WorldWideScience

Sample records for large acute tertiary-care

  1. Pattern and outcome of acute poisoning cases in a tertiary care hospital in Karnataka, India

    Directory of Open Access Journals (Sweden)

    Ramesha K

    2009-01-01

    Full Text Available Background and Objective: Acute poisoning is a medical emergency. It is important to know the nature, severity and outcome of acute poisoning cases in order to take up appropriate planning, prevention and management techniques. This study aimed to assess the pattern and outcome of acute poisoning cases in a tertiary care hospital in Karnataka. Materials and Methods: This is a retrospective hospital record-based study conducted in a tertiary care hospital attached to a medical institution in Karnataka. The study included 136 cases and data regarding age, sex, time elapsed after intake; circumstances of poisoning, name of the poisonous substance, chemical type, duration of hospitalization, severity and outcome were collected in the prestructured proforma. Results: Incidence was more common among males (75.4% compared to females (24.3. Most cases of acute poisoning presented among 20- to 29-year age group (31.2% followed by 12- to 19-year age group (30.2%. A majority of poisoning cases (36.0% were due to organophosphorus compound (OPC. Total mortality was found to be 15.4%. Mortality rate due to corrosives was significantly high compared with OPC poisoning (χ2 = 4.12, P = 0.04. Of the 56 patients of OPC and carbamate poisoning, 13 patients (23.2% had respiratory arrest and required respiratory support. Time lapse had a significant role on the mortality in cases of acute poisoning (χ2 = 10.9, P = 0.01. Conclusion: Poisoning is more common in young males. The overall mortality is substantially high, mainly contributed by self-poisoning with insecticides and corrosives. Early care in a tertiary care center may help to reduce mortality in India.

  2. Epidemiological profile of acute respiratory distress syndrome patients: A tertiary care experience

    Science.gov (United States)

    Magazine, Rahul; Rao, Shobitha; Chogtu, Bharti; Venkateswaran, Ramkumar; Shahul, Hameed Aboobackar; Goneppanavar, Umesh

    2017-01-01

    Background: Acute respiratory distress syndrome (ARDS) is seen in critically ill patients. Its etiological spectrum in India is expected to be different from that seen in western countries due to the high prevalence of tropical infections. Aim: To study the epidemiological profile of ARDS patients. Setting: A tertiary care hospital in Karnataka, India. Materials and Methods: Retrospective analysis of 150 out of the 169 ARDS patients diagnosed during 2010–2012. Data collected included the clinical features and severity scoring parameters. Results: The mean age of the study population was 42.92 ± 13.91 years. The causes of ARDS included pneumonia (n = 35, 23.3%), scrub typhus (n = 33, 22%), leptospirosis (n = 11, 7.3%), malaria (n = 6, 4%), influenza (H1N1) (n = 10, 6.7%), pulmonary tuberculosis (n = 2, 1.3%), dengue (n = 1, 0.7%), abdominal sepsis (n = 16, 10.7%), skin infection (n = 3, 2%), unknown cause of sepsis (n = 18, 12%), and nonseptic causes (n = 15, 10%). A total of 77 (51.3%) patients survived, 66 (44%) expired, and 7 (4.7%) were discharged against medical advice (AMA). Preexisting comorbidities (46) were present in 13 survivors, 19 nonsurvivors, and four discharged AMA. History of surgery prior to the onset of ARDS was present in one survivor, 13 nonsurvivors, and one discharge AMA. Mean Acute Physiology and Chronic Health Evaluation (APACHE) II, APACHE III, and Sequential Organ Failure Assessment scores in survivors were 9.06 ± 4.3, 49.22 ± 14, and 6.43 ± 2.5 and in nonsurvivors 21.11 ± 7, 86.45 ± 23.5, and 10.6 ± 10, respectively. Conclusion: The most common cause of ARDS in our study was pneumonia, but a large percentage of cases were due to the tropical infections. Preexisting comorbidity, surgery prior to the onset of ARDS, higher severity scores, and organ failure scores were more frequently observed among nonsurvivors than survivors. PMID:28144059

  3. Epidemiological profile of acute respiratory distress syndrome patients: A tertiary care experience

    Directory of Open Access Journals (Sweden)

    Rahul Magazine

    2017-01-01

    Full Text Available Background: Acute respiratory distress syndrome (ARDS is seen in critically ill patients. Its etiological spectrum in India is expected to be different from that seen in western countries due to the high prevalence of tropical infections. Aim: To study the epidemiological profile of ARDS patients. Setting: A tertiary care hospital in Karnataka, India. Materials and Methods: Retrospective analysis of 150 out of the 169 ARDS patients diagnosed during 2010–2012. Data collected included the clinical features and severity scoring parameters. Results: The mean age of the study population was 42.92 ± 13.91 years. The causes of ARDS included pneumonia (n = 35, 23.3%, scrub typhus (n = 33, 22%, leptospirosis (n = 11, 7.3%, malaria (n = 6, 4%, influenza (H1N1 (n = 10, 6.7%, pulmonary tuberculosis (n = 2, 1.3%, dengue (n = 1, 0.7%, abdominal sepsis (n = 16, 10.7%, skin infection (n = 3, 2%, unknown cause of sepsis (n = 18, 12%, and nonseptic causes (n = 15, 10%. A total of 77 (51.3% patients survived, 66 (44% expired, and 7 (4.7% were discharged against medical advice (AMA. Preexisting comorbidities (46 were present in 13 survivors, 19 nonsurvivors, and four discharged AMA. History of surgery prior to the onset of ARDS was present in one survivor, 13 nonsurvivors, and one discharge AMA. Mean Acute Physiology and Chronic Health Evaluation (APACHE II, APACHE III, and Sequential Organ Failure Assessment scores in survivors were 9.06 ± 4.3, 49.22 ± 14, and 6.43 ± 2.5 and in nonsurvivors 21.11 ± 7, 86.45 ± 23.5, and 10.6 ± 10, respectively. Conclusion: The most common cause of ARDS in our study was pneumonia, but a large percentage of cases were due to the tropical infections. Preexisting comorbidity, surgery prior to the onset of ARDS, higher severity scores, and organ failure scores were more frequently observed among nonsurvivors than survivors.

  4. CLINICAL PROFILE AND OUTCOME OF ACUTE PEDIATRIC POISONING IN URBAN TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Basavaraj

    2015-01-01

    Full Text Available Childhood poisoning is a significant public health problem. Poisoning though an important cause of morbidity and mortality in children, has received little attention over the years. Objective: To determine the clinical profile and outcome of acute poisoning in children admitted to tertiary care hospital in South In dia. MATERIALS AND METHODS: We retrospectively reviewed the hospital records of all children aged 1 month to 18 years with definite history of poisoning during the 2 - years period from January 2013 to December 2014. We took the profile of all cases and note d their outcome. RESULTS: 50 patients presented with acute poisoning during the study period. Majority of children were in the age group between 12 to 18 years (30 cases, 60%. Median age of our patients was 10 years. The majority of our patients resided i n urban areas. Drugs (40%, Kerosene oil (24% and Insecticides (20% were the agents most frequently implicated. 52% cases were suicidal in nature and the above children belonged to age group of 12 to 18 years. Almost all cases in 1 - 6 years age group were accidental in nature. One case of kerosene oil consumption died whereas outcome in other cases was good. CONCLUSION: Poisoning in pediatric age group is a common problem. Incidence of poisoning with suicidal intension is increasing with accidental poisoni ng due to kerosene oil consumption is still common in younger age group

  5. Frequency of Hyperthermia in Acute Ischemic Stroke Patients Visiting a Tertiary Care Hospital.

    Science.gov (United States)

    Maheshwari, Amrat Kumar; Kumar, Pawan; Alam, Muhammad Tanveer; Aurangzeb, Muhammad; Parkash, Jai; Imran, Khalid; Masroor, Muhammad

    2016-06-01

    To determine the frequency of hyperthermia in acute ischemic stroke patients visiting a tertiary care hospital in a developing country. Cross-sectional, observational study. Medical Wards of Civil Hospital, Karachi, from January to June 2013. Patients aged ≥18 years of either gender with acute ischemic stroke presenting within 24 hours of onset of symptoms were included. Written informed consent was obtained from all participants as well as approval of ethical review committee of the institute. Axillary temperature by mercury thermometer was monitored at the time of admission and after every 6 hours for 3 days. The data was analyzed using SPSS version 17.0 (SPSS Inc., IL, Chicago, USA). Atotal of 106 patients of ischemic stroke were included. The mean age of enrolled participants was 60.1 ±9.5 years. Among these, 61 (57.5%) were males and 45 (42.5%) females. Among all patients, 51.9% presented with loss of consciousness, 30.2% with slurred speech, 77.4% with limb weakness, and 9.4% with decrease vision. Atotal of 17 (16%) patients with ischemic stroke developed hyperthermia. When the prevalence of hyperthermia was stratified according to age, among patients of ischemic stroke was 16% and it should be looked for as it has significant impact on the outcome. The hyperthermia was significantly more common in younger adults as compared to older adults. However, gender had no influence on the prevalence rate of hyperthermia.

  6. Chikungunya Fever Among Patients with Acute Febrile Illness Attending a Tertiary Care Hospital in Mumbai

    Science.gov (United States)

    Galate, Lata Baswanna; Agrawal, Sachee R; Shastri, Jayanthi S; Londhey, Vikram

    2016-01-01

    Background: Chikungunya fever (CHIK) is an arboviral disease. Dengue fever (DENG) and CHIK are indistinguishable clinically and need to be differentiated by laboratory investigations. Purpose: This study aimed at estimating the seroprevalence of CHIK mono-infection and CHIK and DENG dual infection in suspected patients. We also analyzed the age, sex distribution, joint involvement, and relation of joint movement restriction with visual analog scale (VAS). Materials and Methods: Two hundred patients clinically suspected with DENG and CHIK were enrolled from a Tertiary Care Hospital in Mumbai from April 2012 to October 2013. The detailed history and examination findings were recorded. Serum samples were subjected to DENG and CHIK immunoglobulin G (IgM) enzyme-linked immunosorbent assay (ELISA). Results: The seroprevalence of CHIK was 12.5%. Mono-infection of CHIK was 3%, and CHIK and DENG dual infection was 9.5%. Most affected age group in CHIK cases was 46–60 years wherein female preponderance was seen. All 6 patients with CHIK mono-infection had fever and joint involvement; knee and elbow were the most commonly affected joints. All CHIK patients had VAS score of 6–10 with restricted joint movement. Of the patients with dual infection, the majorities were from 31 to 45 years with male preponderance; all had fever and joint pain mainly affecting knee and elbow. Of patients who had VAS score 6–10 in patients with dual infection, only 5.26% had restricted joint movement. Conclusion: IgM ELISA for Chikungunya infection should be included in the routine laboratory tests for acute febrile illness. PMID:27365916

  7. Biopsy series of acute kidney injury from a tertiary care referral center in south India

    Science.gov (United States)

    Sujatha, Siddappa; Ramprasad, Kowalya

    2015-01-01

    Acute kidney injury (AKI) is common in hospital patients and more so in critically ill patients. It is frequent, harmful and potentially treatable condition. In a total of 243 renal biopsies 130 cases fulfilled the criteria of acute kidney injury. The usual mode of presentation was renal failure followed by acute nephritis. Histopathologically acute interstitial nephritis was the usual finding followed by post infectious-glomerular nephritis. The acute renal failure (ARF) prognosis is influenced by the co-morbidity states and we had a high mortality of 8.46% in our referral centre.

  8. Noninvasive Ventilation Practice Patterns for Acute Respiratory Failure in Canadian Tertiary Care Centres: A Descriptive Analysis

    Directory of Open Access Journals (Sweden)

    Geneviève C Digby

    2015-01-01

    Full Text Available BACKGROUND: The extent of noninvasive ventilation (NIV use for patients with acute respiratory failure in Canadian hospitals, indications for use and associated outcomes are unknown.

  9. MICROBIAL SURVEILLANCE OF ACUTE AND CHRONIC DACRYOCYSTITIS IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Jithendra

    2015-01-01

    Full Text Available BACKGROUND : Dacryocystitis acute or chronic poses a constant threat to cornea and orbital soft tissue if neglected revealing the importance of the condition. Infection with microbes in these patients can cause severe morbidity. Hence it is important to know the pathogen wise in man agement of the condition. Our study was determined to know the bacterial and fungal etiology of both acute and chronic dacryocystitis and their invitro antibacterial susceptibility and resistance to commonly used antibacterial agents. METHODS : This hospita l based study was conducted during March 2011 to March 2013. Patients with suffering with acute and chronic dacrocystitis were included in the study. Specimens were collected from these patients, processing, isolation, identification and antibiogram of the isolates were done as per standard procedures. RESULTS : A total of 298 patients were included in the study based upon the inclusion criteria. Out of 298 patients 126(42.29% presented with acute dacryocystitis and 172(57.71% were with chronic dacryocysti tis. Single eye involvement was noticed in 184 (61.75% cases and 114 (38.25% presented with involvement of both eyes. Out of 298 cases pure growth was seen in 255(85.57% and 43(14.43% yielded no growth on culture. On observation more percentage of cult ure positivity was noticed in chronic cases (164 of 172, 95.34% and less in acute cases (91 of 126, 72.23% and the difference was also statistically significant. Single isolate was found in 218 cases, two/three isolates were recovered from 37 cases. All cases of polymicrobial growth were observed in chronic dacryocystitis. Staphylococcus aureus as the most common gram positive pathogen (43/77, 55.84% in acute, 34/77, 44.16% in chronic dacryocystitis followed by Staphylococcus epidermidis (38/64, 59.37% i n acute, 26/64, 40.63% in chronic dacryocystitis, Streptococcus pneumoniae ( 10/12, 83.34% in acute, 2/12, 16.67% in chronic dacryocystitis and least Micrococcus

  10. A retrospective study of paradigm and outcome of acute poisoning cases in a tertiary care teaching hospital in Southern India

    Directory of Open Access Journals (Sweden)

    Arulmurugan C.

    2015-10-01

    Results: Incidence was high among males (60.36% compared to females (39.64%. Most of the cases of acute poisoning were in the age group 10 to 30 years (60.95% followed by 30 to 50 years age group (30.77%. A majority of poisoning cases (27.2% were due to organophosphorus (OPC insecticide. Total mortality was found to be 5.32%. Mortality rate due to Paraquat, Abrus Pretorius seeds was significantly high compared with OPC because there is no specific antidote. Time lapse had a very significant role in the mortality in cases of poisoning. Conclusions: Poisoning is common with young males. The mortality is high, in cases of self-poisoning with parquet and abrus seeds. Despite the highest consumption rate, no mortality was observed with organophosphorus because of early medical intervention and specific antidote. Early medical care in a tertiary care hospital will help to reduce significant mortality in India. [Int J Res Med Sci 2015; 3(10.000: 2654-2657

  11. Clinical profile of acute myocardial infarction patients: a study in tertiary care centre

    Directory of Open Access Journals (Sweden)

    Nagabhushana Seetharama

    2015-02-01

    Conclusion: There is need for early detection of risk factor to prevent the progression of coronary heart disease, need for creating awareness in the community regarding risk factors, symptoms and signs of acute myocardial infarction so that early referral can be done to coronary care unit to prevent morbidity and mortality in the community. [Int J Res Med Sci 2015; 3(2.000: 412-419

  12. Acute Brucellosis with Splenic Infarcts: A Case Report from a Tertiary Care Hospital in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Mishal Alyousef

    2015-01-01

    Full Text Available Splenic infarction is an extremely rare and unique presentation of brucellosis. Only few cases have been reported worldwide. We here report a case of a young man, presenting with acute onset of fever, left hypochondial pain, and vomiting. Further evaluation revealed multiple splenic infarcts and positive blood culture for brucellosis despite negative transesophageal echocardiography for endocarditis. Significant improvement in clinical symptoms and splenic lesions was achieved after six weeks of combination therapy against brucellosis.

  13. SYNDROME X IN ACUTE CORONARY SYNDROME PATIENTS- A TERTIARY CARE CENTER STUDY

    Directory of Open Access Journals (Sweden)

    Yogendra

    2015-12-01

    Full Text Available Metabolic Syndrome (MS or insulin resistance syndrome is commonly defined as a group of risk factors or abnormalities associated with insulin resistance that markedly increased risk for both coronary heart disease and diabetes. Cardiovascular disease and all-cause mortality, even in the absence of baseline CVD and diabetes. Early identification, treatment and prevention of the metabolic syndrome present a major challenge for health care professionals facing an epidemic of overweight and sedentary lifestyle. AIMS AND OBJECTIVES To study the prevalence of metabolic syndrome in pts. with Acute Coronary Syndrome (ACS and its effect on hospital outcomes. MATERIALS AND METHODS Observational study in 55 cases (28 cases and 27 controls was conducted in Dr. BRAMH, Raipur and each patient was assessed with detailed clinical history and was also assessed for parameters of MS. The cases and controls were also followed up during their hospital stay for the presence of or development of heart failure, arrhythmias, shock and death. Chi square and ‘t’ test were used to analyse obtained data. RESULTS AND CONCLUSIONS In the present study sex ratio amongst the cases was (M:F 1.15:1 and 2.6:1 in controls. Maximum patients were between the ages of 50-60. Non-ST elevation MI was more common in patients with metabolic syndrome and they presented late to the hospital for treatment. Hypertension and fasting hyperglycemia are the most prevalent components of metabolic syndrome in patients of acute coronary syndrome. Our Study also suggests that hypertriglyceridemia is the most common lipid abnormality in patients of acute coronary syndrome. An increase in the incidence of heart failure was observed in patients with metabolic syndrome Cardiogenic shock is seen with increased frequency in patients with metabolic syndrome. Case fatalities were seen with equal frequency in both the groups, hence metabolic syndrome is not associated with increased case fatality while

  14. Acute nonvariceal upper gastrointestinal bleeding--experience of a tertiary care center in southern India.

    Science.gov (United States)

    Simon, Ebby George; Chacko, Ashok; Dutta, Amit Kumar; Joseph, A J; George, Biju

    2013-07-01

    Over the last few decades, epidemiologic studies from the West have shown changing trends in etiology and clinical outcomes in patients with nonvariceal upper gastrointestinal bleed (NVUGIB). There are limited data from India on the current status of NVUGIB. The aim of this study therefore was to assess the etiological profile and outcomes of patients with NVUGIB at our center. We prospectively studied all patients (≥15 years) who presented with NVUGIB over a period of 1 year. The clinical and laboratory data, details of endoscopy, and course in hospital were systematically recorded. Outcome measures assessed were rebleeding rate, surgery, and mortality. Two hundred and fourteen patients (age, ≥15 years) presented to us with NVUGIB during the study period. The mean age was 49.9 ± 16.8 years and 73.8 % were males. Peptic ulcer was the commonest cause (32.2 %) of NVUGIB. About one third of patients required endoscopic therapy. Rebleeding occurred in 8.9 % patients, surgery was required in 3.7 %, and mortality rate was 5.1 %. Rebleeding and mortality were significantly higher among inpatients developing acute NVUGIB compared to those presenting directly to the emergency room. Peptic ulcer was the most common cause of NVUGIB. Outcomes (rebleed, surgery, and mortality) at our center appear similar to those currently being reported from the West.

  15. Invasive candidiasis in severe acute pancreatitis: Experience from a tertiary care teaching hospital

    Directory of Open Access Journals (Sweden)

    Arvind Kumar Baronia

    2017-01-01

    Full Text Available Background: Invasive candidiasis (IC is associated with increased morbidity in severe acute pancreatitis (SAP. There is limited information regarding the predisposing factors, Candida species distribution and in vitro susceptibility. Methodology: Current data have been derived from a larger prospective nonintervention study conducted on 200 critically ill patients which was done to study the antifungal prescription practices, collect epidemiological data, and perform an external validation of risk prediction models for IC under senior research associateship program of Council of Scientific and Industrial Research New Delhi. Of these critically ill patients, thirty had SAP and were included for analysis. Results: There were 23 males and 7 females. Out of eight patients (27% who developed IC, three had isolated candidemia, two had isolated deep-seated candidiasis while three had both candidemia and deep-seated candidiasis. SAP patients with IC had a longer duration of Intensive Care Unit stay, hospital stay, days on mechanical ventilation and duration of shock. Mortality was not different between SAP patients with or without IC. Conclusion: There is a high rate of Candida infection in SAP. More studies are needed to generate epidemiological data and develop antifungal stewardship in this subset of high-risk population.

  16. Profile of acute kidney injury after open heart surgeries in a tertiary care hospital.

    Science.gov (United States)

    Rather, Fayaz A; Najar, Saleem M; Malla, Hilal A; Ahangar, A G; Bhat, Hilal M; Wani, Imtiyaz A

    2015-11-01

    Our objective is to determine the incidence, etiology, risk factors and outcome of acute kidney injury (AKI) after open heart surgery. A prospective study was conducted on 62 patients who underwent open heart surgery and were followed-up for the development of AKI and to determine its incidence, etiology and outcome. Post-operative AKI was considered when the post-operative serum creatinine was >1.5 mg/dL or there was doubling of serum creatinine above the baseline (pre-operative) with a prior normal renal function. The incidence of AKI in the post-operative period in our study was 17.7%. The common etiological factors for AKI in our study were sepsis, hypotension, prolonged need for ventilator and inotropic support and drugs given in the post-operative period. The important risk factors for the development of AKI in the post-operative period were hypertension, diabetes mellitus, gout, prolonged total bypass time and prolonged aortic cross-clamp time. The overall mortality in our study subjects was 11.3% (seven of 62 died) and the mortality in the patients who developed post-operative AKI was 71.4%.

  17. Invasive Candidiasis in Severe Acute Pancreatitis: Experience from a Tertiary Care Teaching Hospital

    Science.gov (United States)

    Baronia, Arvind Kumar; Azim, Afzal; Ahmed, Armin; Gurjar, Mohan; Marak, Rungmei S. K.; Yadav, Reema; Sharma, Preeti

    2017-01-01

    Background: Invasive candidiasis (IC) is associated with increased morbidity in severe acute pancreatitis (SAP). There is limited information regarding the predisposing factors, Candida species distribution and in vitro susceptibility. Methodology: Current data have been derived from a larger prospective nonintervention study conducted on 200 critically ill patients which was done to study the antifungal prescription practices, collect epidemiological data, and perform an external validation of risk prediction models for IC under senior research associateship program of Council of Scientific and Industrial Research New Delhi. Of these critically ill patients, thirty had SAP and were included for analysis. Results: There were 23 males and 7 females. Out of eight patients (27%) who developed IC, three had isolated candidemia, two had isolated deep-seated candidiasis while three had both candidemia and deep-seated candidiasis. SAP patients with IC had a longer duration of Intensive Care Unit stay, hospital stay, days on mechanical ventilation and duration of shock. Mortality was not different between SAP patients with or without IC. Conclusion: There is a high rate of Candida infection in SAP. More studies are needed to generate epidemiological data and develop antifungal stewardship in this subset of high-risk population. PMID:28197050

  18. Pattern of Acute Poisoning Attending a Tertiary Care Hospital of Western Nepal

    Directory of Open Access Journals (Sweden)

    Raju Prasad Shakya

    2016-12-01

    Full Text Available Introduction: Poisoning with various substances is a major public health problem and a reason for significant morbidity and mortality throughout the globe. It is one of the most common presentation in an emergency department. This study was conducted to determine the sociodemographic, poisoning types, and mode of poisoning in cases attending a tertiary hospital of Western Nepal.   Methods: A retrospective observational study of two years was conducted from July 2014 to June 2016. Demography details, name of poisonous substance, and reasons for poisoning were reviewed and analyzed using descriptive statistics.   Results: A total of 65 cases of poisoning were recorded. The occurrence was more common in female (n=44, 67.7% than in male (n=21, 32.3% with a F:M ratio of 2.1:1.  Poisoning  was most  common in the age group of 11-20 years (32.3%. Most of the cases were students (37% followed by farmers (26%. The most commonly abused poisoning substance were organophosphorous compounds, zinc-phosphate,  and  kerosene in adults, adolescents, and children respectively. Oral route was the most common (99% route of administration. Suicidal attempt, as a mode of poisoning, accounted for 70.8% of total poisoning cases.   Conclusion: Female and young people are at greater risk of acute poisoning. Insecticide was the most common agent and self administer poisoning was the most common mode of poisoning. The occurrence of poisoning and its morbidity and mortality can be reduced by developing and implementation of effective prevention strategies like restricting easy poison sales, establishing drug and poison information centers,  and community awareness programs.

