Chengalpattu Medical College

Abstract Background: Infectious diseases remain a major public health concern in India. Reliable diagnostics and continuous surveillance are essential for detecting outbreaks, monitoring trends, and guiding public health responses. This study assessed trends in diagnostic testing for viral and parasitic infections from 2017 to 2024 at a tertiary care virus research and diagnostic laboratory. Materials and Methods: This retrospective observational study analyzed laboratory records of 19 infectious disease diagnostic tests conducted between 2017 and 2024. Annual data on the total number of tests and positive results were compiled and assessed to identify patterns in testing volume and positivity rates. Results: More than 850,000 diagnostic tests were performed during the study period. A sharp rise in testing occurred in 2020–2021 due to the severe acute respiratory syndrome Coronavirus -2 pandemic. Dengue immunoglobulin (Ig)M testing remained consistently high, peaking in 2024 (3307 tests). Scrub typhus IgM testing increased markedly from 86 tests in 2018 to 2828 in 2024. Screening for hepatitis B and hepatitis C rose steadily, with viral load testing introduced in 2022. A noticeable spike in hepatitis A virus and hepatitis E virus testing occurred in 2024. Other infections, such as chikungunya, leptospirosis, and malaria, showed fluctuating patterns. Conclusions: Diagnostic trends reflect seasonal disease patterns, emerging infections, and public health emergencies, emphasizing the importance of sustained surveillance and laboratory preparedness.

Molecular diagnostics, which provide quick and precise detection of infectious agents, have completely changed clinical microbiology. To identify bacterial, viral, fungal, and parasitic infections, this review looks at the fundamentals and uses of molecular techniques such as polymerase chain reaction (PCR), nucleic acid sequencing, and microarray technologies. Molecular techniques provide several advantages over traditional culture-based methods, such as the capacity to identify species-level information, identify fastidious organisms, and identify antibiotic resistance genes directly from clinical specimens. There is also a discussion of difficulties, including assay standardization, cost, and technical know-how. Notwithstanding these difficulties, molecular diagnostics has dramatically improved pathogen detection speed and accuracy in clinical settings, leading to better patient outcomes through infection management and tailored therapy. Novel biomarkers and automation will be incorporated in the future to improve diagnostic capabilities and further expedite testing procedures.

Background and Aims Nitrous oxide (N₂O) diffuses into air-filled endotracheal tube cuffs, increasing intracuff pressure beyond safe limits (>30 cm H₂O) and causing tracheal ischaemia, mucosal damage, and postoperative complications. This study aimed to compare intracuff pressure changes when inflated with air versus alkalinized lignocaine during general anaesthesia with N₂O. Methods A prospective, randomised clinical trial was conducted on 50 adult patients (ASA I–II), aged 18–65 years, undergoing elective surgery. Patients were randomised into two groups: Group A received cuff inflation with air (n=25) and Group L received alkalinized lignocaine (19:1 dilution of 2% lignocaine and sodium bicarbonate, n=25), both to 20 cm H₂O baseline pressure. Intracuff pressures were recorded before N₂O administration and thereafter every 30 minutes. Intraoperative haemodynamics, tube tolerance, and postoperative complications (sore throat, cough, hoarseness) were assessed. Results Intracuff pressure increased significantly in Group A (31.56±1.64 cm H₂O at end of surgery) compared to Group L (21.21±0.93 cm H₂O), p<0.0001. Group L demonstrated better endotracheal tube tolerance at extubation (72% without agitation vs. 40% in Group A, p=0.045). Volume deflated from the cuff was significantly higher in Group A (12.30±2.30 ml vs. 8.57±1.96 ml, p<0.0001). Postoperative sore throat at 24 hours was significantly lower in Group L (8% vs. 36%, p=0.04). Haemodynamic parameters remained comparable between groups. Cough and hoarseness showed no statistically significant differences. Conclusion Alkalinized lignocaine cuff inflation effectively prevents excessive cuff pressure rise during N₂O anaesthesia, reduces airway trauma, improves tube tolerance, and decreases postoperative sore throat incidence compared to air inflation.

Abstract Aim To describe Kangaroo Mother Care (KMC) practice in the community (cKMC) two months after discharge from the Neonatal Intensive Care Unit (NICU). in South Indian mother-LBW infants. Method A prospective study enrolling 420 dyads at discharge from the NICU with follow-up on cKMC practice two months after discharge. Factors associated with cKMC were explored using logistic regression. Result Among the 420 enrolled, 2 (0.5%) infants died, and 12 (2.9%) were lost to follow-up. Of the remaining families, 25% (101) never practiced cKMC, effective practice was done by 19% (77). Infant birth weight ≥ 1.5 kg (OR: 3.1, 95% CI 1.8, 5.3) was associated with higher odds of practicing cKMC, while being born at term (OR: 0.5, 95% CI 0.3, 0.8) and mothers’ weight > 45 kg (OR: 0.3, 95% CI 0.1–0.7) was associated with lower odds of practicing cKMC. Continued KMC practice 48 h before discharge was associated with higher odds (OR: 3.4, 95% CI 1.8–6.2), while absence of father’s support was associated with lower odds (OR: 0.6, 95% CI 0.3, 1.0) of effective cKMC. Conclusion The continuum of cKMC after discharge from the NICU was inadequate. Factors associated with cKMC practice should be considered when planning interventions to improve cKMC practices.

Abstract Background Reirradiation of thoracic malignancies presents significant clinical challenges due to cumulative lung dose and radiation-induced toxicity risk. With the advent of advanced modalities such as helical tomotherapy (HT), precise targeting may allow safe reirradiation in select cases. We report a case of locally advanced lung adenocarcinoma managed with accelerated HT and concurrent capecitabine after prior breast radiation, highlighting the complexities of dose overlap and treatment toxicity. Case Report A 73-year-old female with a remote history of left breast carcinoma (lumpectomy and adjuvant radiation in the 1990s, reirradiated for local recurrence in 2020) and prior heavy tobacco use presented with cough and chest discomfort. Imaging revealed a 2.4 cm left lower lobe mass with mediastinal and hilar lymphadenopathy, consistent with AJCC 8th Edition cT1cN3M0 Stage IIIB adenocarcinoma. Molecular testing: PD-L1 TPS 20%, ALK-, ROS1-, pan-TRK-. She received concurrent chemoradiation with helical tomotherapy (HT) and capecitabine (Xeloda). After 25 fractions, therapy was held due to progressive pleural effusions causing alignment errors. She later developed chronic pleural effusions, acute limb ischemia, and pulmonary embolism, ultimately opting for comfort care. Discussion This case underscores the complexities of thoracic reirradiation, particularly in patients with prior breast irradiation and significant smoking history. The overlapping dose to previously irradiated lung segments likely contributed to radiation-induced lung injury and impaired drainage leading to recurrent effusions. Advanced image-guided platforms like HT improve precision, yet toxicity remains a concern when cumulative V20 and mean lung dose exceed tolerance thresholds. Conclusion Helical tomotherapy with concurrent capecitabine can be considered in select thoracic reirradiation scenarios; however, careful dose mapping, multidisciplinary review, and vigilant toxicity monitoring are essential. This case illustrates the delicate balance between local control and pulmonary tolerance in reirradiation of lung malignancies. This abstract is funded by: None