6 months (July 1-December 31, 2021). We analyze admission criteria and discharges in those patients. We recorded the sequential organ failure assessment (SOFA) score, the quick sequential organ failure assessment (qSOFA) score, the length of stay in ICU, the total length of stay, and the outcomes of the patients. The analysis was done with SPSS.

RESULTS: We collected records of 355 patients admitted in the medicine ICU during the defined period. There was a male preponderance in our study. The mean age of patients admitted was 54.75 ± 17.53 (range 16-82). Most patients were transferred in from the ward (53.5%), and the rest (46.5%) were directly from the emergency department. When we categorized the patients' admission according to ACCM Guidelines, 39.4% of patients were in category I, 11.3% patients in category II, 36.6% in category III, 7% in category IV, and 5.6% in category V. When we compared the SOFA score along with the admissions category, there was no significant association. Mean ICU length of stay was 6.11 ± 4.99. There was no association found between the category of admission and the mean ICU length of stay. Overall, out of 355 patients, 255 patients (71.8%) transferred out, 20 patients (5.6%), and 80 patients (22.6%) could not be saved. In our study, 80.3% of transfers out were unplanned (this also includes the death of patients). There was a significant association between the admission category of patients and their outcome in the ICU.

CONCLUSION: The intensive care unit is an expensive setup. It is yet to be used in its maximum capacity for those who really need it. Triaging patients for the ICU is a must for better utilization of resources. Admissions and discharge policies should be followed stringently for optimum utilization of facilities.

BACKGROUND: Polycystic ovary syndrome (PCOS) is a complex endocrine-metabolic disorder with significant age-related, anthropometric, and metabolic variations. Understanding the interplay between age, body composition, and micronutrient status can help identify predictors of metabolic dysfunction and long-term complications in women with PCOS. Most studies assess these factors in isolation, resulting in fragmented evidence and inconsistent conclusions.

OBJECTIVES: This study aimed to evaluate the predictive associations of age, anthropometric parameters, and micronutrient levels (vitamin B12 and vitamin D3) with key metabolic, cardiovascular, and nutritional markers in women diagnosed with PCOS.

MATERIALS AND METHODS: A cross-sectional analysis was conducted among women with PCOS, divided into two age-groups: group I (15-30 years) and group II (31-40 years). One-way analysis of variance (ANOVA) and linear regression analyses were performed to investigate age- and obesity-related differences in metabolic parameters. Pearson's correlations and regression models were applied to assess the predictive strength of age, body mass index (BMI), waist circumference (WC), vitamin B12, and vitamin D3 on metabolic outcomes. The Benjamini-Hochberg method was applied to control the false discovery rate (FDR) for multiple comparisons and ensure conclusions account for the increased risk of type I error due to multiple comparisons, thereby supporting the validity of the study's observations.

RESULTS: The PCOS cohort exhibited generalized overweight (BMI 23.0-24.9 kg/m2) and obesity (BMI ≥25.0 kg/m2) in 40 and 54% of subjects, respectively; notably, visceral obesity (WC ≥80 cm) was present in 97% of the cohort, underscoring a marked predominance of central adiposity even among those with lower BMI thresholds. The PCOS cohort demonstrated high metabolic risk, with frequent insulin resistance, dyslipidemia, and hypertension; notably, 25% had nonalcoholic fatty liver disease (NAFLD), predominantly mild steatosis, indicating a substantial risk for future cardiometabolic complications. Advancing age was significantly associated with higher fasting blood sugar (FBS) (p = 0.019) and glycated hemoglobin (HbA1c) (p = 0.048), while fasting insulin declined with age (p = 0.048). BMI and WC were strong predictors of metabolic risk, positively impacting fasting insulin, FBS, HbA1c, and blood pressure (p < 0.05), while showing significant negative associations with high-density lipoprotein cholesterol (HDL-C) (p < 0.001). Vitamin B12 and D3 levels showed no significant impact on metabolic parameters. Vitamin B12 was predicted only by age (p < 0.001) and vitamin D3 (p < 0.001), while vitamin D3 was influenced by age (p < 0.001) and vitamin B12 levels (p = 0.041).