  19. Diffuse large B-cell lymphoma in elderly: Experience from a tertiary care oncology center in South India

    Directory of Open Access Journals (Sweden)

    K N Lokesh

    2017-01-01

    Full Text Available Introduction: Diffuse large B-cell lymphoma (DLBCL is the most frequent non-Hodgkins lymphoma in the elderly. With the rising proportion of older persons in India, it is important to study current patterns and management of this disease, given that data in this regard are scarce in Indian settings. The aim of this study was to document the clinical features of DLBCL among elderly patients and their outcome over 7 years at a tertiary care oncology center. Materials and Methods: This was a retrospective records review of 119 DLBCL cases between January 2007 and January 2015 aged 60 years and above done at Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India. Clinical staging was done according to Ann Arbor staging as modified by Cotswold's and International Prognostic Index (IPI calculated. Results: The mean age was 69.54 years (±5.44 with male: female ratio of 1.52:1. B symptoms were seen in 33% of patients. Thirty-six percent of the patients had stage II disease. The advanced stage was seen in 12% and bulky disease in 9.5%. Bone marrow was involved in 12%. The most common extranodal site was the head and neck region. The distribution according to the IPI was as follows: Low risk 38 (31.93%, low-intermediate risk 53 (44.54%, high-intermediate risk 20 (16.80%, and high risk 8 (6.72%. Among 119 patients, 98 (64.7% received treatment with either combination of rituximab, cyclophosphamide, adriamycin, vincristine, epirubicin, and prednisolone. Overall response rate was 63.26% with a complete response rate of 38.77%. The overall survival ranged from 2 to 123 months with the median being 9.5 months. Conclusion: In elderly, DLBCL is common in seventh decade and most of them present in an early stage and low IPI. The incorporation of rituximab to anthracycline based chemotherapy shows a significant improvement in survival in elderly DLBCL.

  20. A STUDY ON YIELD AND USEFULNESS OF NON-CONTRAST CT BRAIN IMAGING IN ACUTE STROKE AT A TERTIARY CARE INSTITUTE IN SOUTH INDIA

    Directory of Open Access Journals (Sweden)

    Jayanthi

    2016-05-01

    Full Text Available BACKGROUND Non-enhanced CT scanning of the head remains the first-line diagnostic test for the emergency evaluation of acute stroke because of its speed, its convenient availability at most hospitals and its ability to sensitively depict intracranial haemorrhage. [1] This is an observational study done to ascertain the yield and usefulness of non-contrast CT brain imaging in acute stroke in a tertiary care centre. METHODS This was a prospective observational study done from June 2015 - November 2015 in a tertiary care centre. The study included 75 patients above 18 years of age who presented with any new-onset neurological deficit to our hospital. CT imaging was done for all those patients. Pregnant patients and those with previous neurological deficits were excluded from this study. A detailed study on the sex, age of the patient, time of presentation to our hospital, types of stroke along with site of involvement were studied. Data was recorded and analysed. RESULTS Amongst the 75 patients we studied 56 were females, 44 were males, 64% of our patients had infarct, 21% had haemorrhage, 19% of our patients had normal study at the time of presentation. Amongst those who had evidence of CT proven infarct, 3 patients presented to us within 6 hours, 6 patients between 6-12 hours, 26 patients between 12-24 hours, 10 patients after 24 hours. Amongst the 19% who had no evidence of stroke in imaging studies, 85% presented within 6 hours to our hospital. CONCLUSIONS Our study concluded that females are predominant in patients presenting with stroke, most common cause of stroke was infarct with capsuloganglionic region being the most common site of involvement and radiological yield of evidence of plain CT had positive correlation with advancing age of infarct.

  1. STUDY OF CERTAIN EPIDEMIOLOGICAL FACTORS AFFECTING OUTCOME OF ACUTE RESPIRATORY INFECTIONS IN CHILDREN ADMITTED IN A TERTIARY CARE HOSPITAL OF WESTERN MAHARASHTRA

    Directory of Open Access Journals (Sweden)

    Jayashree D

    2015-11-01

    Full Text Available : BACKGROUND: The incidence of acute respiratory infections (ARI is high among under-fi ve children, especially in developing countries. However, the data on ARI from urban areas in India are scarce. AIM: To assess various socio-demographic and environmental factors of ARI cases admitted in tertiary care hospital and to determine their association with outcome of disease. STUDY DESIGN AND SETTING: A Cross-sectional descriptive study conducted in a tertiary care hospital in Western Maharashtra, targeting all ARI cases admitted over a period of 1 yr. in the Pediatric ward at Govt. Medical College & Hospital, Miraj, from 1 January to 31 December 2011. METHODS AND MATERIALS: A pre- tested structured questionnaire with details regarding socio demographic characteristics and Environmental factors influencing outcome of ARI cases was used to collect the information from person accompanying ARI child preferably mother. STATISTICAL ANALYSIS: Statistical software SPSS 16 for proportions, chi square test and odds ratio. RESULTS: Out of all (352 cases of ARI, 93.75% (330 were cured and 6.25% (22 were died. In this study majority of cases were less than one year, mostly among boys from joint family, urban area, Hindu religion. Socioeconomic status and family history of smoking, were statistically significant while overcrowding, seasonal variation and Type of fuel for cooking were not significantly associated with outcome of ARI. CONCLUSION: Efforts should be made to improve the socio-economic and environmental status of the parents by the administration. Improving them can reduce the incidence of the Acute respiratory infection among the under five children and better outcome of disease.

  2. High Sensitivity C-reactive Protein Levels in Acute Ischemic Stroke and Subtypes: A study from a Tertiary Care Center

    Directory of Open Access Journals (Sweden)

    Jaydip Ray Chaudhuri

    2013-07-01

    Full Text Available Background: Stroke is a heterogeneous disease with several risk factors. High sensitivity C-reactive protein (hsCRP is a marker for cardiovascular and cerebrovascular diseases. Recent studies have shown that high hsCRP level is a risk factor for ischemic stroke. The objective of our study was to investigate the association of high hsCRP(> 3 mg/L levels with ischemic stroke and its subtypes in Indian patients.Methods: We recruited 210 consecutive acute stroke patients and 150 age and sex matched controls. Stroke patients were admitted within 72 hours of onset, at Yashoda Hospital, Hyderabad, India. The study period was from January 2011 to December 2012. All patients underwent tests as per standard protocol for stroke workup. Serum hsCRP level was assessed in all stroke patients and controls on the day of admission.Results: The mean hsCRP was significantly higher in stroke patients (3.8 ± 2.5 than controls (1.8 ± 1.5 (P < 0.001. High hsCRP had higher frequency in stroke patients 130 (61.9% compared to controls 10 (6.6%, P < 0.001. High hsCRP level was more prevalent in the stroke subtypes of cardioembolic stroke (83.3% and large artery atherosclerosis (72%. High hsCRP level was significantly associated with hypercholesterolemia (P = 0.001, age(P = 0.01, and mortality (0.04. After adjustment of regression analysis it was observed that high level hsCRP is independently associated with acute ischemic stroke (Odds 4.5; 95% CI: 2.5-12.2; especially the stroke subtypes of cardioembolic stroke, (odds ratio 3.4, 95% CI: 1.9-10.5 and large artery atherosclerosis (odds ratio 2.1, 95% CI: 1.5-3.8.Conclusion: High hsCRP level is strongly associated with and an independent predictor of acute ischemic stroke. The association was found in all ischemic stroke subtypes.

  3. A comparative study between abdominal plain radiography and ultrasonography in non-traumatic acute abdominal emergencies in tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Chiranjeev Kumar Gathwal

    2016-12-01

    Conclusions: We concluded that Plain X rays can be used as screening modality in the diagnosis of acute abdominal emergencies; however ultrasound examination is cheaper, non-invasive, quick, reliable and highly accurate modality in diagnosing the exact cause of pain and its origin in a patient presenting with an acute abdomen and thus helps the physician or surgeon to plan the timely management.

  4. A STUDY ON THE INCIDENCE AND ETIOLOGY OF ACUTE KIDNEY INJURY IN HEMOTOXIC SNAKE ENVENOMATION CASES IN A TERTIARY CARE CENTRE

    Directory of Open Access Journals (Sweden)

    Purushottam Rao

    2015-02-01

    Full Text Available INTRODUCTION: Snake bite envenomation is a frequently encountered problem in tropical countries like India, especially in the rural areas of south India. Most of the victims are farmers. The World Health Organization has estimated that nearly 1,25,000 deaths occur among 2,50,000 poisonous snake bites world - wide, of which India accounts for 10,000 deaths. Acute Kidney Injury (AKI is an important consequence of a snake bite and its proper supportive management after the anti - venom administration is of utmost importance, for a good patient outcome. AIM AND OBJECTIVES : To assess the incidence of Acute Kidney Injury in patients with hemotoxic snake envenomation . To assess the etiological factors involved in Acute Kidney Injury on snake bite victims. METHODOLOGY: This prospective study was carried out at King George Hospital, Visakhapatnam, Andhra Pradesh. It is a tertiary care government hospital, attached to Andhra Medical College, Visakhapatnam. STUDY DESIGN: This was a prospective and descriptive type of study. RESULTS: A total of 214 cases of hemotoxic snake bite were included in this study, who were admitted in the hospital from September 2012 to August 2014. The incidence of renal failure in hemotoxic snake bite is 23.3%. The probable etiology of AKI in snake bite victims is DIC in 48% of cases, direct nephrotoxicity in 24% of cases. CONCLUSION: This study concludes that Acute Kidney Injury occurs in 23.3% of cases of hemotoxic snake bite. DIC is the most common etiologic factor for AKI in snake bite followed by direct nephrotoxicity, hypotension, capillary leak syndrome and sepsis

  5. Short-term diagnostic stability of acute psychosis: Data from a tertiary care psychiatric center in South India

    Directory of Open Access Journals (Sweden)

    Janardhanan C Narayanaswamy

    2012-01-01

    Full Text Available Context: Studies on acute psychosis in patients from India report good outcome. A small proportion of these patients may suffer relapses or other develop major psychiatric disorders later. Aim: The aim of this study was to examine the diagnostic stability of acute psychosis in patients from India. Materials and Methods: The records of patients who presented with the first episode of acute and transient psychotic disorder (n=57 over 1 year (2004 were analyzed, and the follow-up data at the end of 1 and 2 years were recorded. Results: The mean age of the sample was 30.72 years. The mean duration of illness episode was 18.15±17.10 days. The follow-up data were available for 77.2% (n=44 and 75.4% (n=43 of the sample at the end of first and second years. Relapse was recorded in 47.4 and 54.4% at the end of first and second years, respectively. Conclusion: The diagnosis changed into other disorders such as bipolar disorder, schizophrenia, and unspecified psychosis, while a majority retained the initial diagnosis of acute psychosis. The findings suggest that acute psychosis is a relatively stable condition. A small percentage of these patients may go on to develop schizophrenia or bipolar disorder.

  6. Prevalence of acute epiglottitis and its association with pulmonary tuberculosis in adults in a tertiary care hospital of Nepal

    Directory of Open Access Journals (Sweden)

    Thapa, Narmaya

    2008-12-01

    Full Text Available Introduction: Acute epiglottitis is a relatively uncommon disease in both children and adults. It can be a serious life threatening disease because of its potential for sudden upper airway obstruction. Objective: To determine the prevalence of acute epiglottitis and to find out its association with Pulmonary Tuberculosis. Methods: All cases of acute epiglottitis admitted in ENT and Head and Neck Surgery ward of TUTH, Kathmandu, Nepal, from April 2001 to September 2007, were enrolled. Routine investigations including x-rays and blood cultures were done. The patients were further investigated to rule out the presence of Pulmonary Tuberculosis.The standard treatment protocol we used included Injection Ampicillin 500 mg intravenously six hourly for 72 hours followed by oral Ampicillin 500mg for 7 days, with analgesics and intravenous steroid (Hydrocortisone 200mg if required. Study Design: Prospective longitudinal study. Results: Majority of the patients presented with a history sore throat (83.3%, dysphagia (78.6% and odynophagia (78.6%. On examination all the patients were found to have swollen and congested epiglottis. Positive "Thumb sign" on plain X-ray soft tissue neck lateral view was found in almost all the patients (95.2%. Four patients presented with stridor and patient needed emergency tracheostomy. None of the investigations done to detect Pulmonary Tuberculosis was found to be positive. Conclusion: Acute epiglottitis is a rare disease which now occurs more commonly in adults. The annual prevalence of Acute Epiglottitis in adult in TUTH is 4.8 per 1000. This study did not find any association of acute epiglottitis with pulmonary tuberculosis.

  7. Drug utilization pattern in acute coronary syndrome at tertiary care hospital: a prospective cross-sectional observational study

    Directory of Open Access Journals (Sweden)

    Praveen Choudhary

    2016-04-01

    Conclusions: The present study provides valuable insight about the overall pattern of drug used in Acute Coronary syndrome. Physician should be encouraged to prescribe drugs with generic name. [Int J Basic Clin Pharmacol 2016; 5(2.000: 513-516

  8. A study on the drug prescribing pattern in acute, recurrent and chronic pharyngitis at a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Deepa Ranabovi

    2016-08-01

    Conclusions: Acute, recurrent and chronic bacterial pharyngitis can be effectively treated by empirical use of various antimicrobials. Co-amoxiclav can be considered as the mainstay/primary option because of the proven efficacy, good tolerability and low cost. [Int J Basic Clin Pharmacol 2016; 5(4.000: 1494-1498

  9. [Acute bacterial parotitis in infants under 3 months of age: a retrospective study in a pediatric tertiary care center].

    Science.gov (United States)

    Makhoul, J; Lorrot, M; Teissier, N; Delacroix, G; Doit, C; Bingen, E; Faye, A

    2011-12-01

    Acute bacterial parotitis is a rare infectious disease in infants under 3 months of age. To describe the clinical characteristics and the course of acute bacterial parotitis in infants less than 3 months old. Infants under 3 months of age, hospitalized at Robert Debré university hospital, Paris, France, between January 2005 and December 2009 for acute bacterial parotitis, were included in a retrospective study. Five infants less than 3 months of age were included in this study, for a frequency of 2.5/1000 hospitalizations in this age group. All were born at term, 4 of 5 were male. Three of the 5 patients had specific clinical signs of parotitis on admission. One patient had septic shock on admission. The ultrasound confirmed the parotitis in all cases. No parotid abscess was demonstrated on imaging. All patients had at least one abnormal inflammatory biological test (WBC, CRP, PCT). Bacteria were identified in 4 of 5 cases: Staphylococcus aureus was isolated in the pus culture of the Stenon duct in 2 patients and a group B Streptococcus was isolated from blood culture of 2 other patients. The duration of intravenous antibiotic therapy varied from 4 to 13 days, and the total duration of antibiotic therapy was between 10 and 16 days. No surgical procedures were needed. Acute bacterial parotitis in infants under 3 months of age might be associated with localized infections due to S. aureus, but also with a more severe clinical presentation due to group B streptococcus infection. Early diagnosis and appropriate antibiotic therapy might prevent the progression to serious complications. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  10. Contemporary Outcomes of Venoarterial Extracorporeal Membrane Oxygenation for Refractory Cardiogenic Shock at a Large Tertiary Care Center.

    Science.gov (United States)

    Truby, Lauren; Mundy, Lily; Kalesan, Bindu; Kirtane, Ajay; Colombo, Paolo C; Takeda, Koji; Fukuhara, Shinichi; Naka, Yoshifumi; Takayama, Hiroo

    2015-01-01

    Refractory cardiogenic shock (RCS) is associated with significant morbidity and mortality, and current mainstays of medical therapy appear inadequate. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) represents an increasingly accepted therapy for RCS. Demographics, past medical history, preoperative characteristics, outcomes, and adverse events were collected for consecutive patients who received VA-ECMO support for RCS at our institution from March 2007 to December 2013. One hundred and seventy-nine patients with a mean age of 56.9 ± 16.1 years were included. Etiologies of RCS included postcardiotomy shock in 70 patients (39%), acute myocardial infarction in 46 patients (26%), primary graft failure in 17 patients (10%), and acute decompensated heart failure in 24 patients (13%). Mean arterial pressure before VA-ECMO support was 59.4 ± 22.8 mm Hg and 30.7% (n = 55) were undergoing active cardiopulmonary resuscitation at the time of cannulation. Overall, 38.6% of patients (n = 69) survived to discharge and 44.7% of patients (n = 80) survived to 30 days. Myocardial recovery was achieved in 79.7% of survivors (n = 55) and 39.1% were transitioned to a more durable device. Univariate analysis identified age (p = 0.002) and etiology of RCS (p = 0.041) as the most significant predictors of in-hospital mortality. Venoarterial extracorporeal membrane oxygenation for RCS appears successful as salvage therapy. Age and etiology should be considered when evaluating patients for VA-ECMO.

  11. ECHOCARDIOGRAPHIC PROFILE OF VALVULAR LESIONS IN CHILDREN WITH ACUTE RHEUMATIC FEVER / RHEUMATIC HEART DISEASE IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Ramu

    2015-03-01

    Full Text Available CONTEXT (B ACKGROUND: Rheumatic Heart disease is still a leading cause of valvular disease in developing countries like India and constitutes 10 to 50% of the cardiac patients in Indian hospitals. Echocardiography is a very sensitive investigation for the diagnosis of Rheumatic Carditis and its sequalae like Mitral, Aortic and Tricuspid valve disease as well as sub clinical Carditis. AIMS & OBJECTIVES: To study the profile, severity and gender based differences of valvular lesions on the Trans Thoracic Echocardiographic records of children diagnosed as Acute Rheumatic fever/ Rheumatic Heart disease. MATERIALS & METHODS: This study was conducted during D ecember’2014 by reviewing the records of trans thoracic Echocardiographic reports of our 36 cases (childhood Acute Rheumatic fever/ Rheumatic Heart disease cases for type and degree of valvular involvement according to AHA guidelines. RESULTS: Mitral valv e was involved most often (23 cases – 63.89%. Severe Mitral regurgitation is the common type of valvular lesions both in Boys and Girls (19.44% and 25% respectively. Isolated Aortic valve/ Tricuspid valve involvement was not found in our study. Mixed les ions were seen most often than pure isolated valvular lesions. CONCLUSION: Mitral valve was most commonly affected, while Regurgitant lesions were more common than Stenotic lesions and most severe in children less than 15 years age group. Aortic Regurgitat ion (AR was found more commonly in Girls than Boys in our study. But all these cases of AR had some other valvular involvement as Mixed lesions. Therefore Echocardiography should be done routinely for patients with Rheumatic Heart Disease, focusing on you nger population to facilitate diagnosis and definitive treatment before complications set in.

  12. PREDICTORS OF LARGE ESOPHAGEAL VARICES IN CIRRHOTIC PATIENTS PRESENTING TO A TERTIARY CARE CENTRE IN SOUTH INDIA

    Directory of Open Access Journals (Sweden)

    Anita

    2015-11-01

    Full Text Available BACKGROUND Variceal bleeding is a major cause of morbidity and mortality in cirrhosis and endoscopic examination is not accessible in most rural centers. The aim of the study is to identify the clinical, hematological, biochemical, and ultrasonographic parameters that predict the presence of large esophageal varices in patients with cirrhosis. METHODOLOGY Seventy two patients fulfilling inclusion criteria were enrolled for this prospective observational study. Relevant clinical parameters like ascites, splenomegaly, jaundice and laboratory parameters like complete blood picture with absolute platelet count, prothrombin time, serum bilirubin, albumin, CTP class and ultrasonographic characteristics like spleen size, splenic vein size, portal vein diameter were recorded and assessed. Univariate and multivariate analysis was done for predictors of large esophageal varices. RESULTS Thirty one (43% patients in this study had varices, out of them 15 (48% had large varices. On multivariate analysis, presence of large esophageal varices was significantly associated with a spleen size >16cm (p value-0.001, platelet count 16cm and CTP class B and C can stongly predict the presence of large esophageal varices. PLC/SD ratio, SAAG, PVD and PVF did not have any statistical significance in predicting large esophageal varices in our study.

  13. Outcome of Childhood Acute Lymphoblastic Leukaemia after Induction Therapy --- Three-Year Experience in a Tertiary Care Hospital in Bangladesh

    Directory of Open Access Journals (Sweden)

    M Belayet Hossain

    2017-01-01

    Full Text Available Background: The incidence of different malignancies is increasing among the world populations. Acute lymphoblastic leukaemia (ALL is the most common of all the paediatric malignancies. Response to induction therapy is one of the most important predictors of long term outcome of ALL. Objective: To see the immediate outcome of paediatric ALL patients following induction therapy. Materials and Methods: This retrospective study was conducted from January 2013 to December 2015. Total 221 paediatric ALL patients were included in this study. Diagnosis was based on history, examination, blast cells count on peripheral blood film and bone marrow study, CSF study and immunophenotyping of peripheral blood/bone marrow aspirate in patients who were financially capable. Among them, parents of 40 (18% patients did not agree to start chemotherapy. According to Modified UK ALL 2003 protocol (Regimen A & B 181 patients were given induction therapy (vincristine, prednisolone, L-asparaginase, and daunomycin in high risk patients. Among them 14 patients discontinued, 10 patients died during chemotherapy and rest 157 patients completed induction phase. Bone marrow study was repeated after completion of induction therapy and remission pattern was seen. Results: Out of 157 chemotherapy completed patients, 137 (87% went into complete remission (25% blast cells in the bone marrow. Ten (5.5% patients died due to bleeding, febrile neutropenia and sepsis during the course of induction therapy. Conclusion: ALL in children is curable with effective chemotherapy. Poverty, ignorance and misconception regarding outcome are responsible for refusal and discontinuation of chemotherapy in third world countries like Bangladesh. Mortality and treatment cost can be reduced with the improvement of the facilities for isolation, barrier nursing and supportive treatment, and by creating awareness.

  14. Extranodal diffuse large B-cell lymphoma: Experience from a tertiary care oncology center in South India

    Directory of Open Access Journals (Sweden)

    K. C. Lakshmaiah

    2014-01-01

    Full Text Available Aims: Diffuse large B-cell lymphoma (DLBCL is the most common non-Hodgkin′s lymphoma (NHL with frequent extra nodal (EN presentation. The overall occurrence of lymphomas has been increasing; however, those of EN-NHL have been increasing much more rapidly. There is limited data found on EN-DLBCL in the Indian population and hence we carried out this retrospective observational study of primary EN-DLBCL at our center in Southern India. Materials and Methods: A total of 90 consecutive cases diagnosed as EN-DLBCL (according to the standard criteria by tissue biopsy confirmed by immunohistochemistry between 2007 and 2011 were included. Staging workup including computed tomography of neck, thorax and abdomen and pelvis, bone marrow aspiration and biopsy was done and International Prognostic Index (IPI calculated. Staging was according to Cotswold′s modification of Ann Arbor. The actuarial survival analysis was performed by Kaplan-Meier. Data were analyzed using the SPSS (version 16 statistical software. Results: The median age in this study was 49 years (18-88 with results showing EN-DLBCL to be 1.36 times more common in males. Advanced stages were seen in 15 subjects (16.6% and bulky disease in 13 subjects (14.4%. CD20 was positive in 89 (98.8% while 32 had high serum lactate dehydrogenase. According to the IPI most were low-risk-56 (66.6%. Overall response rate for the various combination chemotherapies was 85.7% with complete response in 62.3%. The overall survival range spanned from 2 to 123 months. Univariate analysis showed only bulky disease was associated with inferior survival. Conclusions: EN-DLBCL was present at an early age compared to nodal DLBCL, present more often in early stage and low IPI score. Chemoimmunotherapy with radiotherapy to the EN or bulky site is the standard treatment at present.

