Care Institute of Medical Sciences

Background: Chronic plaque psoriasis is a systemic immune-mediated inflammatory dermatosis characterized by dysregulated cytokine networks and persistent cutaneous inflammation. Serum inflammatory biomarkers have emerged as potential objective indicators of disease activity, yet their precise correlation with clinical severity indices remains incompletely characterized. Methods: This cross-sectional study enrolled 120 patients with chronic plaque psoriasis and 60 age- and sexmatched healthy controls from the dermatology outpatient department of a tertiary care hospital. Patients were stratified into mild (PASI <7), moderate (PASI 7–12), and severe (PASI >12) groups. Serum biomarker levels were quantified using enzyme-linked immunosorbent assay (ELISA). Correlations between biomarker levels and PASI scores were analyzed using Spearman's rank correlation coefficient. Results: Mean serum levels of CRP (14.82 ± 6.41 mg/L vs. 2.14 ± 1.03 mg/L; p<0.001), IL-6 (28.67 ± 11.54 pg/mL vs. 5.23 ± 2.18 pg/mL; p<0.001), TNF-α (45.39 ± 18.72 pg/mL vs. 8.91 ± 3.44 pg/mL; p<0.001), and IL17A (38.56 ± 14.83 pg/mL vs. 6.47 ± 2.76 pg/mL; p<0.001) were significantly elevated in psoriasis patients compared to controls. All biomarkers demonstrated significant positive correlations with PASI scores, with IL17A exhibiting the strongest correlation (r=0.784, p<0.001). Conclusion: Serum inflammatory biomarkers are significantly elevated in chronic plaque psoriasis and correlate positively with disease severity. IL-17A demonstrated the strongest association with PASI, supporting its utility as a reliable serological indicator of disease activity and therapeutic monitoring.

Abstract Background: This study aimed to evaluate and compare NCD awareness and associated risk factors among adolescents in rural and urban schools of West Bengal. Subjects and Methods: A school-based, analytical study was conducted from March to August 2021 in selected schools across three districts of West Bengal using a multistage sampling technique. A total of 320 adolescents (160 urban, 160 rural) were selected using probability proportional to size and simple random sampling. Data were collected using a pre-tested, validated questionnaire and standardised physical measurements. Awareness was assessed using an 8-item Likert scale. Risk factors, including dietary habits, physical activity, body mass index, waist–hip ratio and blood pressure, were evaluated. Statistical analysis was done using SPSS v20. Results: Urban students showed higher awareness of NCDs, including hypertension (100% vs. 88.6%), diabetes and coronary heart disease ( P < 0.001). Median knowledge scores were lower (better awareness) in urban students (10, interquartile range [IQR]: 8) than rural students (11, IQR: 7, P < 0.001). Rural students had higher overweight/obesity prevalence (26.9% vs. 14.4%, P = 0.008) and extra salt intake (27.5% vs. 12.5%, P < 0.001). Physical activity and fruit/vegetable intake were suboptimal in both groups. Conclusion: Urban students demonstrated better awareness, whereas rural adolescents showed a higher burden of modifiable risk factors. School-based programs, parental engagement and community surveillance are vital to prevent NCDs in adolescence.

Background: Rheumatoid arthritis is a chronic inflammatory disease characterized by persistent synovitis and progressive joint damage. Musculoskeletal ultrasound has emerged as a valuable imaging modality for detecting subclinical inflammation and guiding treatment decisions. Objective: To evaluate the role of musculoskeletal ultrasound in predicting treatment planning among patients with rheumatoid arthritis. Methods: A prospective observational study was conducted among 120 patients diagnosed with rheumatoid arthritis. Clinical assessment, laboratory investigations, and musculoskeletal ultrasound evaluation using GSUS and PDUS scoring systems were performed. Treatment decisions were documented based on combined clinical and imaging findings. Results: Active synovitis was detected in 68.3% of patients, and higher PDUS grades were significantly associated with treatment escalation. Ultrasound findings influenced therapeutic decisions including initiation, escalation, or tapering of therapy. Conclusion: Musculoskeletal ultrasound serves as an effective adjunct to clinical evaluation by identifying subclinical disease activity and supporting individualized treatment planning in rheumatoid arthritis patients.