CONCLUSION: Central obesity markers-particularly WC and BMI-are robust predictors of metabolic dysfunction in PCOS, offering greater prognostic value than micronutrient levels such as vitamin B12 or D3, which showed limited association with metabolic disturbances in this population. These findings highlight the primacy of early detection and intervention targeting adiposity and insulin resistance to reduce long-term cardiometabolic risk among women with PCOS. Integrated, multifactorial risk assessment remains essential, as age, nutritional deficits, and obesity-related factors independently and collectively drive adverse metabolic outcomes in PCOS, emphasizing the need for comprehensive preventive and management strategies.

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD), has emerged as a significant public health concern, affecting approximately 25% of the global population with its prevalence rising from 22% in 1991 to 37% in 2019.1 While the hepatic consequences of MASLD, such as steatohepatitis, fibrosis, and cirrhosis, are well documented, its systemic implications are increasingly coming to light. While traditionally viewed as a hepatic disorder, growing evidence highlights MASLD as a multisystem disease with profound implications on cardiovascular health. Atherosclerotic cardiovascular disease (ASCVD) has now been recognized as the leading cause of mortality in patients with MASLD, surpassing liver-related complications. MASLD is present in up to 75% of patients with type 2 diabetes mellitus (T2DM). Notably, MASLD is linked to a higher risk of cardiovascular diseases (CVD), including arrhythmia, atherosclerotic heart disease, heart failure, and CVD-related mortality.2 The association between MASLD and ASCVD is particularly alarming, positioning MASLD as a critical gateway for cardiovascular morbidity and mortality.

Advance care planning (ACP) refers to the process through which patients, their families, and healthcare providers discuss and record preferences for end-of-life care.1 Internationally, ACP has been shown to reduce unnecessary interventions, align medical decisions with patient wishes, and provide dignity at the end-of-life. In India, however, structured ACP is virtually absent. Good end-of-life care is directly linked to the quality of death that Indians achieve, which has been consistently poor; in the 2021 Quality of Death Index report, India ranked 59 out of 81 countries that were studied.2.

BACKGROUND: Hydration plays a vital role in metabolic health, particularly in diabetes, where factors such as osmotic diuresis, polypharmacy, and comorbidities heighten the risk of dehydration. Effective management of fluid, electrolyte, and energy (FEE) deficits is crucial, yet gaps persist in current practices. This is the first study to assess the knowledge, attitude, and practices of cross-specialty healthcare professionals (HCPs) managing diabetes on such a unique issue in persons with diabetes.

OBJECTIVES: This study assessed the knowledge, attitudes, and practices (KAP) of 525 cross-specialty HCPs managing diabetes in India regarding FEE management in diabetic patients with acute nondiarrheal illnesses to identify gaps and inform interventions.

MATERIALS AND METHODS: An online cross-sectional survey evaluated physician perspectives on dehydration in diabetes using a 30-item questionnaire covering knowledge of dehydration in diabetes, attitudes toward the oral FEE formulations, and current practice.

RESULTS: Most respondents (90%) identified osmotic diuresis as a key driver of dehydration in diabetes, with 75% highlighting Sodium-glucose cotransporter 2 (SGLT-2) inhibitors as a risk factor. Despite widespread recognition of the adverse effects of dehydration and energy deficits (86%), only 46.5% routinely assessed hydration status during acute illnesses in persons with diabetes. Slow-release carbohydrates, such as isomaltulose, D-tagatose, and trehalose, were favored by 68.9% of respondents for their metabolic benefits to address energy deficits. 84.2% of HCPs perceived ready-to-drink (RTD) FEE formulations supporting rehydration and enhanced recovery, with an average impact on recovery time of 4.1 days.

CONCLUSION: This study highlights the gaps in understanding the role of hydration in persons with diabetes. It also underscores the need for standardized oral FEE management guidelines and innovative solutions, such as RTD FEE drinks, to improve outcomes in diabetic care.