  15. The usage of complementary and alternative medicine in gastrointestinal patients visiting the outpatients’ department of a large tertiary care centre-views from Pakistan

    Science.gov (United States)

    Lail, Ghulamullah; Luck, Nasir; Tasneem, Abbas Ali; Rai, AyeshaAslam; Laeeq, Syed Mudasir; Majid, Zain

    2016-01-01

    Introduction The use of complementary and alternative medicine (CAM) has increased over the last few years, and an emergent data suggests that some CAM modalities may be helpful in addressing gastrointestinal (GI) conditions. Our aim was to find out the prevalence of such practices for GI condition amongst patients visiting an OPD of a large tertiary care centre of Karachi, Pakistan. Methods Patients visiting outpatient department of Hepatogastroenterology department at SIUT, Pakistan from March 2014 to March 2015, were included in this cross sectional study. A pre designed questionnaire was used that included the demographic data, primary disease of the patient, CAM modality used, reason for the use of CAM therapy and reasons for stopping it. Frequencies of different variables were computed using SPSS version 18. Results 906 patients were interviewed, out of which 52% (471) were males. The mean age at presentation was 39.81±12.4 years. 234 (25.8%) of the participants used one of the CAM modalities; Herbal medicine being most common one, seen in 122 (52.13%) followed by spiritual 61 (26%), and homeopathy 33 (14%). The duration of therapy was limited to six months in 161(68%), whereas 7 patients (2.9%) had prolonged duration of use of more than five years. Reasons for using CAM therapy included advice by family and friends in 66 patients (28%), personal will in 42 (17.94%), no benefit from allopathic treatment in 34 (14.5%), while high cost was the reason of use in 3(5%) of the patients. The most common reason for discontinuation of CAM was no benefit, seen in 113 patients (48.30%), followed by physician's advice in 32 (17%) patients, and side effects in 19 (8%). On the other hand 44 patients (18.80%) reported benefit from the therapy while 14 (5.9%) were still continuing with CAM modality. Among the CAM users 140 (60.09%) were un-educated or had primary education while CAM nonusers had 328 (47%) were either uneducated or had primary education only correlation

  16. The business of palliative medicine--part 4: Potential impact of an acute-care palliative medicine inpatient unit in a tertiary care cancer center.

    Science.gov (United States)

    Walsh, Declan

    2004-01-01

    In this study, a hematology/oncology computerized discharge database was qualitatively and quantitatively reviewed using an empirical methodology. The goal was to identify potential patients for admission to a planned acute-care, palliative medicine inpatient unit. Patients were identified by the International Classifications of Disease (ICD-9) codes. A large heterogenous population, comprising up to 40 percent of annual discharges from the Hematology/Oncology service, was identified. If management decided to add an acute-care, palliative medicine unit to the hospital, these are the patients who would benefit. The study predicted a significant change in patient profile, acuity, complexity, and resource utilization in current palliative care services. This study technique predicted the actual clinical load of the acute-care unit when it opened and was very helpful in program development. Our model predicted that 695 patients would be admitted to the acute-care palliative medicine unit in the first year of operation; 655 patients were actually admitted during this time.

  17. Impact of Antimicrobial Stewardship Program (ASP) on Outcomes in Patients with Acute Bacterial Skin and Skin Structure Infections (ABSSSIs) in an Acute-Tertiary Care Hospital.

    Science.gov (United States)

    Loo, Li Wen; Liew, Yi Xin; Lee, Winnie; Chlebicki, Piotr; Kwa, Andrea Lay-Hoon

    2015-09-01

    Acute bacterial skin and skin structure infections (ABSSSIs) are among the most common infections treated in hospitals, but to date, there has been little information with regards to the implementation of Antimicrobial Stewardship Programs (ASPs) for patients with ABSSSIs. Hence, we aim to evaluate the impact of ASPs on the following outcomes in patients with ABSSSIs: duration of therapy and hospital stay, 14-day reinfection, infection-related readmissions and mortality. A retrospective review of the ASP database was conducted, focusing on selected outcomes (as above) among all patients in whom the institution's ASP recommended a change in antibiotic regimen-de-escalation of the antibiotic based on culture results; discontinuation of the antibiotic; narrowing of the empirical coverage; and intravenous-to-oral (i.v.-to-p.o.) switch between September 2009 and December 2012. Data were expressed as mean ± standard deviation for continuous variables, and unpaired Student's t test was performed to determine intergroup differences between mean values. For categorical variables, data were presented as number and percentage and analyzed using the χ (2) test or Fisher's exact test, as appropriate. ASP recommended 407 interventions with an overall acceptance rate of 66.8%. ASP interventions significantly reduced median duration of therapy by 2 [from a median (interquartile range, IQR) of 8 (6-12) days to 6 (4-9) days] and median length of stay by 5 days [from median (IQR) of 12 (5-32) days to 7 (3-18) days]. This led to an estimated total cost avoidance of USD 0.7 million. There were no significant differences in the 14-day reinfection, infection-related readmission and mortality rates between patients whose physicians accepted and those who rejected ASP interventions. Interventions recommended by the ASP in Singapore General Hospital were safe and associated with a significant reduction in duration of therapy and hospital stay. The results of our study have affirmed

  18. The need for a population-based, dose optimization study for recombinant tissue plasminogen activator in acute ischemic stroke: A study from a tertiary care teaching hospital from South India

    Directory of Open Access Journals (Sweden)

    Siju V Abraham

    2017-01-01

    Full Text Available Context: The guideline recommended dose of intravenous (i.v recombinant tissue-type plasminogen activator (rt-PA for acute ischemic stroke is 0.9 mg/kg in the European and American populations. In Asiatic population, some studies have shown that a lower dose of i.v rt-PA is equally efficacious. Aims: To assess if there is a need for a dose optimization for i.v rt-PA study among Indians. Setting and Design: A prospective, observational database of acute stroke cases that presented to a tertiary care institute over a period of 1 year was made. Methods: The data procured using a prestructured elaborate pro forma. Based on the dose of rt-PA received, the individuals were divided into three groups; Group 1 (0.6–0.7 mg/kg, Group 2 (0.7–0.8 mg/kg, and Group 3 (0.8–0.9 mg/kg. Improvement was assessed in each group and between the thrombolysed and nonthrombolysed individuals. Statistical Analysis Used: The nonparametric Mann–Whitney U-test (Wilcoxon rank-sum test was applied for assessing improvement of National Institutes of Health Stroke Scale score with significance level of α < 0.05 (P < 0.012 and compliance level at 95%. Results: Between the thrombolysed (n = 46 and nonthrombolysed (n = 113 group, there was a statistically significant neurological improvement in the thrombolysed group. Clinical improvement was noted in 75%, 85.7%, and 66.7% of individuals receiving rt-PA in Groups 1, 2, and 3, respectively. Four out of the five who developed a clinically significant intracranial hemorrhage were thrombolysed at a dose of 0.8–0.9 mg/kg rt-PA (Group 3. Conclusion: There is a need for a properly randomized, dose optimization study of i.v rt-PA in the Indian subcontinent.

  19. Comparative evaluation of acute respiratory distress syndrome in patients with and without H1N1 infection at a tertiary care referral center

    Directory of Open Access Journals (Sweden)

    Tanvir Samra

    2011-01-01

    Full Text Available H1N1 subtype of influenza A virus has clinical presentation ranging from mild flu like illness to severe lung injury and acute respiratory distress syndrome (ARDS. The aim of our study was to compare the demographic characteristics, clinical presentation, and mortality of critically ill patients with (H1N1+ and without H1N1 infection (H1N1-. We retrospectively analyzed medical charts of patients admitted in "Swine Flu ICU" with ARDS from August 2009 to May 2010. Real-time reverse transcriptase polymerase chain reaction (RT-PCR assay was used for detection of H1N1 virus in the respiratory specimens. Clinical data from 106 (H1N1 , 45; H1N1+, 61 patients was collected and compared. Mean delay in presentation to our hospital was 5.7 ± 3.1 days and co-morbidities were present in two-fifth of the total admissions. Sequential Organ Failure Assessment (SOFA score of patients with and without H1N1 infection was comparable; 7.8 ± 3.5 and 6.6 ± 3.1 on day 1 and 7.2 ± 4.5 and 6.5 ± 3.1 on day 3, respectively. H1N1+ patients were relatively younger in age (34.2 ± 12.9 years vs. 42.8 ± 18.1, P = 0.005 but presented with significantly lower PaO 2 :FiO 2 ratio (87.3 ± 48.7 vs. 114 ± 51.7 in comparison to those who subsequently tested as H1N1 . The total leucocyte counts were significantly lower in H1N1+ patients during the first four days of illness but incidence of renal failure (P = 0.02 was higher in H1N1+ patients. The mortality in both the groups was high (H1N1+, 77%; H1N1, 68% but comparable. There was a mean delay of 5.7 ± 3.1 days in initiation of antivirals. Patients with H1N1 infection were relatively younger in age and with a significantly higher incidence of refractory hypoxia and acute renal failure. Mortality from ARDS reported in our study in both the groups was high but comparable.

  20. Severity of acute hepatitis and its outcome in patients with dengue fever in a tertiary care hospital Karachi, Pakistan (South Asia

    Directory of Open Access Journals (Sweden)

    Akhtar Jaweed

    2010-05-01

    Full Text Available Abstract Background Liver injury due to dengue viral infection is not uncommon. Acute liver injury is a severe complicating factor in dengue, predisposing to life-threatening hemorrhage, Disseminated Intravascular Coagulation (DIC and encephalopathy. Therefore we sought to determine the frequency of hepatitis in dengue infection and to compare the outcome (length of stay, in hospital mortality, complications between patients of Dengue who have mild/moderate (ALT 23-300 IU/L v/s severe acute hepatitis (ALT > 300 IU/L. Methods A Cohort study of inpatients with dengue viral infection done at Aga Khan University Hospital Karachi. All patients (≥ 14 yrs age admitted with diagnosis of Dengue Fever (DF, Dengue Hemorrhagic Fever (DHF or Dengue Shock Syndrome (DSS were included. Chi square test was used to compare categorical variables and fischer exact test where applicable. Survival analysis (Cox regression and log rank for primary outcome was done. Student t test was used to compare continuous variables. A p value of less than or equal to 0.05 was taken as significant. Results Six hundred and ninety nine patients were enrolled, including 87% (605 patients with DF and 13% (94 patients with DHF or DSS. Liver functions tests showed median ALT of 88.50 IU/L; IQR 43.25-188 IU/L, median AST of 174 IU/L; IQR 87-371.5 IU/L and median T.Bil of 0.8 mg/dl; IQR 0.6-1.3 mg/dl. Seventy one percent (496 had mild to moderate hepatitis and 15% (103 had severe hepatitis. Mean length of stay (LOS in patients with mild/moderate hepatitis was 3.63 days v.s 4.3 days in those with severe hepatitis (P value 0.002. Overall mortality was 33.3% (n = 6 in mild/moderate hepatitis vs 66.7% (n = 12 in severe hepatitis group (p value Conclusion Severe hepatitis (SGPT>300IU in Dengue is associated with prolonged LOS, mortality, bleeding and RF.

  1. A STUDY OF CLINICAL PROFILE OF ADULT PATIENTS WITH ACUTE ENCEPHALITIS SYNDROME COMING TO A TERTIARY CARE HOSPITAL OF NORTH EAST INDIA

    Directory of Open Access Journals (Sweden)

    Anupam Dutta

    2016-06-01

    Full Text Available CONTEXT Acute encephalitis syndrome (AES is a public health problem in north east India with Japanese encephalitis being a major aetiology. Government of India initiated an adult JE vaccination in Assam in 2011. AIMS We aim to study the clinical profile and outcome in adult AES and JE patients after Government’s JE vaccination. SETTINGS AND DESIGN Adult AES patients from 1st May 2014 to 31 st October 2014 were included in this open label, observational, prospective study. METHODS AND MATERIALS Data was collected regarding clinical history and outcome. JE confirmation was done by CSF and sera samples screened to detect JEV- specific immunoglobulin M (IgM. STATISTICAL ANALYSIS USED Data analysis was done using GraphPad Prism software version 6.0. RESULTS 141 (96 males, 45 females patients of AES, were studied. With average hospital stay of 5.87 days, 100% had fever, 99.3% headache, 56.7% vomiting, 93.6% altered sensorium, 87.2% dizziness and 51.1% had seizure. 44% AES improved, 29.07% suffered residual neurological deficit and 26.65% expired. Out of 38 patients who died, 29(76.31% patients had a GCS ≤ 7. JE was detected in 26 patients, equivocal in 2 patients and negative in 113 patients. 14(53.84% JE patients improved, 9(34.61% suffered residual neurological deficit and 3(11.53% expired. JE vaccination was present in 7(4.96% patients. CONCLUSIONS JE positive cases have reduced in adults AES patients after Government vaccination program but vaccination coverage among the AES patients was low. Clinical presentation of adult AES patients differs from most reported paediatric AES cases. However, the mortality and morbidity of AES and JE still remains high, GCS < 7 being a bad prognostic marker.

  2. Development of the 24/7 Nurse Practitioner Model on the Inpatient Pediatric General Surgery Service at a Large Tertiary Care Children's Hospital and Associated Outcomes.

    Science.gov (United States)

    Rejtar, Marketa; Ranstrom, Lee; Allcox, Christina

    Nurse practitioners (NPs) have been providing high-quality and safe patient care for a few decades, and evidence showing the extent of their impact is emerging. This article describes the implementation of a 24/7 NP patient care model on an inpatient pediatric general surgery service in a tertiary free-standing Children's Hospital in the Northeastern United States. The literature shows that there is limited evidence regarding NP models of care and their effect on patient outcomes. In response to policy changes leading to reduction of resident work hours and a more acute and complex inpatient pediatric general surgery patient population, our existing NP model evolved into a 24/7 NP Model in June 2011. The results from two quality improvement projects showed positive registered nurse and attending surgeon staff satisfaction with the 24/7 NP Model of care and a decreased trend of unplanned intensive care unit patient transfers after the 24/7 NP Model implementation. These findings further support the evidence in the literature that NPs provide safe and quality patient care. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

  3. MATERNAL MORTALITY IN A TERTIARY CARE CENTRE

    Directory of Open Access Journals (Sweden)

    Harpreet

    2013-06-01

    Full Text Available ABSTRACT: Maternal Mortality in A Tertiary Care Centre. OBJECTIVE: To study maternal mortality and the complications leading to maternal death. METHODS: A retrospective study of hospital record to study maternal mortality and its causes over 3 years from January 2010 to December 2012. RESULTS: There were a total of 58 maternal deaths out of 2823 live births giving a maternal mortality ratio of 2054.55 per one lakh live births. Unbooked and late referrals account for 77.58% of maternal deaths. The majority of deaths around 75.86% were in 20-30 years age group. Haemorrhage was the commonest causes of death (24.12% followed by sepsis (18.96% and pregnancy induced hypertension 15.51% Anemia contributed to the most common indirect cause of maternal morality. CONCLUSION: Haemorrhage, sepsis and pregnancy induced hypertension including eclampsia were the direct major causes of death. Anaemia and cardiac diseases were other indirect causes of death.

  4. Diabetic nephropathy: Prescription trends in tertiary care

    Directory of Open Access Journals (Sweden)

    Devi D

    2008-01-01

    Full Text Available Diabetic nephropathy is a leading cause of end stage renal disease. Drug utilization studies could promote rational drug use. The objective of this study was to evaluate prescribing trends in hospitalized patients with diabetic nephropathy. A prospective, observational study was conducted in a tertiary care hospital. The demographic, disease and treatment data of patients with diabetic nephropathy were collected for a period of six months and analysed. Drugs were classified using World Health Organization recommended Anatomic Therapeutic Chemical classification. A total of 755 drugs (7.4 drugs per prescription were prescribed to 102 study patients, who were all hypertensive and in late stages of diabetic nephropathy. Drug classes with largest representation were those acting on gastrointestinal tract plus metabolism (37% and cardiovascular drugs (28%. Calcium channel blockers represented the largest antihypertensive drug class (41%. Almost three-fourths of patients received more than one antihypertensive agent. Approximately 37% of patients did not receive any antidiabetic medication. Of those who did, prescriptions for insulin (91% exceeded those of oral hypoglycaemic drugs (9%. Antimicrobials accounted for 10.2% of all drugs prescribed, of which 31.8% were quinolones. Drugs prescribed by generic name accounted for 11.98%. While all patients received antihypertensive therapy, more than a third were not on any antidiabetic treatment. Antihypertensive poly-therapy was observed in the majority with calcium channel blockers being most frequently prescribed antihypertensive drug class. Insulin was the preferred to hypoglycaemic drugs.

  5. Suboptimal Clinical Documentation in Young Children with Severe Obesity at Tertiary Care Centers

    OpenAIRE

    Cassandra C. Brady; Thaker, Vidhu V.; Todd Lingren; Woo, Jessica G; Kennebeck, Stephanie S.; Bahram Namjou-Khales; Ashton Roach; Bickel, Jonathan P.; Nandan Patibandla; Savova, Guergana K; Imre Solti; Holm, Ingrid A.; Harley, John B.; Kohane, Isaac S; Nancy A. Crimmins

    2016-01-01

    Background and Objectives. The prevalence of severe obesity in children has doubled in the past decade. The objective of this study is to identify the clinical documentation of obesity in young children with a BMI ≥ 99th percentile at two large tertiary care pediatric hospitals. Methods. We used a standardized algorithm utilizing data from electronic health records to identify children with severe early onset obesity (BMI ≥ 99th percentile at age

  6. Patterns of cancer occurrence in a tertiary care centre

    Directory of Open Access Journals (Sweden)

    Atla Bhagyalakshmi

    2016-06-01

    Conclusions: The current study mainly summarizes the different patterns of cancer incidence in the tertiary care centre region. Cancer incidence is increasing gradually among the population and there is raise of cancer incidence in females compared to their counterparts. [Int J Res Med Sci 2016; 4(6.000: 2153-2163

  7. A case control study to find out child feeding practices responsible for severe acute malnutrition among under-five children admitted in MTC at a tertiary care centre, Bikaner, Rajasthan

    Directory of Open Access Journals (Sweden)

    Kavita Choudhary

    2014-12-01

    Full Text Available Introduction: There is no significant difference between NFHS II &III with respect to under- nutrition data but Gross national income has increased many times, so poverty and unavailability of food alone cannot be the only reasons of under- nutrition. Under-nutrition is the result of many interrelated factors such as poverty, insufficient household food security, inadequate health services, poor maternal and child care practices and inadequate water and sanitation. For communities with a high prevalence of under- nutrition, it may take years or even decades before all of these factors can be addressed. Aims and Objectives:  to find out child feeding practices responsible for severe acute malnutrition among Under-five Children and to recommend a Community Action Plan based on Positive Deviance Approach to deal with under-nutrition quickly, affordably and sustainably in a culturally acceptable manner. Materials & Methods: Study design: Matched Case Control study. Sample size: 143 cases and age, socio-economic status matched 143 controls. Study place: MTC and Immunization clinic. Study Duration: May, 2013- May, 2014. Study Tool and Data Collection: Semi-structured pre-tested questionnaire. Data analysis: with help of SPSS16 (Mean, SD, Proportion, odds ratio. Results: Strong positive association was found between duration of exclusive breast feeding(both shorter and longer, prelacteals, diluted milk as weaning food, bottle feeding, giving excess milk and less solid protein diet, not able to recognize cue of hunger by mother, lack of demand feeding, and severe acute malnutrition. Conclusion: Not any nutritional programme can help in preventing SAM unless we motivate the mothers for good child feeding and rearing practices. This can be achieved by identification of the Positive Deviant mothers from the same community and SES, who can motivate the mothers of SAM children and can practically demonstrate positive child feeding practices in a culturally

  8. Profile of Under-Five Malnourished Children Admitted in a Tertiary Care Teaching Hospital in Pune, India

    Directory of Open Access Journals (Sweden)

    Dhrubajyoti J Debnath

    2014-01-01

    Full Text Available Background: Malnutrition is a major public health problem in a developing country like India. Keeping this in mind a study was carried out to find the proportion of under-five children suffering from malnutrition among the under-five hospitalized children and to study co-morbid illnesses and epidemiological factors associated with malnutrition. Methods: This was a hospital-based cross sectional study carried out in the pediatric ward of a tertiary care teaching hospital in Pune, India. All under-five children suffering from malnutrition were studied over a period of 1 month. Results: Total number of under five children diagnosed as malnourished were 47 (39.83%. Moderate and severe/very severe malnutrition was statistically significantly higher in a girl child. The proportion of moderate and severe/very severe malnutrition was higher in low birth weight babies, children who were incompletely immunized for age. Faulty infant feeding practice was observed in 28 (59.6% children. Some of the co-morbid illnesses contributing to morbidity in the malnourished child were acute diarrheal diseases, acute respiratory infection, anemia, and septicemia. Conclusion: A large proportion of hospitalized children were malnourished. Girl child suffered from moderate to severe forms of malnutrition as compared to male child and this was the only statistically significant association. This may be due to neglect of girl child.

  9. Maternal mortality: a tertiary care hospital experience in Upper Egypt

    Directory of Open Access Journals (Sweden)

    Ahmed M. Abbas

    2016-05-01

    Conclusions: Preeclampsia and PPH, as well as their complications are the leading causes of death in one of the biggest tertiary care university hospitals in Egypt. However, there are other important avoidable predisposing factors that should be dealt with including lack of patient education, delayed transfer from other hospitals, and substandard practice. [Int J Reprod Contracept Obstet Gynecol 2016; 5(5.000: 1466-1471

  10. Prevalence of malnutrition in a tertiary care hospital in India

    OpenAIRE

    2013-01-01

    Introduction: Malnutrition adversely affects clinical outcome of hospitalized patients. This observational prospective study was done to assess the prevalence of malnutrition and its grade among patients admitted in a mixed intensive care unit (ICU) of a tertiary care hospital in order to help devise a comprehensive nutrition program for the malnourished. Materials and Methods: A total of 500 sequential patients admitted to the ICU were screened on admission over a year period for malnutritio...

  11. An Audit of plasma usage in Tertiary care hospital

    OpenAIRE

    Patel, Vaidehi Rajnikant; Gajjar, Maitrey; Bhatnagar, Nidhi; Shah, Mamta; Shah, Megha; Lahre, Saurabh

    2015-01-01

    Aims & Objectives:    1) To evaluate the usage of plasma in a tertiary care hospital.   2) To evaluate reasons for inappropriate transfusion of plasma. Introduction:  FFP contains plasma proteins and all the coagulation factors, including the labile factors V and VIII. There exist only a few firm indications for fresh frozen plasma transfusions and there is a growing consensus that most of the time this blood product is used inappropriately and without any scientific rationale.FFP transfu...

  12. Pattern of Breast Cancer in a Tertiary Care Center

    Directory of Open Access Journals (Sweden)

    A K Jha

    2010-03-01

    Full Text Available INTRODUCTION: Breast Cancer is the second commonest cause of cancer death in women. Almost all women survive breast cancer if it is detected before it starts to spread. The aim of the study is to analyze the demographical profile, stage of presentation, histological type, and treatment modalities of breast cancer in a tertiary care setting. METHODS: Total 1141 cases of breast cancer had been followed retrospectively from 1999 to 2006 A.D. in a tertiary care center and their patterns were analyzed. RESULTS: The mean age of presentation of breast cancer was 47.30 +/- 11.57 years in female and 59.03 +/- 14.63 in male, 31 (2.1% cases of breast cancer were male. There were 123 (10.78% stage I, 281 (24.62% stage II, 466 (40.84% stage III, and 271 (23.75% stage IV patients. Infiltrating ductal carcinoma was the commonest variety 610 (53.5%. Chemotherapy was the mainstay for treatment of breast cancer 341 (29.9% followed by surgery 287 (25.2%. CONCLUSIONS: Breast cancer trend is rising with more in late and advanced stages, mostly due to lack of awareness. Infiltrating ductal carcinoma is the commonest variety. Chemotherapy is the most commonly used modality of treatment. Male breast cancer present late and is not so uncommon. Keywords: breast cancer; chemotherapy; infiltrating ductal carcinoma; staging.

  13. Prevalence of malnutrition in a tertiary care hospital in India

    Directory of Open Access Journals (Sweden)

    Chandrashish Chakravarty

    2013-01-01

    Full Text Available Introduction: Malnutrition adversely affects clinical outcome of hospitalized patients. This observational prospective study was done to assess the prevalence of malnutrition and its grade among patients admitted in a mixed intensive care unit (ICU of a tertiary care hospital in order to help devise a comprehensive nutrition program for the malnourished. Materials and Methods: A total of 500 sequential patients admitted to the ICU were screened on admission over a year period for malnutrition using the Subjective Global Nutritional Assessment (SGNA score. Distribution of the degree of malnutrition according to co-morbidities was also documented. Results: Of the total, 198 (39.6% patients were malnourished, including one patient qualifying as severely malnourished; 68% patients were male, however, there was no statistically significant difference between nutrition status between sexes. Hypertension, diabetes, and cancer were the three most commonly encountered co-morbidities among the malnourished. A total of 86% of all cancer patients admitted were malnourished against only 12% of trauma patients. Conclusion: This study showed that almost two-fifth of the patients admitted were malnourished in this tertiary care hospital and that there is an urgent need to develop a comprehensive nutritional care program in many such Indian ICUs.

  14. Customer Satisfaction Survey With Clinical Laboratory and Phlebotomy Services at a Tertiary Care Unit Level

    National Research Council Canada - National Science Library

    Koh, Young Rae; Kim, Shine Young; Kim, In Suk; Chang, Chulhun L; Lee, Eun Yup; Son, Han Chul; Kim, Hyung Hoi

    2014-01-01

    We performed customer satisfaction surveys for physicians and nurses regarding clinical laboratory services, and for outpatients who used phlebotomy services at a tertiary care unit level to evaluate...

