Pellagra: An Unusual Cause for Altered Mental Status.

Pellagra, a rare disorder caused by niacin deficiency, manifests as 4Ds: dermatitis, diarrhea, dementia, and, if left untreated, death. Though it was thought to be eradicated from the United States after fortification with niacin, there have been concerns about its reemergence in specific high-risk populations such as chronic alcoholism, malabsorption, and anorexia nervosa. Here we present a patient with altered mental status who subsequently developed diarrhea during the course of hospitalization.

Audit-based corrective and preventive actions to reduce wastage of blood components at a single blood center: A quality improvement study.

Introduction: The rate of discarded blood components or "wastage rate" reflects on the whole process, preparation, and production of blood and its quality control. It is the ratio of blood and blood components discarded to the total number of collections. The discard or unusability of blood products are many, and the ones that can be monitored and regarded as indicators to be improvised on are QC failure rate, transfusion-transmitted infection (TTI) positivity, and component discards (other than TTI), including those that caused transfusion reactions.

Oral Cancer Risk and Screening Prevalence Among Hospitalized Women.

Background Oral cancer screenings are often on the back burner in the face of other cancer screenings. In high-risk individuals, early detection of oral cancer has a better prognosis and survival. Hospitalization may offer an opportunity to target high-risk populations.

No frugal innovation without frugal evaluation: the Global IDEAL Sub-Framework.

Objective: The Global IDEAL Sub-Framework Study aimed to combine the intended effects of the 2009/2019 IDEAL (Idea, Development, Exploration, Assessment, Long-term study) Framework recommendations on evaluating surgical innovation with the vision outlined by the 2015 Lancet Commission on Global Surgery to provide recommendations for evaluating surgical innovation in low-resource environments.

Design: A mixture of methods including an online global survey and semistructured interviews (SSIs). Quantitative data were summarized with descriptive statistics and qualitative data were analyzed using the Framework Method.

Fibrinolysis and clinical outcomes in acute pulmonary embolism. Madras medical college pulmonary embolism (M-PER) registry from India.

Background: Acute pulmonary embolism (APE) is the third most common cause of vascular death. Data on APE from India and other low-and middle-income countries is sparse.

Objectives: Study the clinical characteristics, prognostic factors, in-hospital mortality (IMH) and 12 months mortality of patients with APE in India.

Bridging gaps: The urgent call for cardio-obstetrics as a subspecialty in India.

Cardiovascular disease complicates 1-4% of pregnancies. Women with heart disease going through pregnancy are on the increase. While global maternal deaths during pregnancy are decreasing, India remains a significant contributor to maternal deaths in the world.

Fallacies of a purely virtual platform: Virtual plus reality versus virtual reality - A case study.

Pretransplant immunological assessment of a transplant donor has evolved significantly over the last few decades with the advent of testing platforms with enhanced sensitivity and varying formats. The single antigen bead assay (SAB) assay, a virtual crossmatch (vXM) is used extensively and considered the gold standard for defining donor-specific antibodies (DSA) in many parts of the World. A country like India, is however challenged by the lack of adequate representation of locally frequent HLA alleles and hence in our institution, we continue to perform a physical crossmatch (pXM) on the Complement Dependent Cytotoxicity and flow cytometry platforms alongside the SAB.

Team based collaborative care model, facilitated by mHealth enabled and trained nurses, for management of heart failure with reduced ejection fraction in India (TIME-HF): design and rationale of a parallel group, open label, multi-centric cluster randomised controlled trial.

Heart failure (HF) is a debilitating condition associated with enormous public health burden. Management of HF is complex as it requires care-coordination with different cadres of health care providers. We propose to develop a team based collaborative care model (CCM), facilitated by trained nurses, for management of HF with the support of mHealth and evaluate its acceptability and effectiveness in Indian setting.

Prevalence of hospitalized women at high-risk for developing lung cancer.

Background: Lung cancer screening with low-dose computer tomography (CT) has been shown to reduce the lung cancer mortality in high-risk individuals by 20%. Despite the proven mortality benefit, the utilization of lung cancer screening among high-risk populations remains low.

Objective: This study explores the prevalence of high-risk population for developing lung cancer among hospitalized women and evaluates the screening behavior toward other common cancers during a hospital stay.

Gasless laparoscopy in rural India-registry outcomes and evaluation of the learning curve.

Background: A program of gasless laparoscopy (GL) has been implemented in rural North-East India. To facilitate safe adoption, participating rural surgeons underwent rigorous training prior to independent clinical practice. An online registry was established to capture clinical data on safety and efficacy and to evaluate initial learning curves for gasless laparoscopy.