Background: Dry eye disease is increasingly recognized as a common ocular complication in patients with Type-2 diabetes mellitus. Objective: To estimate the prevalence of dry eye in patients with Type-2 diabetes mellitus and to compare various diagnostic tests of dry eye. Methods: An analytical cross-sectional study was conducted on 120 patients (240 eyes) with Type-2 diabetes mellitus. Dry eye symptoms were assessed using Ocular Surface Disease Index (OSDI) questionnaire. Objective evaluation included fluorescein staining, Tear Film Break-Up Time (TBUT), and Schirmer’s test. Diagnostic accuracy, sensitivity, specificity, and Area under Curve were calculated. Results: Dry eye prevalence based on OSDI was 38.33%. TBUT detected dry eye in 34.17% of eyes with highest sensitivity (85.00%) and diagnostic accuracy (92.92%). Schirmer’s test detected 28.33% while fluorescein staining detected 20.83%. TBUT showed very good agreement (kappa 0.86) with OSDI compared to other tests. Conclusion: Dry eye is a common complication in Type-2 diabetes mellitus. TBUT demonstrated superior diagnostic performance and agreement with symptoms compared to Schirmer’s test and fluorescein staining. Routine ocular surface screening is recommended in diabetic patients.

Introduction: Adult vaccination is widely recognized as a highly cost-effective public health measure, despite its benefits many diabetics may not grasp their importance or have misconceptions, affecting their acceptance. The purpose of the study was to assess the awareness and to estimate the coverage and find out the level of acceptance of adult vaccination. Methods: An observational study with cross-sectional design was conducted in Diabetes OPD of tertiary care hospital in Kolkata among 423 diabetics patients using consecutive sampling methods attending Diabetic OPD for a duration 6 months (September 2023-February 2024). A pre-designed, pre-tested, structured schedule comprising of socio demographic clinical profile, awareness, coverage and acceptance of vaccine was used for face-to-face interview. Data were analysed by Microsoft Excel 2019 and SPSS v25.0. Results: Out of 423 participants more than half (57%) were male, and mean age of them were 50.7 years (±11.2). Ninety one percent (91%) of study participants had type II Diabetes Mellitus, and more than two thirds (67.4 %) suffered from co-morbidities. Thirteen percent (13%) had adequate awareness about adult vaccination and very few (7%) had administered Hepatitis B vaccine. Seventy one percent (71%) of the study participants were ready to get Influenza vaccine after being aware. Fear of adverse effects and out of pocket expenditure were the major reason from non-acceptance of vaccines. Conclusion: Eighty-seven percent (87%) of the participants had inadequate awareness about adult vaccines and only seven percent (7%) of them had taken Hepatitis B vaccination.

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

Despite robust clinical guidelines and the availability of potent lipid-lowering therapies (LLTs), many very-high-risk dyslipidaemia patients fail to achieve target LDL cholesterol (LDL-C) levels, primarily due to poor adherence and delayed treatment intensification. Two virtual meetings were convened involving a panel of senior cardiologists. Insights were synthesised into an expert framework, developed through polling and collective inputs from expert. The panel strongly recommends LDL-C target of <55 mg/dl (<1.4 mmol/l) for very-high-risk patients. A 2 × 2 matrix was proposed to tailor LLTs based on patient adherence and CV risk, emphasising early initiation of combination therapy and use of inclisiran in non-adherent patients. Patients with very high baseline LDL-C require combination therapy with high-intensity statins, with add-on proprotein convertase subtilisin/kexin type 9 inhibitors, which significantly enhances LDL-C reduction and improves goal attainment. A simplified decisionmaking algorithm that accounts for adherence and promotes timely treatment intensification with combination LLTs needs to be implemented to effectively lower LDL-C in very-high-risk Indian patients in clinical practice.

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. 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. 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. 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. 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.

Mould pneumonia can be life-threatening, and its incidence is increasing in Asia. Due to significant variability in diagnostic setups and the availability of antifungal agents, especially in resource-limited settings, the current treatment practices and recommendations for local clinicians are poorly described. This study aimed to develop a consensus statement on the clinical management of mould pneumonia in Asia, particularly within resource-limited settings. Clinicians and infectious disease experts from the Asia Fungal Working Group answered questions about the regional epidemiology as well as diagnostic and resource-limited treatment approaches of mould pneumonia. Guided by a literature review, 22 initial questions were generated and voted upon anonymously using a Delphi-based methodology with predefined consensus criteria. The study comprised two rounds: one to generate summary statements based on the panelists’ questionnaire responses, and the other to review, confirm and rate the level of agreement of the consensus statements using a five-point Likert scale. The panelists generated 21 summary statements on the epidemiology (5), diagnosis (8), and treatment (8) of mould pneumonia, 20 of which achieved ≥ 70% consensus. Through a consensus-building exercise, clinical experts from Asia developed a set of 21 consensus statements for the diagnosis and management of mould pneumonia in resource-limited settings.