  15. Clinico-etiological profile of childhood stroke in a Tertiary Care Hospital in Eastern India

    Directory of Open Access Journals (Sweden)

    Chaitali Patra

    2015-01-01

    Full Text Available Background: The clinical pattern and etiology of stroke may vary over time or with geographical location. In Asian countries, specific etiology and outcome of childhood stroke have been rarely reported. Objective: To determine the clinical and etiological pattern of childhood stroke and their outcome in a Tertiary Care Center. Materials and Methods: This study was conducted in a Tertiary Care Hospital of Kolkata over a period of 3 years. All children from 6 months to 12 years, diagnosed as childhood stroke by radio-imaging were included in our study. Children presenting with paraplegia/paraparesis were excluded. Etiologies were determined on the basis of clinical examination, related blood investigations and radio-imaging findings. Data gathered from the stroke patients were entered into a preformed proforma and appropriate statistical analyses were done. Result: Most commonly found clinical presentation was hemiparesis (70.6%. Next in place was a seizure (61.8% and alteration of consciousness (58.8%. The most common etiology of childhood stroke in our hospital was found to be an intracranial infection (41.2%, followed by vascular etiology. Stroke was ischemic in nature in 91.2% of cases. Among the clinical features, vomiting, alteration of sensorium, and fever were significantly (P < 0.01 more in infectious cases of stroke, but hemiparesis was significantly (P < 0.05 more common in noninfectious etiology. Most of the cases of noninfectious etiology (95% completely recovered without any persistent neurodeficit or mortality. Conclusion: Intracranial infection is the commonest etiology of stroke in pediatric patients presenting at our hospital. Commonest type is an ischemic stroke. The most of the patients completely recovered from the acute neurological insult after proper and timely management.

  16. EPISTAXIS - ETIOLOGICAL PROFILE AND TREATMENT OUTCOME AT A TERTIARY CARE CENTRE

    Directory of Open Access Journals (Sweden)

    Waseem Ahmad

    2015-04-01

    Full Text Available BACKGROUND: Epistaxis is the commonest otolaryngological emergency affecting up to 60% of the population in their lifetime, with 6% requiring medical attention. This study was conducted to describe the etiological profile and treatment outcome of epistaxis at SKIMS Me dical College, Bemina, Srinagar, a tertiary care hospital. METHODS: This was a prospective descriptive study of the cases of epistaxis managed at SKIMS Medical College, Bemina, Srinagar, a tertiary care hospital, from July 2014 to January 2015.All patients of acute epistaxis due to any cause were included. The data for the following variables was collected; gender, age, age group, cause, type and laterality of epistaxis and success rate of treatment modalities. RESULTS: A total of 114 patients with epistaxi s were studied. Males were affected more than the females (1.8:1. Their mean age was 32.24 ± 12.54 years (range 4 to 82 years. The commonest cause of epistaxis was trauma (46.22% followed by hypertension (25.43% and idiopathic (18.43%. Anterior nasal bleeding was noted in majority of the patients (69.29%. Non - surgical measures were the main intervention methods in 99.12% of cases and of this, local cauterization (49.12% and anterior nasal packing (26.31% were most common non - surgical measures. Surgi cal measures mainly tumor resection was carried out in 0.87% of cases. The overall success rate of treatment was 92.0%. CONCLUSION: Epistaxis is the commonest otolaryngological emergency. Trauma resulting from road traffic accident (RTA remains the most c ommon etiological factor for epistaxis. Most cases can be successfully managed with conservative (non - surgical treatment alone and surgical intervention with its potential complications may not be necessary in most cases and should be the last resort. Red ucing the incidence of trauma from RTA will reduce the incidence of emergency epistaxis.

  17. Spectrum of Oral Lesions in A Tertiary Care Hospital

    Science.gov (United States)

    Chauhan, Ashok; Kumar, Parbodh

    2015-01-01

    Aim The present study was undertaken to study the spectrum and pattern of various oral cavity lesions in a tertiary care hospital in Rohilkhand region of Uttar Pradesh, India. Background Oral cavity is one of the most common sites for tumour and tumour like lesions especially in males. It has been observed that benign lesions are more common than malignant ones. Materials and Methods A retrospective study was carried out in a tertiary care hospital during the period of two years from June 2012 to May 2014. The study included 133 cases of oral cavity lesions. The parameters included in the study were age, gender, site of the lesion and histopathological diagnosis. Special stains and Immunohistochemical markers were applied as and when required. Data collected were analysed. Results A total of 133 cases were included in the present study. The age ranged from 8 to 80 years. Males were affected more often than females with a Male: Female ratio of 3.3:1. The most common involved site was tongue 39 (29.32%) followed by tonsil in 30 (22.56%), buccal mucosa 27(20.32%), floor of mouth 14 (10.53%), palate 12(9.02%), lower lip 8 (6.02%), upper lip 2(1.50%) and vestibule in 1 (0.75%) cases. Of the 133 cases, 63 cases (47.36%) were malignant, 52 non-neoplastic (39.10%) and 18 cases (13.53%) of benign neoplasias. The various lesions included - Squamous cell carcinoma, Verrucous carcinoma, Carcinoma-in-situ, Leukoplakia, Fibroma, Lipoma, Squamous cell papilloma, Lymphoid hyperplasia, Pseudoepitheliomatous hyperplasia, Haemangioma, Schwannoma, Atypical Pleomor -phic adenoma, Pleomorphic adenoma, Epidermal cyst, Retention cyst, Parasitic infestation, Tubercular pathology, Granulation tissue, Chronic Sialadenitis and Chronic non-specific inflammatory pathology. A larger epidemiopathological study in this region needs to be carried out for detailed statistical analysis. Conclusion Benign lesions were the predominant pathology. Squamous cell carcinoma was the commonest malignant

  18. ANALYSIS OF ORGANOPHOSPHORUS POISONING, AT TERTIARY CARE HOSPITAL: A REPORT

    Directory of Open Access Journals (Sweden)

    Shakuntala

    2015-01-01

    Full Text Available BACKGROUND: Organophosphorus (OP compounds are the most common suicidal poison in developing countries and mortality continues to be high. The present study was aimed to know the pattern and outcome of the OP poisoning. METHODOLOGY: A record based retrospective study from January 2013 - December 2013 was Conducted in a tertiary care hospital and data regarding age, gender, domicile, type of poison, manner of poisoning, seasonal trends, marital status, motive behind poisoning , socio - economic status and outcome was collected in a pre - structured Performa. All data were documented, analyzed and interpreted as per the laid down protocol. RESULTS : out of total 1575 cases of OP compound poisoning, 71.73% (1130 were male, 28.27% (445 were female, 34.6% were in the age group 21 - 30 years, 70.95% were of low socio - economic status, Occupation wise agricultural workers were on top of the list (70.07%, The commonest (93.78% motive behind poisoning was suicidal in both males and females, Financial problem was one of the commonest (51.22% reasons of poisoning. The mortality rate in our study was 13.47%. CONCLUSION : Y oung and adult males of Low socio - economic class, rural, both literate and illiterate agriculturists commonly abuse this substance to commit suicide

  19. Septic arthritis in adults in a tertiary care center.

    Science.gov (United States)

    Ornelas-Aguirre, José Manuel

    2016-01-01

    To describe the history, clinical features and microorganisms involved in a group of adult subjects with and without septic arthritis (SA) at a tertiary care in Mexico. A cross-sectional descriptive study was conducted on 96 adults with clinical suspicion of AS in one or more joints. In all cases synovial fluid arthrocentesis and culture was performed. The comparison group subjects were culture negative. A descriptive statistical analysis and binary logistic regression model was performed between the variables associated with the development of AS. A value of P≤.05 was significant. A total of 49 out of 96 subjects had a positive culture, mostly of the monoarticular type (96%; P=.02). The knee was the most common site (61%; P=.06) and pain was the main clinical manifestation (59%; P=.001). Staphylococcus was the most common etiological agent (65%; P<.001). The risk factors revealed in the final regression model were SA the history of joint disease (OR=25; P=.03) and volume increase (OR=13.16; P=.06). Functional limitation (OR=8.54; P=.04) showed a significant risk among borderline for SA. Our results are consistent with previous studies, and can be generalized to geographical areas with similar clinical features to those observed in this study. Copyright © 2014 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  20. Needle stick injuries in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Jayanth S

    2009-01-01

    Full Text Available Background: Accidental needle stick injuries (NSIs are an occupational hazard for healthcare workers (HCWs. A recent increase in NSIs in a tertiary care hospital lead to a 1-year review of the pattern of injuries, with a view to determine risk factors for injury and potential interventions for prevention. Methods: We reviewed 1-year (July 2006-June 2007 of ongoing surveillance of NSIs. Results: The 296 HCWs reporting NSIs were 84 (28.4% nurses, 27 (9.1% nursing interns, 45 (21.6% cleaning staff, 64 (21.6% doctors, 47 (15.9% medical interns and 24 (8.1% technicians. Among the staff who had NSIs, 147 (49.7% had a work experience of less than 1 year ( P < 0.001. The devices responsible for NSIs were mainly hollow bore needles ( n = 230, 77.7%. In 73 (24.6% of the NSIs, the patient source was unknown. Recapping of needles caused 25 (8.5% and other improper disposal of the sharps resulted in 55 (18.6% of the NSIs. Immediate post-exposure prophylaxis for HCWs who reported injuries was provided. Subsequent 6-month follow-up for human immunodeficiency virus showed zero seroconversion. Conclusion: Improved education, prevention and reporting strategies and emphasis on appropriate disposal are needed to increase occupational safety for HCWs.

  1. Seroprevalence of syphilis in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Kawal Preet Kaur

    2014-02-01

    Full Text Available Objective: To determine the prevalence of syphilis in a tertiary care hospital situated in Hisar, Haryana. Methods: The study is a five year study (Jan 2006 to Dec 2010, in which a total of 1550 sera obtained from clinically suspected cases of syphilis and pregnant females were screened for cardiolipin antibodies by the rapid plasma reagin (RPR test. The total number of males was 650 while the total number of females was 900. Results: The RPR test was positive in 48 patients (3.09%. Out of a total of 850 pregnant females, 10 (1.18% were tested positive through RPR test. Among the remaining 38 positive patients, males were 35 and females were 3. The most common age group affected was 19-24 years in both the sexes. Conclusions: Our findings showed that there is a substantial benefit of using an economical test like RPR for the diagnosis of syphilis in resource-poor setting. Great importance should be given to the screening of pregnant females for syphilis.

  2. Open-Access Single Balloon Enteroscopy: A Tertiary Care Experience.

    Science.gov (United States)

    Holman, Nathan; Wallace, Kristin; Moore, J Matthew; Brock, Andrew S

    2015-12-01

    To compare single balloon enteroscopy (SBE) between patients seen in consultation by a member of our gastroenterology team with those performed as open-access cases. Retrospective study of all patients who underwent SBE at a single tertiary care center from April 2008 to January 2012. Open- and closed-access procedures were compared in terms of diagnostic and therapeutic yield, adverse events, and procedural success. A total of 125 SBEs were performed on 125 patients. The mean age was 63.1 (53% men) years. In all, 43 procedures were performed open access and 82 after face-to-face consultation. Indications included anemia/gastrointestinal bleeding (110), abdominal pain (8), and other (7). Diagnostic yield for open- and closed-access procedures was 53% and 60%, respectively (P = 0.501) and therapeutic yield was 37% and 52%, respectively (P = 0.11). Overall technical success was 91% with no difference between the groups (P = 0.27). There were no major adverse events in either group. SBE can be performed as an open-access procedure without compromise to safety or diagnostic yield.

  3. Pediatric Mortality in a Rural Tertiary Care Center in Liberia

    Science.gov (United States)

    Tsai, Carmelle; Walters, Camila B.; Sampson, John; Kateh, Francis; Chang, Mary P.

    2017-01-01

    Liberia is a low-income country in West Africa that has faced significant challenges, including a civil war and the recent Ebola epidemic. Little data exists on the more current post-war and pre-Ebola trends of child health in Liberia in the rural setting. This study is a retrospective chart review of pediatric mortality in 2013 at a rural tertiary care center in Liberia, 10 years post-war. From January 2013 to December 2013, there were 50 pediatric deaths, or 5.4% of the 920 total pediatric admissions. The most common cause of neonatal death was sepsis, and the most common cause of death under five years of age was malaria. The majority (82.0%) of the deaths were in children under five. Pediatric mortality at this hospital was similar to other reported mortality six years post-war, and lower than that reported immediately post-war. Neonatal sepsis and malaria are two significant causes of pediatric mortality in this community and, therefore, further efforts to decrease childhood mortality should focus on these causes. PMID:28146099

  4. A study of medication errors in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Nrupal Patel

    2016-01-01

    Full Text Available Objective: To determine the nature and types of medication errors (MEs, to evaluate occurrence of drug-drug interactions (DDIs, and assess rationality of prescription orders in a tertiary care teaching hospital. Materials and Methods: A prospective, observational study was conducted in General Medicine and Pediatric ward of Civil Hospital, Ahmedabad during October 2012 to January 2014. MEs were categorized as prescription error, dispensing error, and administration error (AE. The case records and treatment charts were reviewed. The investigator also accompanied the staff nurse during the ward rounds and interviewed patients or care taker to gather information, if necessary. DDIs were assessed by Medscape Drug Interaction Checker software (version 4.4. Rationality of prescriptions was assessed using Phadke′s criteria. Results: A total of 1109 patients (511 in Medicine and 598 in Pediatric ward were included during the study period. Total number of MEs was 403 (36% of which, 195 (38% were in Medicine and 208 (35% were in Pediatric wards. The most common ME was PEs 262 (65% followed by AEs 126 (31%. A potential significant DDIs were observed in 191 (17% and serious DDIs in 48 (4% prescriptions. Majority of prescriptions were semirational 555 (53% followed by irrational 317 (30%, while 170 (17% prescriptions were rational. Conclusion: There is a need to establish ME reporting system to reduce its incidence and improve patient care and safety.

  5. Mucormycosis at a tertiary care centre in Gujarat, India.

    Science.gov (United States)

    Patel, Atul K; Patel, Ketan K; Patel, Kamlesh; Gohel, Swati; Chakrabarti, Arunaloke

    2017-06-01

    The prevalence of mucormycosis is reportedly high in India, although the studies are mainly from north and south India only. We analysed the mucormycosis cases at tertiary care centres of West India. We retrieved the clinical details of all the patients with probable and proven mucormycosis diagnosed at Sterling Hospital and ID clinic at Ahmedabad, Gujarat over the period from 1 January 2013 through 30 April 2015. The data were analysed to determine demography, risk factors, underlying diseases, site of infection and outcome of these patients. A total of 27 patients with the median age of 50 (16-65) years were diagnosed with mucormycosis during the period. Rhino-orbital-cerebral mucormycosis was the most common (51.9%) presentation. Majority (55.6%) of the patients had uncontrolled diabetes with or without ketoacidosis; 25.9% patients had no underlying disease and most of them (85.7%) had cutaneous mucormycosis. In this group, the mortality was 25.9% and an equal percentage of patients were lost to follow up; 14 (51.9%) patients could complete 6 weeks of amphotericin B therapy. All patients who completed antifungal therapy survived except one. Like other parts of India, uncontrolled diabetes was the predominant risk factor for mucormycosis in our group. Patients completing 6 weeks of amphotericin B treatment were likely to survive. © 2017 Blackwell Verlag GmbH.

  6. Perceived nursing service quality in a tertiary care hospital, Maldives.

    Science.gov (United States)

    Nashrath, Mariyam; Akkadechanunt, Thitinut; Chontawan, Ratanawadee

    2011-12-01

    The present study explored nurses' and patients' expectations of nursing service quality, their perception of performance of nursing service quality performed by nurses, and compared nursing service quality, as perceived by nurses and patients. The sample consisted of 162 nurses and 383 patients from 11 inpatient wards/units in a tertiary care hospital in the Maldives. Data were collected using the Service Quality scale, and analyzed using descriptive statistics and the Mann-Whitney U-test. The results indicated that the highest expected dimension and perceived dimension for nursing service quality was Reliability. The Responsiveness dimension was the least expected dimension and the lowest performing dimension for nursing service quality as perceived by nurses and patients. There was a statistically significant difference between nursing service quality perceived by nurses and patients. The study results could be used by nurse administrators to develop strategies for improving nursing service quality so that nursing service delivery process can be formulated in such a way as to reduce differences of perception between nurses and patients regarding nursing service quality. © 2011 Blackwell Publishing Asia Pty Ltd.

  7. SPECTRUM OF POISONING IN CHILDREN: STUDY FROM TERTIARY CARE HOSPITAL IN SOUTH INDIA

    Directory of Open Access Journals (Sweden)

    Mallesh

    2015-08-01

    Full Text Available PURPOSE: To understand pattern of poisoning in different age group in tertiary child care center and quantify burden of poisoning in pediatric admissions and mortality. DESIGN: Retrospective observation study. SETTING: Tertiary care center for children. METHODS: All the children admitted with diagnosis of acute poisoning between January 2013 and June 2015 was studied. RESULTS: There were 332 admissions due to poisoning during the study period (5.4% of total admissions. Mortality due to poisoning was 7, i.e. , 1.97% of all - cause mortality. 2.1% of poisonings died during the study period where a s overall mortality from all causes was 5.71%. House hold Products topped the list with 112 cases, followed by agricultural products (88 cases, animal bites and stings (69 cases, drugs (48 cases and industrial compounds (7 cases. Majority of admissions were in summer seasons 31% of all poisoning followed by rainy season. CONCLUSIONS: Incidence of acute poisoning in childhood has not changed significantly over time. Organophosphorus compounds, phosphides and drugs poisoning peak during adolescence and is particularly alarming. Conditions such as free availability of these compounds, co morbid conditions of adolescents, adolescent stressors have to be addressed

  8. Awareness and practices regarding bio-medical waste management among health care workers in a tertiary care hospital in Delhi

    Directory of Open Access Journals (Sweden)

    G Bhagawati

    2015-01-01

    Full Text Available Health care institutions are generating large amount of Bio-Medical Waste (BMW, which needs to be properly segregated and treated. With this concern, a questionnaire based cross-sectional study was done to determine the current status of awareness and practices regarding BMW Management (BMWM and areas of deficit amongst the HCWs in a tertiary care teaching hospital in New Delhi, India. The correct responses were graded as satisfactory (more than 80%, intermediate (50–80% and unsatisfactory (less than 50%. Some major areas of deficit found were about knowledge regarding number of BMW categories (17%, mercury waste disposal (37.56% and definition of BMW (47%.

  9. Pneumothoraces in a Neonatal Tertiary Care Unit: Case Series

    Directory of Open Access Journals (Sweden)

    Rehan Ali

    2013-01-01

    Full Text Available Objective: Neonatal pneumothoraces are associated with high mortality. Prompt recognition to minimize its complications is paramount for ultimate outcome of these babies.Methods: A retrospective case series study was carried out at Aga khan University Hospital, from January 2010 to December 2010 to determine the etiology and outcome of neonates with pneumothorax in a neonatal tertiary care unit.Results: Ten neonates diagnosed radiologically with pneumothoraces were included. M: F ratio was 1:2.3. Birth weight ranged from 1750-3600 grams with a mean of 2100 grams. The occurrence of pneumothoraces was 50% on the left side, 20% on right, and 30% were bilateral. Primary etiology included pneumonia and sepsis (30%, hyaline membrane disease (20%, meconium aspiration syndrome (20% and congenital diaphragmatic hernia (10%. Spontaneous pneumothoraces were present in 20% of cases. In our study, the incidence of neonatal pneumothoraces was 2.5/1000 births compared to 10-15/1000 in Denmark, 10-20/1000 in Turkey and 6.3/1000 from Vermont Oxford Group. Despite the small number of cases, one incidental finding was the occurrence of pneumothorax, which declined in elective cesarean section after 37 weeks gestation i.e., 1.3 of 1000 births. Mortality was 60% determined mainly by the primary etiology and other co-morbid conditions.Conclusion: The study showed a higher number of mortality cases (60%. Although, it was difficult to draw a conclusion from the limited number of cases, there may be a benefit on neonatal respiratory outcome to be obtained by better selection of mothers and by waiting until 37 weeks before performing elective cesarean section. Adequate clinician training in soft ventilation strategies will reduce the occurrence of pneumothoraces.

  10. Trichomonas vaginalis Infection in a Tertiary Care Vaginitis Center.

    Science.gov (United States)

    Keating, Maria A; Nyirjesy, Paul

    2015-09-01

    Trichomonas vaginalis infection (TVI) is one of the most common sexually transmitted diseases in the United States. We sought to determine the features of TVI in a referral-based vaginitis center, focusing on diagnosis and treatment of difficult cases. We conducted a retrospective review of all patients with TVI, based on International Classification of Diseases, Ninth Revision codes, seen at the Drexel Vaginitis Center between January 2008 and November 2013. Information collected on each subject included demographics, symptoms, examination findings, diagnostic tests, and treatment regimens. Of approximately 4000 new patient visits during our study period, 80 subjects were identified with TVI. Twenty subjects presented with known TVI, with most having clinically resistant infections. Diagnosis was confirmed by saline microscopy in 45%, OSOM rapid test in 40%, and clinical history in the remaining 15%. Treatment regimens varied: 20% received single 2-g dosing of either metronidazole or tinidazole, 50% received high-dose regimens, 20% received therapy with vaginal paromomycin, and 10% underwent desensitization for nitroimidazole allergy. Sixty subjects had newly diagnosed TVI, with 35% diagnosed by saline microscopy, 41.7% by OSOM rapid test, and 23.3% by APTIMA. Treatment regimens for these subjects included single 2-g dosing in 88.3%, high-dose regimen in 8.3%, and other formulations in the remaining 3.4%. In total, 80% of our subjects returned for follow-up; all of whom were cured. T. vaginalis infection is a rare condition in a tertiary care vaginitis center and often requires nonstandard treatments. Among those who returned for follow-up, the cure rate was 100%.

  11. Neurological manifestations of HIV-AIDS at a tertiary care center in western Maharashtra

    Directory of Open Access Journals (Sweden)

    Virendra C Patil

    2014-07-01

    Full Text Available Background: There is an increasing incidence of patients infected with human immunodeficiency virus (HIV in India. The neurological manifestations of the disease are being seen more frequently. The nervous system is the most frequent and serious target of HIV infection. Aims and Objectives: To elucidate the spectrum of neurological involvement in patients with HIV infection at a tertiary care teaching hospital in western Maharashtra. We investigated various neurological manifestations of HIV including opportunistic infections (OPIs and non-opportunistic infections (non-OPIs. Settings and Design: This was a retrospective observational study conducted at a tertiary care center in western Maharashtra over a period of 2 years from Jan 2009 to Dec 2010. Materials and Methods: A total of 81 HIV seropositive patients of both genders, of age >18 years, with neurological manifestations admitted at a tertiary care center were studied for clinical parameters, laboratory investigations and imaging. Statistical Analysis: Data were coded by numbers and double entered in a computer software SSPE-11 trial version. Results: A total of 179 patients admitted with HIV infection, of which 81 (45.25% presented with neurological manifestations (neuro-acquired immunodeficiency syndrome [AIDS], were enrolled in the study. Overall, 53 (65.43% patients were male (34 years ± 11 and 28 (34.56% were female (29 years ± 8. The male patients were outnumbered compared with the female patients, with P = 0.02. A total of 45 (55.55% patients had OPIs and 36 (44.44% patients had non-oppurtunistic neurological manifestations affecting the nervous system (P = 1573; insignificant. A total of 15 (18.51% patients had immune reconstitution syndrome on antiretroviral therapy (A total of 11 (13.58% patients had seizures, eight (9.87% had ischemic stroke, eight (9.87% had aseptic meningitis, two (2.46% had intracranial hemorrhage, two (2.46% had vacuolar myelopathy, four (4.93% had AIDS

  12. Seroprevalence of dengue virus in a tertiary care hospital, Andhra Pradesh, South India

    Directory of Open Access Journals (Sweden)

    Srinivas Rao M.S.