BACKGROUND: Traditional lipid parameters like low-density lipoprotein (LDL), high-density lipoprotein (HDL), and total cholesterol (TC) are commonly used in evaluating cardiovascular risk. Recently, emerging biomarkers such as apolipoprotein B (ApoB) and apolipoprotein A1 (ApoA1) are proposed to provide improved accuracy in assessing atherosclerotic risk. This study examined the association between conventional and novel lipid parameters and plaque burden in statin-naïve acute coronary syndrome (ACS) patients.

METHODOLOGY: We enrolled 81 statin-naïve patients with ACS. Each underwent both standard and extended lipid profiling. Coronary angiograms were evaluated using the Gensini score to quantify plaque burden. All participants were followed for 28 days to monitor for major adverse cardiac events (MACE).

RESULTS: The average age was 51 years, with males comprising 77%. The ST-segment elevation myocardial infarction (STEMI) was observed in 58% of cases, non-ST-segment elevation myocardial infarction (NSTEMI) in 31%, and unstable angina in 11%. There was a significant correlation between the Gensini score and TC/HDL ratio (r = 0.35), LDL/HDL ratio (r = 0.31), and ApoB levels (r = 0.24). LDL and the ApoB/ApoA1 ratio did not exhibit significant associations with plaque burden. STEMI patients had higher LDL/HDL and TC/HDL ratios compared to those with NSTEMI or unstable angina. MACE occurred in 16% of participants, with no significant difference across ACS subtypes.

CONCLUSION: The ratios of TC/HDL, LDL/HDL, and ApoB levels were positively associated with coronary plaque burden. While conventional lipid parameters continue to serve well in cardiovascular risk assessment (CRA), ApoB presents a promising standalone marker for identifying atherogenic risk and may serve as a practical alternative in clinical practice.

BACKGROUND: Heart failure (HF) is a major public health concern with increasing prevalence worldwide. Serum uric acid (SUA) has been proposed as a potential biomarker in HF, with its levels potentially correlating with the severity of systolic dysfunction. However, the relationship between SUA and left ventricular ejection fraction (LVEF) remains unclear.

METHODOLOGY: A cross-sectional study was conducted at DY Patil University School of Medicine, Navi Mumbai, involving 60 patients diagnosed with HF. Patients were categorized based on LVEF into HF with preserved ejection fraction (HFpEF), mid-range ejection fraction (HFmrEF), and reduced ejection fraction (HFrEF). SUA levels were measured, and patients were classified into hyperuricemia or normal uric acid level groups. Demographics, comorbidities, and clinical symptoms were also recorded. Statistical analysis was performed to determine the correlation between SUA and LVEF.

RESULTS: Of the 60 patients enrolled, 65% were female, with a mean age of 61-70 years. The majority had HFrEF (70%), followed by HFmrEF (26.67%) and HFpEF (3.3%). Hyperuricemia was observed in 38.3% of patients. A weak negative correlation was found between LVEF and SUA (r = -0.070), which was not statistically significant (p = 0.599). Although hyperuricemia was more prevalent in HFrEF, no significant relationship was established between SUA levels and severity of systolic dysfunction.

CONCLUSION: The study found a weak and statistically insignificant correlation between SUA levels and LVEF in HF patients. This suggests that SUA may not be a reliable biomarker for assessing the severity of systolic dysfunction. Further studies involving larger, more diverse populations are needed to clarify the prognostic role of SUA in HF.

BACKGROUND: The global incidence of fatty liver (FL) [alcoholic and nonalcoholic FL disease (NAFLD)] is increasing. Imaging-based elastography techniques, being noninvasive, may eliminate the need for more invasive techniques for the diagnosis and staging of liver fibrosis in FL disease.

OBJECTIVE: Our study aims to address the gap in the current research by exploring the correlation between mean liver stiffness measurement (LSM) as obtained through magnetic resonance elastography (MRE) and transient elastography (TE), and two commonly used clinical scores, fibrosis-4 index (FIB-4) score and aspartate aminotransferase to platelet ratio index (APRI) score.

MATERIALS AND METHODS: In this hospital-based cross-sectional study, 62 patients diagnosed with FL on ultrasound were recruited. The patients were further subjected to MR liver elastography and TE, and LSM using both modalities was recorded. A history of diabetes mellitus and alcohol intake was taken. Moreover, noninvasive fibrosis scores such as FIB-4 and APRI were calculated using standard formulas.