Assessment of the Key Performance Indicator Proposed by NABH in the Blood Centre of a Tertiary Health Care Hospital in Southern India.

Quality indicators are tools for continuous improvement to enable the blood center to achieve its standards of the highest quality. Hence, they have to be established and monitored regularly for which NABH (National Accreditation Board for Hospitals) accreditation should be sought for. This study was undertaken to assess the Key Performance Indicators (KPI) through clinical audit quality control study of ten parameters, with a goal to improve and meet the benchmark as defined by NABH.

Point-Of-Care Ultra-Sound (POCUS) for suspected surgical abdominal conditions in rural India-a mixed-method health needs assessment.

Introduction: Evidence has shown a trend towards rising mortality from surgical abdominal conditions with increasing distance from hospitals in Eastern India. It has been claimed that imaging modalities such as portable ultrasound are ideal for use in rural areas of developing countries for diagnosis and management of a variety of acute abdominal conditions. This mixed-methods study aimed to explore the need for increased access to POCUS in rural, hard-to-reach populations within India, and to identify barriers that may exist to increasing this access.

Optimising platelet usage during the induction therapy of acute myeloid leukaemia: Impact of physician education.

Introduction: Platelet products are scarce and expensive resources to be used judiciously. However, inappropriate usage is common. Lack of physician awareness is an important issue.

Osmotic Demyelination After Rapid Correction of Hyperosmolar Hyperglycemia.

Osmotic demyelination syndrome (ODS) is seen due to an overt rise in serum osmolality, most often during rapid correction of chronic hyponatremia. We present the case of a 52-year-old patient who presented with polydipsia, polyuria, and elevated blood glucose with rapid correction of glucose levels under five hours and developed dysarthria, left-sided neglect, and unresponsiveness to light touch and pain in the left extremities on the second day of hospitalization. MRI revealed restricted diffusion in the central pons, extending into extrapontine areas suggestive of ODS.

Hereditary Angioedema Presenting as Isolated Jejunal Swelling.

Hereditary Angioedema (HAE) is a rare disorder caused by C1 esterase inhibitor deficiency or dysfunction. Patients with HAE usually present without urticaria or pruritis affecting the skin, upper airway, or the gastrointestinal tract. They can also present with involvement of unusual sites making the diagnosis challenging and leading to unnecessary testing and complications.

Hospitalized Women's Willingness to Pay for Inpatient Screening Colonoscopy.

Background: Despite the proven mortality benefit of screening colonoscopy, ∼27% of hospitalized women are nonadherent with colorectal cancer (CRC) screening guidelines. Colonoscopy is the most frequently used test for CRC screening in the United States. Although CRC is the second most common cause of cancer death in the United States, CRC screening has not been part of usual hospital care.

Cost-effectiveness of gasless laparoscopy as a means to increase provision of minimally invasive surgery for abdominal conditions in rural North-East India.

Laparoscopic surgery, a minimally invasive technique to treat abdominal conditions, has been shown to produce equivalent safety and efficacy with quicker return to normal function compared to open surgery. As such, it is widely accepted as a cost-effective alternative to open surgery for many abdominal conditions. However, access to laparoscopic surgery in rural North-East India is limited, in part due to limited equipment, unreliable supplies of CO2 gas, lack of surgical expertise and a shortage of anaesthetists.

The RAIS Device for Global Surgery: Using a Participatory Design Approach to Navigate the Translational Pathway to Clinical Use.

Background: Over 5 billion people worldwide have no access to surgery worldwide, typically in low-resource settings, despite it being a primary life-saving treatment. Gas Insufflation-Less Laparoscopic Surgery (GILLS) can address this inequity, by improving current GILLS instrumentation to modern surgical standards.

Objective: to develop and translate a new Retractor for Abdominal Insufflation-less Surgery (RAIS) into clinical use and thus provide a context-appropriate system to advance GILLS surgery.

Effect of inpatient breast cancer education and risk assessment on mammography utilization among hospitalized women post discharge.

Objective: To evaluate prevalence of nonadherence to breast cancer screening guidelines after bedside educational intervention and informed individualized risk assessment score during an inpatient stay.

Methods: A prospective intervention study was conducted among 507 cancer-free (except skin cancer) women aged 50-75 years hospitalized to a general medicine service. Study intervention included one-on-one bedside education via handout and videos about breast cancer screening and informed individualized risk assessment using the Gail risk model to predict 5-year risk for breast cancer development.