    2013-08-01

    Full Text Available Background: Dengue fever and Dengue Haemorrhagic fever (DF/DHF is an acute viral disease caused by Dengue virus. The infection is transmitted by the bite of an infected female mosquito- Aedes aegypti. The Dengue virus causes significant morbidity and mortality in many parts of the world, including India, where it was first isolated in Calcutta, West Bengal during 1945. This study was conducted to know the seroprevalence of Dengue virus in a tertiary care hospital, Hyderabad Methods: Blood for serological studies are carefully collected taking due universal precautions from suspected DF/DHF cases (a as soon as possible after hospital admission or attendance. All the patients were screened for anti-Dengue IgG and IgM antibodies By Enzyme Immunoassay. The study period was 18 months from 2012. Results: From a total of 1327serum samples tested were screened for Dengue IgM and IgG among which 706(53.2% were positive. 125(17.7% were only IgM positive and 198(28.05% of the tested samples showed only IgG positive. 383(54.25% of the tested samples revealed positive for both IgM and IgG antibodies. Conclusion: Surveillance is prerequisite for monitoring the dengue situation in the area and should be carried out regularly for early detection of an impending outbreak and to initiate timely preventive and control measures. [Int J Res Med Sci 2013; 1(4.000: 448-450

  13. Trend and manifestations of falciparum malaria in a tertiary care hospital of India.

    Science.gov (United States)

    Saya, Rama Prakasha; Saya, Ganesh Kumar; Debabrata, Goswami

    2016-01-01

    The recent focus is on the increase in the burden of falciparum cases with a varied spectrum of presentation and outcome, especially in developing countries like India. This study was undertaken to analyze the trend and manifestations of falciparum malaria in a tertiary care hospital. This descriptive study was carried out at the Gauhati Government Medical College and Hospital from June 2006 to May 2007. The data were collected on demographic and time characteristics, clinical and laboratory findings, the outcome of disease and expressed in proportion or percentages. Out of the 100 cases, around 2(nd)/3(rd) (63%) of cases were in the age group of 15-30 years and the mean age was found to be 29.51 years. About 66% of them were males. Clinical presentations included pain abdomen (42, 42%), nausea and vomiting (35, 35%), jaundice (34, 34%), oliguria (24, 24%), altered sensorium (24, 24%), breathing difficulty (10, 10%), and seizures (5, 5%). Number of cases and mortality were more with a peak in the month of May and September. Manifestations of severe falciparum malaria included hepatopathy (38%), renal failure (28%), shock (9%), acute respiratory distress syndrome (7%), hypoglycemia (3%), and severe anemia (1%). Eighty-two cases (82%) recovered and 18 cases (18%) expired. Falciparum malaria is more among younger adult age group and males. Complications and mortality are also more due to falciparum malaria.

  14. Features of central serous chorioretinopathy presenting at a tertiary care hospital in Lahore.

    Science.gov (United States)

    Jamil, Ahmad Zeeshan; Mirza, Khurram Azam; Qazi, Zaheer Uddin Aqil; Iqbal, Wasim; Khaliq, Javed; Fawad-ur-Rahman; Ahmed, Arslan

    2013-04-01

    To evaluate the clinical, angiographic and optical coherence tomographic features of central serous chorioretinopathy in patients presenting at a tertiary care centre in Lahore. The observational study was conducted at the Layton Rehmatulla Benevolent Trust Eye and Cancer Hospital Lahore from July 15, 2010 to December 15, 2011. Patients who had received prior treatment for the condition and allergy to fluorescein were excluded. There were 86 eyes of 64 adult patients with central serous chorioretinopathy. The following data was recorded: history, signs and symptoms, best corrected visual acuity, fundus fluorescein angiography, and central macular thickness measurement with optical coherence tomography. Data was analyzed using SPSS 17. Mean age of patients who presented during the study duration was 39.52 +/- 8.85 years.There were 53 (82.8%) males and 11(17.2%) females. Of the total, 42 (65.6%) cases had unilateral and 22 (34.4%) cases had bilateral involvement. Chronic central serous chorioretinopathy was seen in 27 (42.2%) cases while 37 (57.8%) cases were acute presentations. Retinal pigment epithelial detachment was observed in 29 (45.3%) cases. On fundus fluorescein angiography, there were 62 (72.1%) eyes that showed ink blot pattern. Median visual acuity at presentation was 0.25. Median central macular thickness at presentation was 550.5micro. Central serous chorioretinopathy in the study sample was associated with pigment epithelial detachment, bilateral involvement, and presence of systemic diseases.

  15. Hypertensive Crisis, Burden, Management, and Outcome at a Tertiary Care Center in Karachi

    Directory of Open Access Journals (Sweden)

    Aysha Almas

    2014-01-01

    Full Text Available Objectives. Hypertension, if uncontrolled, can lead to hypertensive crisis. We aim to determine the prevalence of hypertensive crisis, its management, and outcome in patients presenting to a tertiary care center in Karachi. Methods. This was a cross-sectional study conducted at the Aga Khan University, Karachi, Pakistan. Adult inpatients (>18 yrs presenting to the ER who were known hypertensive and had uncontrolled hypertension were included. Results. Out of 1336 patients, 28.6% (387 had uncontrolled hypertension. The prevalence of hypertensive crisis among uncontrolled hypertensive was 56.3% (218. Per oral calcium channel blocker; 35.4% (137 and intravenous nitrate; 22.7% (88 were the most commonly administered medication in the ER. The mean (SD drop in SBP in patients with hypertensive crisis on intravenous treatment was 53.1 (29 mm Hg and on per oral treatment was 43 (27 mm Hg. The maximum mean (SD drop in blood pressure was seen by intravenous sodium nitroprusside; 80 (51 mm Hg in SBP. Acute renal failure was the most common complication with a prevalence of 11.5% (24. Conclusion. The prevalence of hypertensive crisis is high. Per oral calcium channel blocker and intravenous nitrate are the most commonly administered medications in our setup.

  16. Hypertensive Crisis, Burden, Management, and Outcome at a Tertiary Care Center in Karachi.

    Science.gov (United States)

    Almas, Aysha; Ghouse, Ayaz; Iftikhar, Ahmed Raza; Khursheed, Munawwar

    2014-01-01

    Objectives. Hypertension, if uncontrolled, can lead to hypertensive crisis. We aim to determine the prevalence of hypertensive crisis, its management, and outcome in patients presenting to a tertiary care center in Karachi. Methods. This was a cross-sectional study conducted at the Aga Khan University, Karachi, Pakistan. Adult inpatients (>18 yrs) presenting to the ER who were known hypertensive and had uncontrolled hypertension were included. Results. Out of 1336 patients, 28.6% (387) had uncontrolled hypertension. The prevalence of hypertensive crisis among uncontrolled hypertensive was 56.3% (218). Per oral calcium channel blocker; 35.4% (137) and intravenous nitrate; 22.7% (88) were the most commonly administered medication in the ER. The mean (SD) drop in SBP in patients with hypertensive crisis on intravenous treatment was 53.1 (29) mm Hg and on per oral treatment was 43 (27) mm Hg. The maximum mean (SD) drop in blood pressure was seen by intravenous sodium nitroprusside; 80 (51) mm Hg in SBP. Acute renal failure was the most common complication with a prevalence of 11.5% (24). Conclusion. The prevalence of hypertensive crisis is high. Per oral calcium channel blocker and intravenous nitrate are the most commonly administered medications in our setup.

  17. Etiological profile of noncompressive myelopathies in a tertiary care hospital of Northeast India

    Science.gov (United States)

    Kayal, Ashok Kumar; Goswami, Munindra; Das, Marami; Basumatary, Lakhshya Jyoti; Bhowmick, Suvorit Subhas; Synmon, Baiakmenlang

    2017-01-01

    Background: The discovery of antibodies against aquaporin-4 and evolving concepts of noncompressive myelopathies in the 21st century have made a major impact on the etiological profile of these diseases, with few cases turning out to be idiopathic. Objective: To find causes of noncompressive myelopathy in a tertiary care hospital of Northeast India. Materials and Methods: An observational study was carried out in the Neurology Department of Gauhati Medical College, Guwahati, from September 2013 to February 2016. Patients of noncompressive myelopathies who underwent magnetic resonance imaging (MRI) of the spine were segregated into two categories: acute-to-subacute myelopathy (ASM) and chronic myelopathy (CM). In addition to routine blood tests, chest X-ray, urinalysis, and visual evoked potentials, investigations included MRI of the brain, cerebrospinal fluid analysis, and immunological, infectious, and metabolic profile based on the pattern of involvement. Results: The study had 151 patients (96 ASM and 55 CM) with a median age of 35 years and male: female ratio 1.4:1. The causes of ASM were neuromyelitis optica spectrum disorder (23), multiple sclerosis (MS) (8), systemic lupus erythematosus (1), Hashimoto's disease (1), postinfectious acute disseminated encephalomyelitis (6), postinfectious myelitis (8), infections (9), spinal cord infarct (5), and electrocution (1). The causes of CM were MS (1), probable or possible sarcoidosis (7), mixed connective tissue disease (1), Hashimoto's disease (2), infections (9), Vitamin B12 deficiency (4), folate deficiency (2), hepatic myelopathy (2), radiation (11), and paraneoplastic (1). No etiology could be found in 48 (31.8%) patients (34 ASM and 14 CM). In 21/96 (21.9%) patients of ASM, acute transverse myelitis was idiopathic based on current diagnostic criteria. Conclusion: Underlying etiology (demyelinating, autoimmune, infectious, vascular, metabolic disorder, or physical agent) was found in 68% patients of

  18. Etiological profile of noncompressive myelopathies in a tertiary care hospital of Northeast India

    Directory of Open Access Journals (Sweden)

    Ashok Kumar Kayal

    2017-01-01

    Full Text Available Background: The discovery of antibodies against aquaporin-4 and evolving concepts of noncompressive myelopathies in the 21st century have made a major impact on the etiological profile of these diseases, with few cases turning out to be idiopathic. Objective: To find causes of noncompressive myelopathy in a tertiary care hospital of Northeast India. Materials and Methods: An observational study was carried out in the Neurology Department of Gauhati Medical College, Guwahati, from September 2013 to February 2016. Patients of noncompressive myelopathies who underwent magnetic resonance imaging (MRI of the spine were segregated into two categories: acute-to-subacute myelopathy (ASM and chronic myelopathy (CM. In addition to routine blood tests, chest X-ray, urinalysis, and visual evoked potentials, investigations included MRI of the brain, cerebrospinal fluid analysis, and immunological, infectious, and metabolic profile based on the pattern of involvement. Results: The study had 151 patients (96 ASM and 55 CM with a median age of 35 years and male: female ratio 1.4:1. The causes of ASM were neuromyelitis optica spectrum disorder (23, multiple sclerosis (MS (8, systemic lupus erythematosus (1, Hashimoto's disease (1, postinfectious acute disseminated encephalomyelitis (6, postinfectious myelitis (8, infections (9, spinal cord infarct (5, and electrocution (1. The causes of CM were MS (1, probable or possible sarcoidosis (7, mixed connective tissue disease (1, Hashimoto's disease (2, infections (9, Vitamin B12deficiency (4, folate deficiency (2, hepatic myelopathy (2, radiation (11, and paraneoplastic (1. No etiology could be found in 48 (31.8% patients (34 ASM and 14 CM. In 21/96 (21.9% patients of ASM, acute transverse myelitis was idiopathic based on current diagnostic criteria. Conclusion: Underlying etiology (demyelinating, autoimmune, infectious, vascular, metabolic disorder, or physical agent was found in 68% patients of noncompressive

  19. MULTIDRUG RESISTANT BACTERIA IN A TERTIARY CARE HOS PITAL.

    Directory of Open Access Journals (Sweden)

    Sujata

    2012-12-01

    bacteria at a particular time, which should be reviewed as an d when required. Rational antibiotic use and effective infection control practices can go a long way in preventing the development of antibiotic resistance. KEY WORDS: Multidrug resistant bacteria; Tertiary care hospital.

  20. Malnutrition Matters in Canadian Hospitalized Patients: Malnutrition Risk in Hospitalized Patients in a Tertiary Care Center Using the Malnutrition Universal Screening Tool.

    Science.gov (United States)

    Rahman, Adam; Wu, Thomas; Bricknell, Ryan; Muqtadir, Zack; Armstrong, David

    2015-10-01

    Malnutrition is common in Canadian hospitalized patients, yet system-wide malnutrition screening is not mandatory in Canada. Our goal was to define the point prevalence of malnutrition risk at a major tertiary care center in Hamilton, Ontario, using the Malnutrition Universal Screening Tool (MUST) to determine feasibility of hospital-wide screening in the Canadian context. After research ethics approval was obtained, we arranged for a clinical nutrition support team to conduct the MUST screening on all inpatients at Hamilton Health Sciences, Juravinski site, a large academic acute care hospital. A total of 315 patients were included (female, n = 160 [51%]; male, n = 155 [49%]; average age, 71 years). We identified 31% at high risk for malnutrition and 14% at medium risk, keeping with reported rates of malnutrition in the literature. Survey of dietitians and interns indicated that the MUST was easy to use and perform and that they had support of their unit supervisors. All respondents thought that the screen was useful and they wanted to repeat it. The MUST is an easy and efficient way to define point prevalence of malnutrition risk in Canadian hospitalized patients. Moving to system-wide nutritional screening will bring about the best practices in nutrition care with the involvement of key stakeholders and decision makers. Nutritional screening will allow us to utilize nutrition resources more efficiently, engage administrators in addressing shortfalls in nutrition care, and form a baseline for which to measure the efficacy of future nutritional interventions. © 2015 American Society for Parenteral and Enteral Nutrition.

  1. Acute Renal Failure in Snake Envenomation: A Large Prospective Study

    Directory of Open Access Journals (Sweden)

    Athappan Ganesh

    2008-01-01

    Full Text Available Venomous snakebite is a common problem in India. The aim of this study is to assess the prevalence, risk factors and prognostic factors in snakebite induced acute renal failure and to determine their outcome from a tertiary care center in India. A total of 1548 cases of snakebite admitted to adult medical wards of Government Rajaji hospital from January 2003 to December 2004, were studied from hospitalization to discharge or death. There were 1180 poisonous and 368 nonpoisonous snakebites. Among the poisonous, there were 1121 viperidae and 59 elapidae bites. A total of 159 (13.5% patients (M = 98, F = 61 developed acute renal failure; of them 72 (45.3% required dialysis and 36 (22.6% expired (of them, 23 required dialysis. ARF patients were older than non ARF (39.1 vs. 35.4 years, p = 0.03. Cellulites (OR 9.20, p = 0.032, regional lymphadenopathy (OR 22.0, p= 0.001, intravascular hemolysis (OR 3.70, p = 0.004 and bite to needle time more than 2 hours (OR 2.10, p = 0.001 were identified as independent risk factors for the development of acute renal failure. Bite to needle time more than 2 hours (OR 2.10, p = 0.01, presence of intravascular hemolysis (OR 13.0, p = 0.004 and hypotension (OR 22.2, p = 0.04 and the presence of bleeding manifestations (OR 7.91, p = 0.032 were identified as independent predictors of poor outcome in snakebite victims. We conclude that our study demonstrates several risk factors and predictors for the development and outcome of ARF in patients with snakebites.

  2. An analysis of paramilitary referrals to psychiatric services at a tertiary care center

    Directory of Open Access Journals (Sweden)

    Rohit Verma

    2013-01-01

    Full Text Available Background: There is a dearth of specialized mental health services for Indian paramilitary service personnel. Those requiring psychiatric evaluation are referred to government psychiatric services often with minimal information. Hence, major diagnostic and decision making relies on the psychiatrist′s clinical evaluation and judgment. The aim of the present study was to quantitatively evaluate the paramilitary referrals to psychiatric services at a tertiary care referral center. Materials and Methods: A retrospective chart analysis of all consecutive referrals by various Indian paramilitary services to a tertiary care hospital (2008-2010 was carried out. Results: Among the sample of 18 referrals, all were males (mean age: 37 years ± standard deviation (SD =7.79. Various reasons for referral included: Evaluation of fitness for duty (83.3%, fitness to handle firearms (16.7%, and for disability certification (5.6%. There were no informants at all in 22.2%, and family members were available in only 11.1%. Hence, most referrals were admitted to the psychiatry ward for observation for various lengths of time. The mean duration of assessment (outpatient and inpatient was 17.89 days (SD = 20.74 and final reported diagnoses were schizophrenia, depression, and bipolar disorder in 16.7, 11.1, and 11.1%, respectively. There was concurrent history of alcohol and nicotine dependence (40%. A large group (40% was diagnosed not to suffer from a major mental illness, while a firm and final diagnosis could not be arrived at in 16.7% subjects. Only one subject was given the fitness to handle firearms, fitness for duty was refused in three (16.7% subjects, and one subject was referred to neurology after being diagnosed as a case of seizure disorder. Conclusion: There is an urgent need for intensive training both to paramilitary physicians as well as to general hospital psychiatrists regarding proper assessment of paramilitary personnel, as there are frequent

  3. CLINICAL PROFILE OF ANAEMIA IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Ather Akhtar

    2016-04-01

    22 and the morphology was normocytic normochromic in 20 cases. Tuberculosis leading to anaemia was seen in 24, Internal haemorrhoids/Fissures 5, Taenia infestation in 3, Haematological Malignancies 2, GI Malignancies 3, Connective tissues disorders 3, Nutritional iron deficiency 8 and Anaemia of chronic diseases in remaining cases. Among the 22 cases having macrocytic anaemia, 11 had vitamin B 12 deficiency, 6 had subclinical hypothyroidism, 5 had alcoholism. Among the 20 patients having normocytic normochromic blood picture, 4 had haemolytic anaemia, 1 had aplastic anaemia and remaining were having anaemia of chronic disease mainly chronic kidney disease. Regarding treatment, 23 patients were transfused blood. Out of total 100 patients included in the study, in-hospital mortality was 10. CONCLUSIONS Anaemia is associated with a variety of diseases. As Tuberculosis and B 12 Deficiency are among the leading causes of anaemia, hypochromic and microcytic picture was the predominant picture in peripheral blood smear. Among the patients having normocytic normochromic blood picture, majority were having chronic kidney disease which may be due to the fact that our hospital is a tertiary referral centre for chronic renal failure. In-hospital mortality due to anaemia alone is lower in tertiary care centres, but the mortality in our study is due to associated comorbid conditions like chronic renal failure and malignancy.

  4. Suboptimal Clinical Documentation in Young Children with Severe Obesity at Tertiary Care Centers

    Science.gov (United States)

    Brady, Cassandra C.; Lingren, Todd; Woo, Jessica G.; Kennebeck, Stephanie S.; Namjou-Khales, Bahram; Roach, Ashton; Bickel, Jonathan P.; Patibandla, Nandan; Savova, Guergana K.; Solti, Imre; Holm, Ingrid A.; Harley, John B.; Kohane, Isaac S.; Crimmins, Nancy A.

    2016-01-01

    Background and Objectives. The prevalence of severe obesity in children has doubled in the past decade. The objective of this study is to identify the clinical documentation of obesity in young children with a BMI ≥ 99th percentile at two large tertiary care pediatric hospitals. Methods. We used a standardized algorithm utilizing data from electronic health records to identify children with severe early onset obesity (BMI ≥ 99th percentile at age <6 years). We extracted descriptive terms and ICD-9 codes to evaluate documentation of obesity at Boston Children's Hospital and Cincinnati Children's Hospital and Medical Center between 2007 and 2014. Results. A total of 9887 visit records of 2588 children with severe early onset obesity were identified. Based on predefined criteria for documentation of obesity, 21.5% of children (13.5% of visits) had positive documentation, which varied by institution. Documentation in children first seen under 2 years of age was lower than in older children (15% versus 26%). Documentation was significantly higher in girls (29% versus 17%, p < 0.001), African American children (27% versus 19% in whites, p < 0.001), and the obesity focused specialty clinics (70% versus 15% in primary care and 9% in other subspecialty clinics, p < 0.001). Conclusions. There is significant opportunity for improvement in documentation of obesity in young children, even years after the 2007 AAP guidelines for management of obesity. PMID:27698673

  5. Pathways to care among persons with dementia: Study from a tertiary care center.

    Science.gov (United States)

    Hossien, Sk Altaf; Loganathan, Santosh; Kolar Sridara Murthy, Meena; Palanimuthu Thangaraju, Sivakumar; Bharath, Srikala; Varghese, Mathew

    2017-08-23

    The prevalence of dementia is increasing rapidly, specifically in low and middle income countries (LAMIC) due to demographic aging. Help seeking is delayed and usually sought at an advanced stage of illness and many are yet to receive a formal diagnosis. We interviewed 35 caregivers of persons with Dementia (as per ICD-10) using a semi-structured questionnaire, the Short Explanatory Model Interview (SEMI). We explored the pathways taken by caregivers of people with dementia en route to a tertiary care centre and the interactions they had with different health care providers. Qualitative data analysis was done using ATLAS.ti. We identified three major pathways: I) The Neuropsychiatric pathway II) The General Practitioner pathway and III) The Non-cohesive pathway. In general, the caregivers were poorly informed about the illness details such as diagnosis, course and outcome. Neurologists communicated the diagnosis of 'Dementia' more frequently. When information was made available, the caregivers were satisfied with proper information about illness and with at least, partial improvement of symptoms. There is a need for increasing the awareness of dementia in community at large. Health services and systems that address this important public health problem need strengthening. Sensitization and training of primary care physician and staff to identify dementia at an early stage are the need of the hour. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Antimicrobial drugs usage in a tertiary care hospital –A descriptive study

    Directory of Open Access Journals (Sweden)

    Priestly Vivekkumar

    2015-10-01

    Full Text Available Background: Emergence of resistant organisms is alarmingly high all over the world. Irrational and inappropriate prescription of antimicrobials is the major contributing factor for developing drug resistance in addition to poor patient compliance. It is the high time to create awareness of antimicrobial resistance among physicians and patients. Encouraging physicians/surgeons to undergo training programmes on infectious disease control periodically would be beneficial to combat the resistant organisms, so called super bugs.Objectives: To assess the pattern of antimicrobial usage in a tertiary care hospital, to determine whether antimicrobials are prescribed judiciously.Methods: A retrospective study was conducted to determine the current antimicrobial prescribing practices at Tagore Medical College Hospital. A randomised sample of 100 inpatient case sheets of General Medicine, OBG, General Surgery, Paediatrics, Chest Medicine, Skin, and ENT from Medical Records Department was analysed with respect to oral and parenteral (iv administration of antimicrobials.Results: In this study, 53% were males and 47% were females. Majority of patients were middle aged (17-60yrs. A total of 16 antimicrobials were prescribed for 100 inpatients. The most frequently used were Metronidazole and Ciprofloxacin. Duration of treatment was minimum 3 days, maximum of 13 days and mean duration was 5.5 days. The common route by which antimicrobials were administered was Parenteral as the patients were inpatients. The Parenteral (iv drugs were Metronidazole (52%, Ciprofloxacin (42%, Cefotaxime (27%, Amikacin (7%, Ceftriaxone (7%. Among 100 prescriptions, 63% were empirical prescriptions, 12% were directed and 25% were targeted prescriptions.Conclusions: The most frequently used antimicrobials were Metronidazole and Ciprofloxacin and the condition for which the antimicrobials were commonly used was acute gastroenteritis. The proportion of targeted prescriptions was low

  7. INCREASING PREVALENCE OF HEPATITIS AMONG TRANSFUSIO N TRANSMITTED INFECTIONS: A TERTIARY CARE CENTRE EXPE RIENCE

    Directory of Open Access Journals (Sweden)

    Rupinder

    2012-11-01

    Full Text Available ABSTRACT: Increasing Prevalence of Hepatitis among Transfusio n Transmitted Infections: A tertiary care centre experience. BACKGROUND: Blood transfusion despite being a lifesaving intervention may result in acute or delayed complica tions and carries the risk of transfusion– transmissible infections (TTI’s. There has been an alarming rise of hepatitis (B&C infection among blood donors and not much related to preventi on or prophylaxis has been done so as to reduce the risk of transmission. AIMS OF THE STUDY: The study was done to find out the prevalence of Hepatitis B and Hepatitis C among transf usion transmitted infections in a healthy blood donor population METHODOLOGY: A six years retrospective study of sero-reactive cas es of TTD’s among the blood donors was done (2004-2009 in Blood Transfusion Unit, Christian Medical College & Hospital, Ludhiana. The data was r etrieved from the blood bank records with special emphasis on hepatitis infection among the blo od donors. RESULTS: Over all 64,528 donors were screened for the Transfusion Transmitte d infections (HBV, HCV, HIV1&2,Malarial Parasite, and VDRL of which majority were males. O verall seroprevelance for the transfusion transmitted infections was 2.72%. Seropositivity for Hepatitis per se was 2.4%. Majority of the donors were reactive for HCV infection (1.4% follo wed by HBV (1.0%, HIV1&2(0.2%, VDRL (0.1% and Malaria parasite infection (0.02%. CONCLUSION: There has been an alarming rise of hepatitis cases, especially HCV among the blood do nor population which need to be looked upon and special preventive measures need to be taken at the national level to combat this problem

  8. Sex differences in native-valve infective endocarditis in a single tertiary-care hospital.

    Science.gov (United States)

    Sambola, Antonia; Fernández-Hidalgo, Nuria; Almirante, Benito; Roca, Ivo; González-Alujas, Teresa; Serra, Bernard; Pahissa, Albert; García-Dorado, David; Tornos, Pilar

    2010-07-01

    The aim of this study was to assess whether the clinical characteristics, management, and outcomes of infective endocarditis differ in women and men through a prospective observational cohort study at a single tertiary care teaching hospital. From January 2000 to December 2008, 271 new cases of infective endocarditis were diagnosed (183 in men, 88 in women) according to modified Duke criteria, and patients were followed for 1 year. Women were older than men (mean age 63 +/- 16 vs 58 +/- 18 years, p = 0.006); more women were taking immunosuppressants (14% vs 3%, p = 0.006) and had mitral valve involvement (52% vs 36%, p = 0.02). However, more men had human immunodeficiency virus infection than women. There were no gender differences in Charlson index, regurgitation severity, culprit pathogens, or major complications. When surgery was indicated, women were less likely to undergo the procedure (26% vs 47%, relative risk [RR] 0.4, 95% confidence interval [CI] 0.2 to 0.7), p = 0.001). Mortality tended to be higher in women in the hospital (32% vs 23%, RR 1.58, 95% CI 1 to 2.5, p = 0.05) and at 1 year (38% vs 26%, RR 1.7, 95% CI 1.0 to 2.9, p = 0.04). Surgical treatment was a protective factor against death in the hospital (RR 0.18, 95% CI 0.04 to 0.77, p = 0.02) and at 1 year (RR 0.12, 95% CI 0.03 to 0.48, p = 0.03) after adjustment for age, gender, Charlson index, infection by Staphylococcus aureus, severity at presentation, heart failure, acute renal failure, stroke, and the ejection fraction. In conclusion, women with infective endocarditis were slightly older than men but showed similar co-morbidities. Women underwent surgery less frequently and consequently had worse prognosis than men.