RESULTS: The correlation analysis revealed a strong positive correlation between LSM values obtained from MRE and TE (r = 0.88) (Cohen's κ = 0.87), a moderate correlation between MRE and FIB-4 score (r = 0.44), and weak positive correlations involving MRE and APRI (r = 0.34), TE and FIB-4 score (r = 0.36), and TE and APRI (r = 0.29). Additionally, significantly higher fat fractions were quantified [median (IQR)] in grade III FL [23.6 (15.9-29.5)] as compared to grades I [8.45 (2.25-13.9)] and grade II [13.1 (8.4-19.7)].

CONCLUSION: MRE shows a strong positive correlation with TE for LSM and stage of fibrosis. Our findings suggest that MRE could be a valuable tool in the diagnostic armamentarium of FLD.

BACKGROUND: International Academy of Cytology (IAC) introduced a breast category to produce comprehensive standardized guidelines for reporting breast cytopathology. IAC Yokohama System for Reporting Breast Cytopathology highlights the indications for getting breast cytology, procedural techniques, preparation of smear, material yielded, uniform system of reporting, use of ancillary investigations and prognostic tests, and correlation with clinical workup algorithms. The triple approach that includes clinical examination, radiological and pathological workup aims to maximize the preoperative detection of malignancy for early, definitive, appropriate treatment to the patient.

MATERIALS AND METHODS: The present study characterized the cytomorphological features of breast lesions ranging from inflammatory, benign to malignant. The lesions encountered were assigned a specific category on the basis of IAC Yokohama System. Histopathological correlation of cytomorphological findings was done wherever possible.

RESULTS: Out of a total of 450 cases included in our study, 98% (441/450) were females, male to female ratio of 1:49, mean age being 32.6 ± 12.5 years. Majority of cases were in Yokohama category benign comprising 345 breast aspirates (76.66%), followed by 40 cases (8.8%) malignant, 28 cases (6.22%) in Yokohama atypical category. Category suspicious for malignancy consisted of 17 (3.7%) cases. A good inter-kappa agreement was found between cytological impression and histopathology diagnosis (>0.5). A sensitivity and specificity of 100 and 92.96% respectively was seen along with positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) of 98.24%, 100%, and 0.98 respectively. Diagnostic accuracy of 98.57% was seen.

CONCLUSION: The IAC Yokohama System is a high-quality reporting system used for diagnosing breast fine needle aspirates accurately with greater reproducibility of reports and better communication between the pathologist and clinician.

OBJECTIVES: Surgical antimicrobial prophylaxis (SAP) is a critical component of postoperative infection prevention, but its misuse is a widespread global issue. This study aims to assess SAP utilization patterns and appropriateness of SAP in terms of choice, timing of administration, and duration of SAP, and to evaluate possible correlation of SAP compliance with reduction in surgical site infection (SSI) rates.

METHODS: A facility-based prospective cross-sectional study was conducted over a period of 6 months to evaluate the prescribing patterns of SAP and the incidence of SSIs. Prophylactic antimicrobial use was considered appropriate when the correct antimicrobial was administered for the appropriate indication, at the correct time, and for the recommended duration, in alignment with institutional protocols.

RESULTS: The findings suggest a general improvement in SAP adherence over the 6-month period, with a peak of 83% in May-24 coinciding with the lowest recorded SSI rate (0.64%). Conversely, the highest SSI rate (5.14%) in Jan-24 corresponded with the lowest adherence (60%), reinforcing the association between proper SAP compliance and reduced infection rates. SAP adherence improvement correlates with reduced SSI rates, but there is still a need to reduce prolonged SAP use.

CONCLUSION: The relationship between SAP adherence and SSI rates underscores the importance of evidence-based antimicrobial stewardship. Strengthening compliance with established protocols and aligning SAP practices with international guidelines will be critical in sustaining low SSI rates while minimizing antibiotic resistance risks. Further, assessing SAP using days of therapy/100 patient-days (DOT/100 PD) data could provide valuable insights into adherence trends and potential areas for improvement.