  9. PRESCRIPTION AUDIT OF ACNE VULGARIS IN SKIN OUTPATIENT DEPARTMENT OF A TERTIARY CARE TEACHING HOSPITAL

    Directory of Open Access Journals (Sweden)

    Vishal Prakash

    2014-10-01

    Full Text Available : OBJECTIVE: To evaluate prescribing pattern in acne vulgaris cases at a tertiary care teaching hospital in south India. METHODS: Prescriptions of 120 patients of acne vulgaris who attended Dermatology OPD of a tertiary care teaching hospital were selected for study and their drug data were analyzed. RESULTS: Topical Benzoyl peroxide, adapalene, ketoconazole were prescribed as monotherapy, while aloevera, liquid paraffin and white soft paraffin as polytherapy. Azithromycin, antibiotics, anti histaminics were prescribed as systemic monotherapy and polytherapy. Statistical analysis revealed p-value was > 0.05. CONCLUSIONS: Prescription patterns were in consensus with the general guidelines, with few changes, in the choice of established therapeutic agents.

  10. Avoidable iatrogenic complications of urethral catheterization and inadequate intern training in a tertiary-care teaching hospital.

    Science.gov (United States)

    Thomas, Arun Z; Giri, Subhasis K; Meagher, David; Creagh, Tom

    2009-10-01

    To examine the magnitude of potentially avoidable iatrogenic complications of male urethral catheterization (UC) within a tertiary-care supra-regional teaching hospital, and to evaluate risk factors and subjective feeling of interns in our institution on the adequacy of training on UC. Male UC-related morbidities were retrospectively identified from our computerized inpatient urology consultation system over a 1-year period from July 2006 to June 2007. Relevant medical records were also reviewed. An anonymous questionnaire was used for the subjective assessment of interns about their training on UC. The primary outcome measures were the prevalence of urethral trauma secondary to UC by a non-urological team member in non-urological departments, risk factors and intern-perceived adequacy of practical and theoretical training on UC during their intern year, and finally the supervision of interns during first UC. Of 864 urological consultations, 51 (6%) were related to complications arising from male UC during the 1-year period. The most common indication for UC was monitoring urinary output for acute medical illness (34/51, 67%). The most common complication was urethral trauma (35/51, 67%). The balloon was accidentally inflated in the urethra in six patients (12%). Of the 51 cases of UC-related morbidity, 38 (74%) resulted from interns performing UC, and of these 28 (73%) occurred during the first 6 months of internship. Overall, 76% of interns felt that their practical training was none or inadequate; 52% (26/50) did not receive any supervision during their first UC. UC-related iatrogenic morbidity is not uncommon even in a tertiary-care teaching hospital. This study identified that interns receive inadequate training on UC. Finally, most of the complications are potentially avoidable and can be prevented by adopting a proper technique of catheterization. Adequate training and supervision of medical students and interns can achieve this.

  11. Adverse blood transfusion reactions at tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Surekha K. Chavan

    2016-06-01

    Conclusions: Not a single case of anaphylactic reactions, TRALI, acute immune hemolytic transfusion reaction, and Sepsis was observed. This can be an underestimation of the true incidence because of under reporting which can be improved by proper hemovigilence system to provide better patient care. [Int J Res Med Sci 2016; 4(6.000: 2402-2407

  12. Anti-Nuclear Antibodies in Daily Clinical Practice: Prevalence in Primary, Secondary, and Tertiary Care

    Directory of Open Access Journals (Sweden)

    Thomas Y. Avery

    2014-01-01

    Full Text Available For the diagnosis of systemic autoimmune rheumatic diseases (SARD, patients are screened for anti-nuclear antibodies (ANA. ANA, as assessed by indirect immunofluorescence (IIF, have a poor specificity. This hampers interpretation of positive results in clinical settings with low pretest probability of SARD. We hypothesized that the utility of positive ANA IIF results increases from primary to tertiary care. We retrospectively determined ANA, anti-ENA, and anti-dsDNA antibody prevalence in patient cohorts from primary (n=1453, secondary (n=1621, and tertiary (n=1168 care settings. Results reveal that from primary care to tertiary care, ANA prevalence increases (6.2, 10.8, and 16.0%, resp.. Moreover, in primary care low titres (70% versus 51% and 52% in secondary and tertiary care, resp. are more frequent and anti-ENA/dsDNA reactivities are less prevalent (21% versus 39% in secondary care. Typically, in tertiary care the prevalence of anti-ENA/dsDNA reactivities (21% is lower than expected. From this descriptive study we conclude that positive ANA IIF results are more prone to false interpretation in clinical settings with low pretest probabilities for SARD, as in primary care. Whether alternative approaches, that is, immunoadsorption of anti-DFS70 antibodies or implementation of anti-ENA screen assays, perform better, needs to be determined.

  13. Patterns of infections, aetiological agents, and antimicrobial resistance at a tertiary care hospital in northern Tanzania

    DEFF Research Database (Denmark)

    Kumburu, Happiness Houka; Sonda, Tolbert; Mmbaga, Blandina Theophil

    2017-01-01

    Objective To determine the causative agents of infections and their antimicrobial susceptibility at a tertiary care hospital in Moshi, Tanzania, to guide optimal treatment. Methods A total of 590 specimens (stool (56), sputum (122), blood (126) and wound swabs (286)) were collected from 575 patie...

  14. Carbapenem Resistance among Enterobacter Species in a Tertiary Care Hospital in Central India

    OpenAIRE

    Atul Khajuria; Ashok Kumar Praharaj; Mahadevan Kumar; Naveen Grover

    2014-01-01

    Objective. To detect genes encoding carbapenem resistance among Enterobacter species in a tertiary care hospital in central India. Methods. Bacterial identification of Enterobacter spp. isolates from various clinical specimens in patients admitted to intensive care units was performed by routine conventional microbial culture and biochemical tests using standard recommended techniques. Antibiotic sensitivity test was performed by standard Kirby Bauer disc diffusion technique. PCR amplificat...

  15. Molecular characterization of hepatitis A virus strains in a tertiary care health set up in north western India.

    Science.gov (United States)

    Singh, Mini Pritam; Majumdar, Manasi; Thapa, Babu Ram; Gupta, Puneet Kumar; Khurana, Jasmine; Budhathoki, Bimal; Ratho, Radha Kanta

    2015-02-01

    Hepatitis A virus usually causes acute viral hepatitis (AVH) in the paediatric age group with a recent shift in age distribution and disease manifestations like acute liver failure (ALF). This has been attributed to mutations in 5'non-translated region (5'NTR) which affects the viral multiplication. The present study was aimed to carry out the molecular detection and phylogenetic analysis of hepatitis A virus strains circulating in north western India. Serum samples from in patients and those attending out patient department of Pediatric Gastroenterology in a tertiary care hospital in north India during 2007-2011 with clinically suspected AVH were tested for anti-hepatitis A virus (HAV) IgM antibodies. Acute phase serum samples were subjected to nested PCR targeting the 5'NTR region followed by sequencing of the representative strains. A total of 1334 samples were tested, 290 (21.7%) were positive for anti-HAV IgM antibody. Of these, 78 serum samples (hepatitis A still a disease of children with III A as a circulating genotype in this region. The mutations at 5'NTR region warrant further analysis as these affect the structure of internal ribosomal entry site which is important for viral replication.

  16. Trend of human brucellosis over a decade at tertiary care centre in North Karnataka

    Directory of Open Access Journals (Sweden)

    D P Patil

    2016-01-01

    Full Text Available Background: Brucellosis is an important zoonotic disease. India having a major agrarian population is expected to have a higher prevalence. However, due to lack of laboratory facility or awareness among clinicians, the disease is largely underreported. The aim of this study was to know the prevalence and trend of human brucellosis over a decade, in patients attending a teaching hospital in North Karnataka, and to understand their geographical distribution. Materials and Methods: The study was conducted from January 2006 to December 2015 at a tertiary care teaching hospital in North Karnataka. A total of 3610 serum samples were evaluated from suspected cases of brucellosis. All serum samples were initially screened by Rose Bengal plate test, and positive samples were further analysed by Serum agglutination test (SAT using standard Brucella abortus antigen from Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh, India. A titre above or equal to 1:80 IU/ml was considered as positive. Demographic data such as age, sex and native place of these patients were also analysed. Results: We observed that human brucellosis is present in North Karnataka. The overall seropositivity of brucellosis in suspected cases was 5.1%. The positive titres ranged from 1:80 to 163,840 IU/ml. The majority of the patients were from Gadag, Koppal and Haveri districts of North Karnataka. Conclusion: Our study confirms the presence of human brucellosis in the northern part of Karnataka. Further studies to understand the prevalence of animal brucellosis in these areas will help in implementing prevention measures.

  17. Medication prescribing errors in a pediatric inpatient tertiary care setting in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Abolfotouh Mostafa A

    2011-08-01

    Full Text Available Abstract Background Medication errors (MEs are among the most common types of medical errors and one of the most common and preventable causes of iatrogenic injuries. The aims of the present study were; (i to determine the incidence and types of medication prescribing errors (MPEs, and (ii to identify some potential risk factors in a pediatric inpatient tertiary care setting in Saudi Arabia. Findings A five-week retrospective cohort study identified medication errors in the general pediatric ward and pediatric intensive care unit (PICU at King Abdulaziz Medical City (KAMC through the physical inspection of physician medication orders and reviews of patients' files. Out of the 2,380 orders examined, the overall error rate was 56 per 100 medication orders (95% CI: 54.2%, 57.8%. Dose errors were the most prevalent (22.1%. These were followed by route errors (12.0%, errors in clarity (11.4% and frequency errors (5.4%. Other types of errors were incompatibility (1.9%, incorrect drug selection (1.7% and duplicate therapy (1%. The majority of orders (81.8% had one or more abbreviations. Error rates were highest in prescriptions for electrolytes (17.17%, antibiotics (13.72% and bronchodilators (12.97%. Medication prescription errors occurred more frequently in males (64.5%, infants (44.5% and for medications with an intravenous route of administration (50.2%. Approximately one third of the errors occurred in the PICU (33.9%. Conclusions The incidence of MPEs was significantly high. Large-scale prospective studies are recommended to determine the extent and outcome of medication errors in pediatric hospitals in Saudi Arabia.

  18. A Retrospective Epidemiological Study of Rhinosporidiosis in a Rural Tertiary Care Centre in Pondicherry

    Science.gov (United States)

    Vijayasundaram, S.; Pulimoottil, Davis Thomas

    2016-01-01

    Introduction Rhinosporidiosis is an age old endemic scourge which has affected various parts of the world, most notably India and Sri Lanka. Although a large body of literature exists regarding this problem, postoperative recurrence rates continue to vary, and the effect of public health education in the eradication of this disease has not been taken into account. Aim The aim of this study was to find out the site, presentation and postoperative recurrence rate in patients with rhinosporidiosis. Materials and Methods This was a retrospective study involving operated cases of rhinosporidiosis in the Department of Ear, Nose and Throat of a rural tertiary care referral centre over a period of 3 years. The behavioural pattern of the disease, its epidemiology, rate of recurrence and outcomes of surgical management were analysed. Results A statistically significant correlation could be found between male gender and rural residential status and incidence of rhinosporidiosis. Bathing in rivers and ponds were found to be strongly associated with rhinosporidiosis (p=0.005). Almost all patients were found to be of low socioeconomic status. Nasal obstruction and epistaxis were the most common presenting complaints. Conclusion Rhinosporidiosis is strongly associated with male gender, young and middle aged adults, agricultural occupations, rural residential status, a history of bathing in ponds and rivers and a low socioeconomic status. Post-surgical recurrence of rhinosporidial masses can be avoided with careful and complete clearance of the mass and cauterization of the base. Appropriate and consistent public health education helps to reduce the incidence of rhinosporidiosis in endemic communities. PMID:27437252

  19. Detection of extended spectrum β-lactamase in Pseudomonas spp. isolated from two tertiary care hospitals in Bangladesh

    Directory of Open Access Journals (Sweden)

    Begum Shahanara

    2013-01-01

    Full Text Available Abstract Background Extended spectrum ß-lactamases (ESBLs represent a major group of lactamases responsible for resistance, mostly produced by gram-negative bacteria, to newer generations of ß-lactam drugs currently being identified in large numbers worldwide. The present study was undertaken to see the frequency of ESBL producing Pseudomonas spp. isolated from six hundred clinical specimens (wound, pus, aural, urine, sputum, throat and other swabs collected over a period of three years from two tertiary care hospitals in Bangladesh. Findings Aerobic bacterial culture was performed on aseptically collected swabs and only growth of Pseudomonas was considered for further species identification and ESBL production along with serotyping of Pseudomonas aeruginosa. Antimicrobial susceptibility testing was carried out using the Kirby-Bauer agar diffusion method and ESBL production was detected on Mueller Hinton agar by double-disk synergy technique using Amoxicillin-Clavulanic acid with Ceftazidime, Cefotaxime, Ceftriaxone and Aztreonam. Culture yielded 120 Pseudomonas spp. and 82 of them were biochemically characterized for species. Pseudomonas aeruginosa was found to be the predominant (90.2% species. Of 82 isolates tested for ESBL, 31 (37.8% were ESBL positive with 29 (93.5% as Pseudomonas aeruginosa, the remaining 2 (6.5% were Stenotrophomonas maltophilia and Ralstonia pickettii. Antibiogram revealed Imipenem as the most effective drug (93.3% among all antimicrobials used against Pseudomonas spp. followed by Aminoglycosides (63.7%. Conclusion ESBL producing Pseudomonas spp. was found to be a frequent isolate from two tertiary care hospitals in Bangladesh, showing limited susceptibility to antimicrobials and decreased susceptibility to Imipenem in particular, which is a matter of great concern.

  20. CLINICAL AND RADIOLOGICAL EVALUATION OF NEW - ONSET EPILETIC SEIZURES IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Chalapathi Rao

    2015-09-01

    Full Text Available BACKGROUND: Epilepsy is one of the most familiar neurological disorders which can cause bodily injury and death from inadequately treated or untreated cases. The imaging and EEG of new onset seizures is done with different indications, to identify an acute illness as the underline course for the seizure and possible neurological deficit. To this purpose we have evaluated new onset seizures in adult patients in correlation with their clinical profile, Electroencephalography (EEG and Computerized tomography (CT imaging of brain. METHODS: This cro ss sectional study was studied in 100 adult patients, presenting with seizures attending the Emergency department, General Medicine and Neurology wards and OPD of Tertiary care teaching hospital during the period of March 2006 to March 2008. All the patien ts were examined clinically and subjected to CT imaging of brain and EEG. Other necessary blood investigations were also done. Correlation between various seizures and CT scan brain and EEG were studied. Descriptive statistics were used to analyze the data . RESULTS: 63% of patients were in the age group of 20 - 39 years, 63% were males and 37% were females. 65% presented with GTCS, 35% with partial seizures. CT scan was found abnormal in 49.2% patients in GTCS, 71.4% in partial seizures. EEG showed abnormal p attern in 39% patients. 40% of the patients with partial seizures had epileptic form discharges. 33% patients had focal lesions on CT brain with normal EEG. CONCLUSION: Generalized Tonic clonic seizures were the commonest type of seizures was present, seen mostly in male patients. CT scan brain was abnormal in 57% of the patients. Neurocysticercosis and calcified granuloma were the commonest causes for seizures up to 3 rd decade of life. Majority of the patients with focal lesions on CT scan brain had epileptic form discharges on EEG which indicate a strong correlation of EEG with CT findings. Initiating the treatment with antiepileptic drugs was

  1. Pediatric anti-N-methyl-D-aspartate (NMDA) receptor encephalitis: experience of a tertiary care teaching center from north India.

    Science.gov (United States)

    Chakrabarty, Biswaroop; Tripathi, Manjari; Gulati, Sheffali; Yoganathan, Sangeetha; Pandit, Awadh Kishore; Sinha, Aditi; Rathi, Bhim Singh

    2014-11-01

    Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is characterized by acute- or subacute-onset encephalopathy with extrapyramidal, psychiatric, and epileptic manifestations. Diagnosis is confirmed by positive antibodies to NMDA receptor in cerebrospinal fluid and serum. Eleven pediatric cases presented over a 2-year period at a tertiary care teaching hospital in North India. The average age at presentation was 9 years (range: 2.5 to 18 years, median: 10 years) with a slight female predominance (1.2:1). The common modes of presentation were progressive extrapyramidal syndrome with global neuroregression in 45% (5 of 11), epileptiform encephalopathy in 27% (3 of 11), and an overlap between the 2 in 27% (3 of 11). Fifty-eight percent showed significant response to steroids and intravenous immunoglobulin. This entity should be considered in an acute- or subacute-onset encephalopathy if common infectious etiologies are ruled out and there are specific clinical pointers. Early diagnosis and treatment significantly improves the outcome.

  2. Adapting a tertiary-care pediatric weight management clinic to better reach Spanish-speaking families.

    Science.gov (United States)

    Guzman, Angelica; Irby, Megan B; Pulgar, Camila; Skelton, Joseph A

    2012-06-01

    Pediatric obesity continues to be an epidemic, affecting Hispanic children disproportionately. Recent recommendations outline a step-wise approach to the treatment of overweight and obese children, culminating in tertiary-care, multidisciplinary programs. We detail here how our tertiary-care, family-based, pediatric weight management clinic addressed the problem of few Spanish-speaking families enrolling in treatment after referral by adding a Bilingual Case Manager. Utilizing a family-centered, high-contact, personal approach, our program increased the number of Hispanic families enrolling over ten-fold. Further, outcomes in Hispanic families were equal to or better than other racial/ethnic groups. Lessons learned from this experience may benefit other obesity treatment programs trying to improve care of Spanish-speaking families.

  3. THE ANALYSIS OF THE DIABETIC FOOT OSTEOMYELITIS AT A TERTIARY CARE CENTER - A PROSPECTIVE STUDY

    OpenAIRE

    Mithun N; Pattanashetty; Reshmina; Sharath Babu; Harikrishna; Sreedhar Reddy; Ramakrishna J

    2015-01-01

    INTRODUCTION : India is considered as the diabetic capital of the world. Diabetic foot osteomyelitis is considered as one of the severe complications of diabetes mellitus. Diabetic foot osteomyelitis tends to complicate around one third of diabetic foot infections. In v iew of this we conducted a prospective study on the bacteriological analysis of diabetic foot osteomyelitis at a tertiary care center. MATERIALS AND METHODS : A prospective study was perform...

  4. Geriatric patients' expectations of their physicians: findings from a tertiary care hospital in Pakistan

    OpenAIRE

    Qidwai Waris; Khalid Umair; Saleem Taimur

    2009-01-01

    Abstract Background Geriatric health is a neglected and under-explored area internationally and in Pakistan. We aimed to ascertain the expectations of the geriatric patients from their physicians and the factors associated with patient satisfaction in this particular age bracket. Methods A cross-sectional survey was carried out at a tertiary care teaching hospital in Karachi, Pakistan. Data collection was carried out via face-to-face interviews based on structured, pre-tested questionnaires. ...

  5. Assessment of chronic diarrhea in early infancy in Tehran Tertiary Care Center; Tehran-Iran

    OpenAIRE

    Farzaneh Motamed; Naheid Kazemi; Raheleh Nabavizadeh

    2015-01-01

    Introduction Chronic diarrhea of infancy is a heterogeneous syndrome that includes several diseases with different etiologies. The aim of this study was investigating chronic diarrhea, its etiologies, clinical features and outcomes in infancy.Materials and Methods Retrospective study investigating infants hospitalized in the gastroenterology department of Tehran tertiary care center.The main demographic data, etiology, characteristics of diarrhea, and outcome were evaluated. Data were analyze...

  6. Analysis of risk factors of stillbirth: a hospital based study in a tertiary care centre

    OpenAIRE

    Paresh Shyam

    2016-01-01

    Background: Stillbirth is an indicator of maternal health and maternal health care services. Developing countries have high stillbirth rate. Documentation and evaluation of the risk factors for stillbirth is required for management of the risk factors and to devise plan in maternal health sector. Methods: It was a hospital based retrospective study carried out in a tertiary care hospital. Inclusion criteria were a case of fetal death with gestational age and #8805;20 weeks or fetal weight...

  7. Hypertensive Crisis, Burden, Management, and Outcome at a Tertiary Care Center in Karachi

    OpenAIRE

    Aysha Almas; Ayaz Ghouse; Ahmed Raza Iftikhar; Munawwar Khursheed

    2014-01-01

    Objectives. Hypertension, if uncontrolled, can lead to hypertensive crisis. We aim to determine the prevalence of hypertensive crisis, its management, and outcome in patients presenting to a tertiary care center in Karachi. Methods. This was a cross-sectional study conducted at the Aga Khan University, Karachi, Pakistan. Adult inpatients (>18 yrs) presenting to the ER who were known hypertensive and had uncontrolled hypertension were included. Results. Out of 1336 patients, 28.6% (387) had un...

  8. Vaginal delivery for breech presentation should be an option: experience in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Isha Gutgutia

    2014-06-01

    Conclusions: Neonatal outcome did not depend on mode of delivery though maternal morbidity and cost of care is increased following Caesarean Section. Proper selection of cases and by improving skill and confidence in new generation obstetrician, vaginal delivery of singleton fetuses in breech presentation at term remains a safe option that can be offered to a woman in a tertiary care centre. [Int J Reprod Contracept Obstet Gynecol 2014; 3(3.000: 562-565

  9. Etiological profile of noncompressive myelopathies in a tertiary care hospital of Northeast India

    OpenAIRE

    Ashok Kumar Kayal; Munindra Goswami; Marami Das; Lakhshya Jyoti Basumatary; Suvorit Subhas Bhowmick; Baiakmenlang Synmon

    2017-01-01

    Background: The discovery of antibodies against aquaporin-4 and evolving concepts of noncompressive myelopathies in the 21st century have made a major impact on the etiological profile of these diseases, with few cases turning out to be idiopathic. Objective: To find causes of noncompressive myelopathy in a tertiary care hospital of Northeast India. Materials and Methods: An observational study was carried out in the Neurology Department of Gauhati Medical College, Guwahati, from September 20...

  10. Clinical Outcomes of Colonic Stent in a Tertiary Care Center

    Directory of Open Access Journals (Sweden)

    Mahesh Gajendran

    2014-01-01

    Full Text Available Introduction. Colonic obstruction is one of the manifestations of colon cancer for which self-expanding metal stents (SEMS have been effectively used, to restore the luminal patency either for palliative care or as a bridge to resective surgery. The aim of our study is to evaluate the efficacy and safety of large diameter SEMS in patients with malignant colorectal obstruction. Methods and Results. A four-year retrospective review of the Medical Archival System was performed and identified 16 patients. The average age was 70.8 years, of which 56% were females. The most common cause of obstruction was colon cancer (9/16, 56%. Rectosigmoid was the main site of obstruction (9/16 and complete obstruction occurred in 31% of cases. The overall technical and clinical success rates were 100% and 87%, respectively. There were no immediate complications (<24 hours, but stent stenosis due to kinking occurred within one week of stent placement in 2 patients. Stent migration occurred in 2 patients at 34 and 91 days, respectively. There were no perforations or bleeding complications. Conclusion. Large diameter SEMS provide a safe method for palliation or as a bridge to therapy in patients with malignant colonic obstruction with high technical success and very low complication rates.

  11. CLINICAL PROFILE OF CHILDHOOD POISONING IN A TERTIARY CARE CENTRE

    Directory of Open Access Journals (Sweden)

    Poornima

    2016-03-01

    Full Text Available BACKGROUND Accidents including poisoning are one of the leading causes of morbidity and mortality among children in the west. Poisoning, while never accounting for a large number of accidental deaths, have acquired prominence now because they have not decreased at the same rate as the infectious diseases. METHODS An observational study was done in Department of Paediatrics KIMS Bangalore to know the incidence and pattern of childhood poisoning, to know the morbidity and mortality resulting from childhood poisoning. 86 children aged between 0-18 years were admitted to the paediatric intensive care unit with history of poisoning during the 2-year period of the study (Nov 13-Nov 15 were included. Diagnosis of poisoning was made on the basis of history and examination findings, Relevant investigations were done and Profile of patients with poisoning, their symptoms, type of poisoning and outcome were analysed. RESULTS The average duration of stay in the hospital was 2.7 days. Poisoning was accidental in 80 (93% patients whereas suicidal intent was present in only 6 (7% patients. Total 5 (5.8% patients died of which 4 were due to insecticide and pesticide poisoning and one was due to kerosene poisoning. CONCLUSION In the present study the probable reason for higher incidence of poisoning by insecticides & pesticides could be the involvement of higher age group and more involvement of adolescent children.

  12. Emergence of vanA gene among vancomycin-resistant enterococci in a tertiary care hospital of North - East India

    Directory of Open Access Journals (Sweden)

    Chimanjita Phukan

    2016-01-01

    Interpretation & conclusions: Emergence of VRE and presence of vanA in a tertiary care hospital setting in North-East India indicate toward a need for implementing infection control policies and active surveillance.

  13. Job satisfaction and Job stress among various employees of tertiary care level hospital in central Uttar Pradesh, India

    National Research Council Canada - National Science Library

    Ruchi Yadav; Dhiraj Kumar Srivastava; Sanjeev Yadav; Sandip Kumar; Pankaj Kumar Jain; Sachin Gupta

    2017-01-01

    ...: To study the relationship between job satisfaction and job stress among various employees of tertiary care level hospital and to find the co-relates of job stress and job satisfaction. Materials & Methods...

  14. TUBERCULOSIS AND HIV COINFECTION: A TERTIARY CARE HOSPITAL STUDY

    Directory of Open Access Journals (Sweden)

    Vivek

    2016-02-01

    Full Text Available OBJECTIVE The aim of the present study is to record the clinical, radiological profile of pulmonary and extra pulmonary tuberculosis (EPTB in HIV positive patients. To win the battle against AIDS we have to fight against TB. Unlike HIV/AIDS, TB is completely curable in the vast majority of cases. MATERIALS AND METHODS This prospective study was conducted in the department of pulmonary medicine, Gadag institute of medical sciences, Gadag. All newly diagnosed HIV patients during the study period were included and screened for TB. HIV infection was confirmed by enzyme linked immunosorbent assay using two different antigens and a rapid test as recommended by NACO. RESULTS Among 370 newly diagnosed HIV positive patients, 113(30.54% patients were diagnosed to have TB. Most common affected age group was 31-40years with a mean age of 38.08 years. Unprotected heterosexual contact was the most common mode of HIV transmission. Fever, weight loss and cough were the commonest symptoms at presentation. Pulmonary TB was diagnosed in 85(22.97% patients, EPTB in 21(5.67% and disseminated TB in 7(1.8% patients. Among the EPTB patients, 2(9.5% patients had extra thoracic lymphadenopathy. Cervical lymph node was the commonest lymph node involved. 14(66.66% patients had pleural effusion, 3(14.28% had abdominal TB, 1(4.76% had tubercular meningitis and 1(4.76% patient had TB testis. CONCLUSION The prevalence of HIV–TB co-infection was high. Moreover, HIV positive patients need early diagnosis and treatment of active TB. However large sample size prospective studies are needed to correlate the clinical and CD4 count with the occurrence of different types of tuberculosis.

  15. Prevalence and genotypic relatedness of methicillin resistant Staphylococcus aureus in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    B A Fomda

    2014-01-01

    Full Text Available Background: Methicillin-resistant Staphylococcus aureus (MRSA is the most common multidrug-resistant pathogen causing nosocomial infections across the world. MRSA is not only associated with significant mortality and morbidity but also places a large economic strain on our health care system. MRSA isolates are also typically resistant to multiple, non-β-lactam antibiotics. We conducted a prospective study in a tertiary care hospital, to determine the prevalence of MRSA and to establish the clonal distribution of MRSA isolates recovered from various clinical specimens. Materials and Methods: Clinical samples were cultured and S. aureus was identified as per standard microbiological procedures. Susceptibility testing was done by agar disk diffusion and minimum inhibitory concentration (MIC method as recommended by CLSI. Methicillin resistance was detected by phenotypic methods namely, oxacillin disc diffusion (ODD, minimum inhibitory concentration (MIC of oxacillin, cefoxitin disk diffusion (CDD, and MIC of cefoxitin. Amplification of mecA gene by PCR was used as gold standard for detection of methicillin resistance. Pulsed field gel electrophoresis (PFGE typing was performed for MRSA isolates. Results: Out of 390 S. aureus isolates, 154 (39.48% isolates were MRSA and 236 (60.51% isolates were MSSA. Penicillin was the least effective antibacterial drug against the hospital associated S. aureus isolates with 85.64% resistance rate. All the isolates were susceptible to vancomycin. The MRSA showed a high level of resistance to all antimicrobials in general in comparison to the MSSA and the difference was statistically significant (P < 0.05. Multiplex PCR performed for all strains showed amplification of both the mecA and nucA genes in MRSA strains whereas MSSA strains showed amplification of only nucA gene. PFGE of these isolates showed 10 different patterns. Conclusion: Prevalence of MRSA in our hospital was 39.48%. Most of these isolates were

  16. Spectrum of Congenital Heart Diseases in Eastern Nepal: A tertiary care hospital experience

    Directory of Open Access Journals (Sweden)

    Prashant Shah

    2017-01-01

    Full Text Available Background & Objectives: Congenital heart diseases are neglected especially in world’s poorest nations and appear to be ignored and unexplored dimension of health. The exact prevalence and spectrum of congenital heart diseases in Nepal is largely unknown. The aim of this study was to describe the local experience on the magnitude and the pattern of congenital heart disease in order to increase the awareness of the public and health policy makers on its burden in Nepal.Materials & Methods: This is an observational hospital based study carried out in a tertiary care hospital in Eastern Nepal. The duration of this study was from April 2015 to July 2016. The echocardiography reports of all patients clinically suspected of having congenital heart disease were retrieved, and their diagnostic details were extracted. Only patients of day one of life to 14 years of age were included. Congenital heart diseases like bicuspid aortic valve, mitral valve prolapse and various inherited cardiomyopathies were excluded.Results: A total of 330 echocardiograms were performed for clinically suspected congenital heart disease.  The mean age of study population was 22.31±34.08 months with male to female ratio of 1.2:1. 23% of clinically suspected congenital heart disease cases turned out to have normal echocardiography. Acyanotic congenital heart disease was most common (81.5% followed by cyanotic congenital heart disease (14.2% and obstructive congenital heart disease (4.3%. Atrial septal defect was found to be the most common form of acyanotic congenital heart disease (52% which was followed by ventricular septal defect (28.8% and patent ductus arteriosus (14.8%. Tetralogy of Fallot and double outlet right ventricle were the most common form of cyanotic CHD representing 44.4% of all cyanotic patients. Pulmonary stenosis was the most common obstructive congenital heart disease observed in this study population (63.6%. Rarer entities, like d-transposition of great

  17. ECTOPIC CUSHING SYNDROME: A 10-YEAR EXPERIENCE FROM A TERTIARY CARE CENTER IN SOUTHERN INDIA.

    Science.gov (United States)

    Sathyakumar, Samantha; Paul, Thomas Vizhalil; Asha, Hesargatta Shyamsunder; Gnanamuthu, Birla Roy; Paul, M J; Abraham, Deepak Thomas; Rajaratnam, Simon; Thomas, Nihal

    2017-08-01

    Ectopic adrenocorticotropic hormone (ACTH) secretion is a less common cause of Cushing syndrome and is seen in 5 to 10% of cases with endogenous hypercortisolemia. We hereby describe our experience of patients with ectopic ACTH syndrome, who have been managed over the past 10 years at a tertiary care center in Southern India. The inpatient and outpatient records of patients from 2006 to 2015 were retrospectively reviewed. The clinical features, clinical history, biochemical values, imaging features, including radiologic findings and positron emission tomography scans, management, details of follow-up, and outcomes, were documented. We compared the biochemical findings in these patients with 20 consecutive patients with Cushing disease (Cushing syndrome of pituitary origin). A total of 21 patients were studied. The median age at presentation was 34 years (range, 19 to 55 years). Seven patients had thymic carcinoid, 7 had bronchial carcinoid, 3 had lung malignancies, 2 had medullary carcinoma thyroid, 1 patient had a pancreatic neuroendocrine tumor, and 1 patient had an occult source of ACTH. The most common clinical features at presentation were muscle weakness (95%), hyperpigmentation (90%), facial puffiness (76%), easy bruising (61%), edema (57%), and striae (52%). Extensive acne was seen in a large number of patients (43%). Only 3 patients (14%) had central obesity. The median 8 am cortisol was 55.5 μg/dL (range, 3.8 to 131 μg/dL), median 8 am ACTH was 207 pg/mL (range, 31.1 to 703 pg/mL), and the median 24-hour urinary free cortisol was 2,484 μg (range, 248 to 25,438 μg). Basal cortisol and ACTH, as well as midnight cortisol and ACTH level, were markedly higher in patients with ectopic Cushing syndrome as compared to patients with Cushing disease. Twelve of 21 patients had developed life-threatening infections by follow-up. Nine patients had undergone surgical intervention to address the primary tumor. However, only 1 patient exhibited a complete cure on

  18. Supply chain management with cost-containment & financial-sustainability in a tertiary care hospital.

    Science.gov (United States)

    Chandra, Hem; Rinkoo, Arvind Vashishta; Verma, Jitendra Kumar; Verma, Shuchita; Kapoor, Rakesh; Sharma, R K

    2013-01-01

    Financial crunch in the present recession results in the non-availability of the right materials at the right time in large hospitals. However due to insufficient impetus towards systems development, situation remains dismal even when funds are galore. Cost incurred on materials account for approximately one-third of the total recurring expenditures in hospitals. Systems development for effective and efficient materials management is thus tantamount to cost-containment and sustainability. This scientific paper describes an innovative model, Hospital Revolving Fund (HRF), developed at a tertiary care research institute in Asia. The main idea behind inception of HRF was to ensure availability of all supplies in the hospital so that the quality of healthcare delivery was not affected. The model was conceptualized in the background of non-availability of consumables in the hospital leading to patient as well as staff dissatisfaction. Hospital supplies have been divided into two parts, approximately 3250 unit items and 1750 miscellaneous items. This division is based on cost, relative-utility and case-specific utilization. 0.1 Million USD, separated from non-planned budget, was initially used as seed money in 1998. HRF procures supplies from reputed firms on concessional rates (8-25%) and make them available to patients at much lesser rates vis-à-vis market rates, levying minimal maintenance charges. In 2009-10, total annual purchases of 14 Million USD were made. The balance sheet reflected 1.4 Million USD as fixed deposit investment. The minimal maintenance charges levied on the patients along with the interest income were sufficient to pay for all recurring expenses related to HRF. Even after these expenses, HRF boosted of 0.2 Million USD as cash-in-hand in financial year 2009-10. In-depth analysis of 'balance sheet' and 'Income and Expenditure' statement of the fund for last five financial years affirms that HRF is a self-sustainable and viable supply chain

  19. Profile of patients attending psychogeriatric clinic in a tertiary care setting

    Directory of Open Access Journals (Sweden)

    Suresh Neethu

    2016-01-01

    Full Text Available Background: Proportion of elderly is increasing among the total population of Kerala, and mental health problems of this group are unique. Objectives: To assess the clinical and sociodemographic profile of patients attending Psychogeriatric Clinic in a tertiary care center and to study the correlation of sociodemographic and clinical variables with psychiatric diagnoses in this population. Materials and Methods: A retrospective chart review of patients, who attended the Psychogeriatric Clinic of a tertiary care center over a period of 1 year, was done. The Institutional Ethics Committee discussed and waived clearance for the review. Results: There were 85 cases with a mean age of 69.5 years (standard deviation-7.36. Majority of them were females (56.5% and belonged to low socioeconomic status (52.9%. Comorbid physical illnesses were seen in 76.5% cases. Diagnoses were made by Junior Residents in Psychiatry and confirmed by a qualified psychiatrist, as per International Classification of Diseases-10 criteria. The most common psychiatric diagnosis was organic mental disorders (24.7%, which included dementias, delirium, and organic mood disorders. This was followed by bipolar affective disorders (22.4%, schizophrenia and related disorders (20.0%, depressive and anxiety disorders (17.6% and mental and behavioral disorders due to substance use (2.4%. Occurrence of organic psychiatric disorders showed positive correlation with age (Spearman's ρ =0.253, P = 0.02 and occurrence of hypertension (ρ =0.222, P = 0.04. Conclusions: Organic psychiatric disorders are more common in elderly patients attending a tertiary care center. Comorbid physical illnesses are seen in more than three-fourths of this population. Organic psychiatric disorders are seen more commonly with increasing age and occurrence of hypertension.

  20. Laringoplastia com balão em crianças com estenose subglótica em evolução: experiência de um hospital terciário Balloon laryngoplasty in children with acute subglottic stenosis: experience of a tertiary-care hospital

    Directory of Open Access Journals (Sweden)

    Claudia Schweiger

    2011-12-01

    Full Text Available O manejo da estenose subglótica (ESG em crianças continua sendo um desafio para os otorrinolaringologistas. A laringoplastia com balão (LPB consiste num procedimento endoscópico, descrito inicialmente em 1984, para tratamento de estenoses da via aérea alta, apresentando várias vantagens em relação a outras técnicas cirúrgicas e com resultados promissores. OBJETIVO: Apresentar a nossa experiência com a realização de LPB em pacientes pediátricos com ESG. MATERIAL E MÉTODO: Estudo prospectivo de pacientes pediátricos com diagnóstico de ESG pós-extubação em evolução (ainda com tecido de granulação. Realizou-se laringoscopia direta sob anestesia geral e dilatação do segmento estenótico com cateter de angioplastia. Os pacientes foram acompanhados e nova laringoscopia foi realizada uma semana após o procedimento inicial. RESULTADOS: Foram incluídas no estudo oito crianças no período de junho de 2009 a outubro de 2010. Destas, quatro apresentavam ESG Grau 3, três apresentavam ESG Grau 2 e uma, ESG Grau 1. Na laringoscopia direta de revisão, apenas duas apresentavam ESG residual assintomática (Grau 1, sendo que as outras seis apresentavam via aérea normal e estavam assintomáticas. CONCLUSÃO: A LPB parece ser um tratamento efetivo para ESG em evolução. Necessitamos mais estudos para sabermos a eficácia, a segurança e as indicações deste procedimento.Management of subglottic stenosis (SGS in children is still a challenge to Otorhinolaryngologists. Balloon laryngoplasty (BLP is an endoscopic procedure, first described in 1984 for the treatment of airway stenosis. It shows promising results and seems to be more effective than other procedures. AIM: To present our experience with BLP in children with SGS. MATERIAL AND METHOD: Prospective study of children diagnosed with acute subglottic stenosis, i.e., stenosis with granulation tissue. They underwent direct laryngoscopy under general anesthesia and dilatation of the

  1. A lifesaving model: teaching advanced procedures on shelter animals in a tertiary care facility.

    Science.gov (United States)

    Spindel, Miranda E; MacPhail, Catriona M; Hackett, Timothy B; Egger, Erick L; Palmer, Ross H; Mama, Khursheed R; Lee, David E; Wilkerson, Nicole; Lappin, Michael R

    2008-01-01

    It is estimated that there are over 5 million homeless animals in the United States. While the veterinary profession continues to evolve in advanced specialty disciplines, animal shelters in every community lack resources for basic care. Concurrently, veterinary students, interns, and residents have less opportunity for practical primary and secondary veterinary care experiences in tertiary-care institutions that focus on specialty training. The two main goals of this project were (1) to provide practical medical and animal-welfare experiences to veterinary students, interns, and residents, under faculty supervision, and (2) to care for animals with medical problems beyond a typical shelter's technical capabilities and budget. Over a two-year period, 22 animals from one humane society were treated at Colorado State University Veterinary Medical Center. Initial funding for medical expenses was provided by PetSmart Charities. All 22 animals were successfully treated and subsequently adopted. The results suggest that collaboration between a tertiary-care facility and a humane shelter can be used successfully to teach advanced procedures and to save homeless animals. The project demonstrated that linking a veterinary teaching hospital's resources to a humane shelter's needs did not financially affect either institution. It is hoped that such a program might be used as a model and be perpetuated in other communities.

  2. Monitoring of antibiotic consumption and development of resistance by enterobacteria in a tertiary care hospital.

    Science.gov (United States)

    Veličković-Radovanović, R; Stefanović, N; Damnjanović, I; Kocić, B; Antić, S; Dinić, M; Petrović, J; Mitić, R; Catić-Djordjević, A

    2015-08-01

    Antibiotics are the most frequently used drugs in hospitalized patients, but studies have shown that the prescribed antibiotics may be inappropriate and may contribute to antibiotic resistance. We carried out a survey of antibiotic consumption and antibiotic resistance in our tertiary care university hospital, from 2005 to 2013. We focus on cephalosporins, one of the most prescribed groups of antibiotics in the tertiary health care. The objective was to identify any relationship between ceftriaxone consumption and resistance by enterobacteria. Antibiotics consumption and antimicrobial resistance were monitored in the tertiary care university hospital from 2005 to 2013. Data on the use of antibiotics in surgical inpatients were obtained and expressed as defined daily doses per 100 bed days. Bacterial resistances were given as percentages of resistant isolates. There was an increasing trend in cephalosporins consumption from 9·56 DBD (2005) to 23·32 DBD (2013), with ceftriaxone as the most frequently used cephalosporin, 3·6 DBD (2005) to 10·78 DBD (2013). E. coli and P. mirabilis resistance to ceftriaxone increased significantly from 22% in 2005 to 47% in 2013 and from 31% in 2005 to 60% in 2013, respectively. We found a significant correlation between ceftriaxone consumption and E. coli resistance (r = 0·895, P antibiotic. E. coli and P. mirabilis resistance to ceftriaxone increased significantly over the study period. E. coli resistance increased with ceftriaxone consumption. © 2015 John Wiley & Sons Ltd.

  3. Prescription pattern of benzodiazepines for inpatients at a tertiary care university hospital in Pakistan.

    Science.gov (United States)

    Khawaja, Muhammad Rizwanulhaq; Khawaja, Muhammad Rizwanullah; Majeed, A; Malik, F; Merchant, K A; Maqsood, M; Malik, R; Mazahir, S; Naqvi, H

    2005-06-01

    To determine the point prevalence of benzodiazepine prescriptions for inpatients at a tertiary care university hospital in Pakistan and to correlate it with prescription patterns of various specialties, indications and demographic variables of the patients. This 24-hours point prevalence study was done at The Aga Khan University Hospital, Karachi. By convenient random sampling, 208 inpatients were interviewed. Patients' files were also studied to record the drugs administered. Data was entered into questionnaires and analyzed by SPSS 10.0. The point prevalence of the benzodiazepines was 21.2%. It was higher among males than females and among surgical than non-surgical patients. Midazolam was the most commonly used benzodiazepine, followed by Alprazolam and Lorazepam. Pre-anesthesia and psychiatric symptoms were the two most common indications. Oral route was used in 84% patients for drug administration and mean Valium equivalent dosage was 4.86 mg/day. Mean length of prescription was 3 days. Longer duration of hospitalization was a significant predictor of the requirement of benzodiazepine prescription (p-value = 0.020). Prescription pattern of benzodiazepines at a tertiary care university hospital is similar to that reported in the developed countries through monitoring at various levels by physicians, clinical pharmacist and nursing staff. Data regarding the prescription pattern of benzodiazepines is scarce, and it needs to be expanded to formulate clear guidelines regarding their prescription.

  4. Sociodemographic and Clinical Characteristics of Patients attending Psychotherapy in a Tertiary Care Hospital in Oman

    Directory of Open Access Journals (Sweden)

    Zena Al-Sharbati

    2012-02-01

    Full Text Available Objectives: There is significant evidence that psychotherapy is a pivotal treatment for persons diagnosed with Axis I clinical psychiatric conditions; however, a psychotherapy service has only recently been established in the Omani health care system. This study aimed to investigate the sociodemographic and clinical characteristics of attendees at a psychotherapy clinic at a tertiary care hospital. Methods: An analysis was carried out of 133 new referrals to the Psychotherapy Service at Sultan Qaboos University Hospital, a tertiary care hospital. Results: The majority of referrals were females (59%, aged 18–34 years, employed (38%, had ≤12 years of formal education (51%, and were single (54%. A total of 43% were treated for anxiety disorders (including obsessive compulsive disorder, while 22% were treated for depression. A total of 65% were prescribed psychotropic medications. The utilisation of the Psychotherapy Service and its user characteristics are discussed within the context of a culturally diverse Omani community which has unique personal belief systems such as in supernatural powers (Jinn, contemptuous envy (Hassad, evil eye (Ain and sorcery (Sihr which are often used to explain the aetiology of mental illness and influence personal decisions on utilising medical and psychological treatments. Conclusion: Despite the low number of referrals to the Psychotherapy Service, there is reason to believe that psychotherapy would be an essential tool to come to grips with the increasing number of mental disorders in Oman.

  5. AWARENESS ABOUT PHARMACOVIGILANCE AMONG RESIDENT DOCTORS IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Amit A.

    2015-01-01

    Full Text Available BACKGROUND: Monitoring and evaluation of adverse drug reactions (ADRs through a well - organized pharmacovigilance system is vital for safe use of medicines. ADR reporting by healthcare professionals forms the backbone of pharmacovigilance system. AIM: To assess the awareness of pharmacovigilance among resident doctors in a tertiary care hospital. MATERIAL AND METHODS: This is a cross sectional descriptive study, carried out in a total 160 resident doctors from various specialities in a government run tertiary care teaching hospital were administered a questionnaire to evaluate knowledge, attitude and practice of pharmacovigilance. The questionnaire consisted of open and closed ended questions. The study was conducted in January/ February 2012. RESULTS: Most of the residents had heard the term ‘pharmacovigilance’ but only 25% knew the actual meaning of it. About 84% of the residents did not know about Pharmacovigilance Programme of India ( PvPI, 68% did not know about existence of any ADR reporting centers in the country. Most of them (75% agreed that ADR reporting is responsibility of the doctors. So far none of the residents have reported an ADR under PvPI. CONCLUSION: The awareness of pharmacovigilance among resident doctors in teaching hospitals is very low. There is an urgent need to train health professionals in pharmacovigilance to improve the current sorry state.

  6. Influenza immunization of chronically ill children in pediatric tertiary care hospitals.

    Science.gov (United States)

    Dubé, Eve; Gagnon, Dominique; Huot, Caroline; Paré, Renée; Jacques, Solange; Kossowski, Alexandra; Quach, Caroline; Landry, Monique

    2014-01-01

    Despite a publicly funded immunization program and continuous promotional efforts, vaccine uptake for seasonal influenza in Quebec (Canada) remains under its goal of 80%. Missed opportunities can explain the low influenza vaccine rates among chronically ill children. To address that, demonstration projects using the live attenuated influenza vaccine (LAIV) were implemented in 3 pediatric tertiary care hospitals to evaluate the feasibility and acceptability of implementing influenza immunization of chronically ill children in hospitals' outpatient clinics. A diary was used to document barriers and enabling factors regarding the implementation, and a questionnaire was distributed to healthcare professionals involved in the project in each hospital. Parent's knowledge, attitudes and behaviors (KAB) about influenza immunization and acceptability of immunization in outpatient clinics were also measured with a questionnaire. As part of the project, 2,478 children were immunized. Enabling factors included the financial support received from Quebec ministry of Health, the nasal mode of administration of the LAIV and the presence of a leader specifically dedicated to influenza immunization. Barriers to influenza immunization in outpatient clinics included difficulties of hiring extra staff to work in immunization clinics and additional tasks added to regular activities of the clinics. Results from both questionnaires illustrated a high level of acceptability of seasonal influenza immunization in hospitals' outpatient clinics by parents and healthcare professionals. Influenza immunization in pediatric tertiary care hospital is an effective way to reach chronically ill children and does not involve major feasibility or acceptability issues.

  7. Sociodemographic and Clinical Characteristics of Patients attending Psychotherapy in a Tertiary Care Hospital in Oman.

    Science.gov (United States)

    Al-Sharbati, Zena; Hallas, Claire; Al-Zadjali, Hazar; Al-Sharbati, Marwan

    2012-02-01

    There is significant evidence that psychotherapy is a pivotal treatment for persons diagnosed with Axis I clinical psychiatric conditions; however, a psychotherapy service has only recently been established in the Omani health care system. This study aimed to investigate the sociodemographic and clinical characteristics of attendees at a psychotherapy clinic at a tertiary care hospital. An analysis was carried out of 133 new referrals to the Psychotherapy Service at Sultan Qaboos University Hospital, a tertiary care hospital. The majority of referrals were females (59%), aged 18-34 years, employed (38%), had ≤12 years of formal education (51%), and were single (54%). A total of 43% were treated for anxiety disorders (including obsessive compulsive disorder), while 22% were treated for depression. A total of 65% were prescribed psychotropic medications. The utilisation of the Psychotherapy Service and its user characteristics are discussed within the context of a culturally diverse Omani community which has unique personal belief systems such as in supernatural powers (Jinn), contemptuous envy (Hassad), evil eye (Ain) and sorcery (Sihr) which are often used to explain the aetiology of mental illness and influence personal decisions on utilising medical and psychological treatments. Despite the low number of referrals to the Psychotherapy Service, there is reason to believe that psychotherapy would be an essential tool to come to grips with the increasing number of mental disorders in Oman.

  8. No systemic reactions to influenza vaccination in egg-sensitized tertiary-care pediatric patients

    Directory of Open Access Journals (Sweden)

    Upton Julia

    2012-03-01

    Full Text Available Abstract Background There are numerous, disparate guidelines for influenza vaccination in egg-allergic patients. We aimed to describe the outcome of selectively applied guidelines, based on risk-stratification, to our high risk, egg-allergic, tertiary-care pediatric population. Methods Egg allergy was confirmed with skin testing. The vaccine administered was an adjuvunated 2009 H1N1 influenza A vaccine with Results Ninety-nine patients were referred and 79 had positive egg testing. Asthma was present in 67% and 30% had prior anaphylaxis to egg. We vaccinated 77 of 79 patients: 71 without performing vaccine skin testing. Two refused vaccination. No patient had a systemic reaction or required treatment. Two patients experienced positive testing to the adjuvanated intradermal vaccine, but were negative without adjuvant. Conclusions Our results suggest that most egg-allergic tertiary care pediatric patients can be vaccinated with a low ovalbumin content influenza vaccine without prior vaccine testing. Vaccine skin testing, if used at all, can be reserved for special circumstances. The squalene adjuvant may cause an irritant reaction with intradermal testing.

  9. Prevalence of carbapenem resistant Enterobacteriaceae from a tertiary care hospital in Mumbai, India

    Directory of Open Access Journals (Sweden)

    Pravin K. Nair

    2013-12-01

    Full Text Available Objective: The emergence of Carbapenem Resistant Enterobacteriaceae (CRE in recent times has become a serious threat to public health due to the high mortality, potential dissemination rates and limited treatment options associated with these organisms. Thus, the present study was conducted in our tertiary care hospital in Mumbai, to retrospectively analyze the prevalence of CRE in the hospital. Methods: The study was carried out in the microbiology department of the tertiary care hospital over a period of 12 months. The samples tested were clinical samples from hospitalized and Out-Patient Department (OPD patients sent to the department for microbiological testing. CRE isolates were identified using the Vitek 2- Compact system (BioMérieux, France. Results: A CRE prevalence rate of 12.26% was obtained from the study, from which the majority of the isolates were detected in urine samples (46%. Although most of the CRE isolates were detected in patient samples from the wards (42% and the ICU (26%, a significant number of isolates was also detected from the OPD patients (19%. Conclusion:Thus, the study shows a significant rate of carbapenem resistance among Enterobacteriaceae isolated from hospitalized and OPD patients. This emphasizes the urgent need for CRE control at the hospital and community level, and to rationalize the use of antibiotics. J Microbiol Infect Dis 2013;3(4: 207-210

  10. Customer satisfaction survey with clinical laboratory and phlebotomy services at a tertiary care unit level.

    Science.gov (United States)

    Koh, Young Rae; Kim, Shine Young; Kim, In Suk; Chang, Chulhun L; Lee, Eun Yup; Son, Han Chul; Kim, Hyung Hoi

    2014-09-01

    We performed customer satisfaction surveys for physicians and nurses regarding clinical laboratory services, and for outpatients who used phlebotomy services at a tertiary care unit level to evaluate our clinical laboratory and phlebotomy services. Thus, we wish to share our experiences with the customer satisfaction survey for clinical laboratory and phlebotomy services. Board members of our laboratory designed a study procedure and study population, and developed two types of questionnaire. A satisfaction survey for clinical laboratory services was conducted with 370 physicians and 125 nurses by using an online or paper questionnaire. The satisfaction survey for phlebotomy services was performed with 347 outpatients who received phlebotomy services by using computer-aided interviews. Mean satisfaction scores of physicians and nurses was 58.1, while outpatients' satisfaction score was 70.5. We identified several dissatisfactions with our clinical laboratory and phlebotomy services. First, physicians and nurses were most dissatisfied with the specimen collection and delivery process. Second, physicians and nurses were dissatisfied with phlebotomy services. Third, molecular genetic and cytogenetic tests were found more expensive than other tests. This study is significant in that it describes the first reference survey that offers a survey procedure and questionnaire to assess customer satisfaction with clinical laboratory and phlebotomy services at a tertiary care unit level.

  11. Prevalence of multidrug resistance among retreatment pulmonary tuberculosis cases in a tertiary care hospital, Hyderabad, India

    Directory of Open Access Journals (Sweden)

    Subhakar Kandi

    2013-01-01

    Full Text Available Background: India is one of the high tuberculosis (TB burden countries in the world. India ranks second in harboring multi drug resistant (MDR-TB cases. About 50,000 of MDR cases are recorded in retreatment pulmonary TB cases. This study was conducted in a tertiary care facility (Government General and Chest Hospital in Hyderabad, India. Objectives: Toassess: Proportion of the TB patients having MDR-TB at the initiation of retreatment regimen; the prevalence of isoniazid (INH resistance in this geographical area. Materials and Methods: An analytical, observational, prospective cohort study of patients attending the out-patient department from December 2010 to March 2011. Results: Sputum samples from 100 patients were subjected to acid fast bacilli (AFB culture and drug sensitivity testing. Of these, 28 (28% were MDR-TB, 42 (42% were non-MDR-TB and 39% being INH resistance. Conclusions: In conclusion, one third of the retreatment pulmonary TB cases attending a tertiary care institute for TB will be MDR-TB at the initiation of treatment and there is a need to include ethambutol in the continuation phase of new TB case treatment in view of high INH resistance.

  12. Pityriasis versicolor: A clinicomycological and epidemiological study from a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Ghosh Sudip

    2008-01-01

    Full Text Available Background: Pityriasis versicolor is a mild, chronic, usually asymptomatic superficial fungal infection of the stratum corneum, caused by Malassezia yeasts. The purpose of the present study is to assess the clinical profile of a group of patients with pityriasis versicolor and to find out the epidemiological characteristics in this part of India as well as any association, if any, with other diseases. Materials and Methods: For this purpose, 110 consecutive patients of pityriasis versicolor were evaluated clinically and diagnosis was confirmed mycologically at a tertiary care hospital in Kolkata. All data were recorded in a predesigned, pretested semi-structured schedule. The total duration of study period was 12 months. Results: Majority of the patients were young adults. Most of the patients were asymptomatic. There is prominent seasonal variation of the patients with a peak in August and September months. Most of the lesions were hypopigmented scaly macules and were KOH positive. Most commonly involved sites were chest, face and back. Seborrheic dermatitis sometimes coexisted with pityriasis versicolor and a number of patients also had diabetes mellitus and immunosuppressive conditions. Conclusions: Overall, the clinicomycological and epidemiological profile of pityriasis versicolor infection as observed in a tertiary care setting in eastern India does not differ significantly from those observed by previous workers elsewhere.

  13. AN AUDIT OF PRESCRIPTION FOR ANTIBIOTIC IN A TERTIARY CARE HOSPITAL IN KOLKATA, INDIA

    Directory of Open Access Journals (Sweden)

    Anjan Adhikari

    2012-12-01

    Full Text Available Antibiotics are most commonly prescribed drugs in tertiary care hospitals; more than 30% of the hospitalised patients were treated with antibiotics. Rational use of antibiotics is very important to ensure the optimum treatment outcomes and to limit the emergence of bacterial resistance. Present study is a hospital based cross-sectional study carried out for a period of three months in different clinical departments of a tertiary care hospital to find out the antibiotics prescribing pattern. Out of total 551 evaluated prescriptions, an antibiotic was prescribed in 45.5% cases. The most commonly prescribed antibiotics were Moxifloxacin 19.5%, Metronidazole 10.4% and Amoxicillin+Cloxacillin 10.2%, broad spectrum antibiotics usage was higher & 87.7% of the antibiotics were prescribed by brand names. The appropriate use of antibiotic is a greatest need of the current situation all over the world. The rising antibiotic resistance is a global problem which is directly related with the irrational prescription of antibiotics.

  14. Epidemiology of Road Traffic Injuries in a Tertiary Care Centre of Lucknow

    Directory of Open Access Journals (Sweden)

    Ashish Chauhan

    2014-05-01

    Full Text Available Introduction: Road traffic injuries are an important cause of mortality and morbidity worldwide. It is the second leading cause of mortality in 15-29 year age group and if the current trend continues then it will be the 5th leading cause of overall mortality worldwide. Objective:  To know the epidemiology of Road Traffic Injuries as seen in a tertiary care centre of Lucknow. Methodology: A cross-sectional study was done among patients of RTI admitted at a Tertiary Care Centre. A systematic random sampling technique was used to collect a sample of 267 patients of RTI in the study duration of four months. A pretested semi-structured interview schedule was used to collect necessary information regarding the time, place and the person involved in the accident. Descriptive statistics for continuous variables and frequency, percentage for categorical variables were determined. Chi-square test of uniform distribution was used to test distribution of variables. The level of significance was set at 0.05. Results: The mean age of the patients of RTI was 32 years and majority of the patients of RTI belonged to 16 to 30 years age group. Males outnumbered females giving a Male: Female ratio of 6.85: 1. Majority of the patients were from rural areas. A high proportion of the patients were MTV users. Conclusion: Fracture was the most common type of injury in the patients of RTI and Lower limb was the most common site of injury, followed by head.

  15. Varied presentations of moyamoya disease in a tertiary care hospital of north-east India

    Directory of Open Access Journals (Sweden)

    Papori Borah

    2014-01-01

    Full Text Available Introduction: Moyamoya disease is a chronic progressive cerebrovascular disorder, characterized by stenosis or occlusion of bilateral internal carotid arteries (ICAs, anterior cerebral arteries (ACAs and middle cerebral arteries (MCAs, accompanied by a collateral network of vessels formed at the base of the brain. Ischemia and intracranial hemorrhage are the common typical manifestations. However moyamoya disease has been associated with atypical presentations like headache, seizures and involuntary movements. Although frequently reported from Asian countries like Japan, China and Korea, only few studies reported on clinical manifestations of moyamoya disease from India. Objectives: To study the varied presentations of moyamoya disease in a tertiary care hospital of north-east India. Material and Methods: Relevant investigations were done to rule out other causes of moyamoya syndrome. Results: We report 6 cases of moyamoya disease with varied presentations from a tertiary care referral government hospital. Case 1, 2 and 6 presented with alternating hemiparesis. Case 3 had amaurosis fugax. Case 4 had history suggestive of ischemic stroke and presented with hemichorea. Case 4 had focal seizure as the only manifestation. Cases 4 and 5 notably had stenosis of posterior cerebral artery (PCA in addition to stenosis of bilateral ICAs, ACAs and MCAs. Conclusion: Owing to its low incidence in India, moyamoya disease is easily overlooked as a possible diagnosis. However, because of its progressive nature, it is imperative to diagnose this disease early and offer surgical treatment to the patients.

  16. Lymphoma of the thyroid gland: a clinicopathologic study over a period of five years in a tertiary care center

    Directory of Open Access Journals (Sweden)

    U. Anjit

    2015-06-01

    Full Text Available Background: Primary Thyroid Lymphoma (PTL is uncommon, accounting for only 5% of thyroid neoplasms and less than 2.5 to 7% of extranodal lymphomas. The study aims to analyze the histopathological findings and to correlate it with clinical features. Methods: This study includes cases of PTL received in the department of pathology in a tertiary care center, Kerala, south India over a period of 5 years. Patient details and follow up data were obtained by communication with treating doctors and reviewing the hospital records. All cases had a minimum follow up of 6 months. Results: 15 cases of PTL were diagnosed over the five year period. In total 72 cases of extranodal lymphomas were diagnosed, thus forming 20.83% of extra nodal lymphomas. Lymphocytic thyroiditis was present in 93.3%. Most of the cases were Extranodal Marginal Zone B Cell Lymphoma (EMZBCL and Diffuse Large B Cell Lymphoma (DLBCL. Conclusion: It is important to consider the diagnosis of primary thyroid lymphoma in patients presenting with an enlarging neck mass especially with the history of Hashimoto's thyroiditis. Random microscopic foci of DLBCL or small areas of MZBL could be overlooked examination or missed with limited sampling. The distinction between MZBL and DLBCL in the thyroid is clinically significant. [Int J Res Med Sci 2015; 3(3.000: 579-582

  17. PROFILE OF CHILDREN BITTEN BY DOGS, REPORTING TO A GOVERNMENT TERTIARY CARE HOSPITAL AND THEIR COMPLIANCE TO POST EXPOSURE PROPHYLAXIS

    Directory of Open Access Journals (Sweden)

    Sridhar

    2014-09-01

    Full Text Available INTRODUCTION: Children make up the largest percentage of people bitten by dogs, with the highest incidence in mid-to-late childhood. There is increased severity, necessity for medical treatment and death rates in children.1Dog bites not only causes wound, bleeding & pain but also transmits diseases like rabies tetanus, etc. which are fatal. The psychological trauma that a child undergoes is also immense. OBJECTIVES: To assess the socio-demographic profile, immediate treatment and compliance to immune globulin and rabies vaccination of dog bite victims aged 15 years or less. METHODOLOGY: This cross sectional study is based on records of the year 2013 in a government tertiary care teaching hospital located in south Karnataka. The descriptive statistics have been calculated using Microsoft excel software. RESULTS: Of the 5238 animal bite victims, 1773 (33.8% were aged 15 years or less and 1727 (97.4% were exposed to dogs. Significantly large proportion of victims was rural boys aged 4 to 7 years belonging to middle & lower class. Most bites were provoked and on the leg. Most reported within the same or next day of bite. Most were category III bites with only a few doing appropriate first aid measures. All took tetanus vaccination. 39% category III victims took rabies immune globulin and 60% were compliant with the rabies vaccination schedule

  18. QUALITY OF LIFE IN PATIENTS WITH PSORIASIS AT A TERTIARY CARE TEACHING HOSPITAL and ndash;A CROSS SECTIONAL STUDY

    Directory of Open Access Journals (Sweden)

    Preksha A Barot

    2015-06-01

    Full Text Available Background: Psoriasis is linked with social stigmatization, pain, discomfort, physical disability and psychological distress. It has a significant negative impact on quality of life. Since there is paucity of the data related to quality of life assessment in Indian psoriatic patients, this study was an earnest attempt in this direction The aim of this study was to evaluate the impact of psoriasis on the quality of life in patients with psoriasis. Materials and Methods: A cross sectional study was carried out in 60 patients at Dermatology outpatient department of a tertiary care teaching hospital. The quality of life assessment was done by DLQI questionnaire in patients above the age of 16 years. Results: The Health related Quality of Life was assessed by DLQI questionnaire in 60 patients at Dermatology outpatient department. The M: F ratio was 2.16:1. The mean DLQI score was 8.95 +/- 8.48 (Mean +/- SD and 66.7% of the patients had moderate to extremely large impact on the quality of life. Highest DLQI Mean score 15.21 was noted in younger (20-29 yrs age group. Conclusion: Psoriasis is chronic recurring disease and has significant negative impact on patients quality of life. These findings provide significant new insights into factors that affect the life quality of patients with psoriasis. [Natl J Med Res 2015; 5(2.000: 93-97

  19. Indicators of malnutrition in children with cancer: A study of 690 patients from a tertiary care cancer center

    Directory of Open Access Journals (Sweden)

    R Srivastava

    2015-01-01

    Full Text Available Background: Large data pertaining to indicators of malnutrition in children with cancer is lacking from India. In view of this, we prospectively analyzed consecutive de novo childhood patients with cancer presenting at a tertiary care center. Materials And Methods: Height and weight of each child (n = 690 were compared with World Health Organization child growth standards-2006 for that particular age and sex to get weight-for-age, height-for-age, and weight-for-height indices and below 2SD of the reference median on these indices were considered as underweight, stunted, and wasted, respectively. Body mass index (BMI for age was also analyzed for thinness and obesity. Results: Prevalence of malnutrition based on Z-score for weight-for-age, height-for-age, weight-for-height, and BMI-for-age was 30%, 31%, 35%, and 41%, respectively. Weight-for-age (underweight was significantly associated (P = 0.018 with solid tumors. Height-for-age, weight-for-age, and BMI-for-age were significantly associated (P = 0.007, P = 0.016, and P ≤ 0.001, respectively with rural community. Conclusion: Malnutrition was observed in approximately one-third of children with cancer. Malnutrition is associated with solid tumors and those coming from rural community. Wasting has a higher prevalence in children with cancer in <5 years of age group.

  20. Short term evolution of a highly transmissible methicillin-resistant Staphylococcus aureus clone (ST228 in a tertiary care hospital.

    Directory of Open Access Journals (Sweden)

    Valérie Vogel

    Full Text Available Staphylococcus aureus is recognized as one of the major human pathogens and is by far one of the most common nosocomial organisms. The genetic basis for the emergence of highly epidemic strains remains mysterious. Studying the microevolution of the different clones of S. aureus is essential for identifying the forces driving pathogen emergence and spread. The aim of the present study was to determine the genetic changes characterizing a lineage belonging to the South German clone (ST228 that spread over ten years in a tertiary care hospital in Switzerland. For this reason, we compared the whole genome of eight isolates recovered between 2001 and 2008 at the Lausanne hospital. The genetic comparison of these isolates revealed that their genomes are extremely closely related. Yet, a few more important genetic changes, such as the replacement of a plasmid, the loss of large fragments of DNA, or the insertion of transposases, were observed. These transfers of mobile genetic elements shaped the evolution of the ST228 lineage that spread within the Lausanne hospital. Nevertheless, although the strains analyzed differed in their dynamics, we have not been able to link a particular genetic element with spreading success. Finally, the present study showed that new sequencing technologies improve considerably the quality and quantity of information obtained for a single strain; but this information is still difficult to interpret and important investments are required for the technology to become accessible for routine investigations.

  1. Urogenital fistulae: A prospective study of 50 cases at a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Mathur Rajkumar

    2010-01-01

    Full Text Available Introduction: The misfortunate incident of formation of a urogenital fistula remains a major challenge for surgical urologists worldwide. Such fistulae may not be a life-threatening problem, but surely the women face demoralization, social boycott and even divorce and separation. The fistula may be vaginal, recto-vaginal or a combination of the two. The World Health Organization (WHO has estimated that in the developing nations, nearly 5 million women annually suffer severe morbidity with obstetric fistulae being the foremost on the list. The objective of our study was to enunciate the patient demography, patient profile, incidence, type of surgery, as well as the long-term outcomes encountered in the management of all types of genital fistulae at a tertiary care centre. Materials and Methods: 50 consecutive patients, attending the outpatient department with urogenital fistulae, were studied during the period of 5 years from July 2005 to July 2009. All female patients with complaints of urinary incontinence and fecal incontinence and dribbling, patients having a history of obstructed labor, radiotherapy, instrumental delivery, foreign body or trauma and with a history of hysterectomy (abdominal/ vaginal and lower segment caesarean section (LSCS were included. A thorough urological examination included a dye study using methylene blue, Renal function tests, X-ray KUB and intravenous urography (IVU. Cystoscopy along with examination under anaesthesia (EUA were done to assess the actual extent of injury. All patients were subjected to appropriate surgical interventions via the same combination of surgeons . Post operatively, prophylactic antibiotics were administered to all patients and patients were managed till discharge and followed thereafter via regular outpatient visits for a period of 3 years. Results: Age of patients ranged from 21 to 40 years. 64% patients hailed from rural areas, 76% were from the lower socio-economic strata, 40

  2. Campylobacter jejuni infection in Guillain-Barré syndrome: a prospective case control study in a tertiary care hospital.

    Science.gov (United States)

    Sharma, A; Lal, V; Modi, M; Vaishnavi, C; Prabhakar, S

    2011-01-01

    Guillain-Barré syndrome (GBS), is a common post-infectious polyradiculoneuropathy worldwide. The commonest implicated causative organism the world over is Campylobacter jejuni (C. jejuni). This study was carried out to determine the relationship between C. jejuni infection and GBS in an Indian setting. This prospective study was carried out on a cohort of 50 patients with GBS who were treated in a tertiary care hospital in India. Based on electrophysiological findings the patients were divided into various subtypes. Serology for C. jejuni (Immunoglogulin G, IgG and Immunoglogulin, IgM) using an enzyme-linked immunosorbent assay method (ELISA) was done both in patients and 40 age, sex and geographically matched controls. Evidence of recent C. jejuni infection was present in 30% of GBS patients compared to 8% of controls (15/50 vs. 3/40 P<0.005). Eight (47%) C. jejuni-positive patients reported symptoms of gastroenteritis 4-30 days (mean 13 days) prior to onset of GBS. Of the 15 patients with evidence of C. jejuni infection, 10 (67%) patients had axonal type of GBS. Axonal variety of GBS presented in a younger age group compared to acute inflammatory demyelinating polyradiculoneuropathy (AIDP) patients (mean age: axonal vs. AIDP: 30.11 + 13.73 vs. 40.2 + 18.77). C. jejuni-positive patients presented mainly in spring and winter and had a similar age and sex incidence as compared to the rest of the GBS patients. Preceding C. jejuni infection is common among GBS patients and is often associated with the axonal variety of GBS. Axonal variety of GBS generally presents in a younger age group as compared to AIDP.

  3. Depression and catastrophizing predict suicidal ideation in tertiary care patients with interstitial cystitis/bladder pain syndrome

    DEFF Research Database (Denmark)

    Tripp, Dean A; Nickel, J Curtis; Krsmanovic, Adrijana

    2016-01-01

    Introduction: We sought to evaluate psychosocial factors as predictors of suicidal ideation (SI) in a tertiary care outpatient sample of women suffering from interstitial cystitis/bladder pain syndrome (IC/BPS). Methods: The patients are women managed at tertiary care centres (n=190). Controls were...... is the first to implicate multiple psychosocial risk factors over and above IC/BPS-specific symptoms and patient pain experience in SI in women with IC/BPS. Depression in particular is uniquely important in predicting suicidality. These results support a multidisciplinary, proactive approach to IC...

  4. Two rare cases of Acremonium acute endophthalmitis after cataract surgery in a tertiary care hospital.

    Science.gov (United States)

    Calderaro, Adriana; Motta, Federica; Larini, Sandra; Gorrini, Chiara; Martinelli, Monica; Piscopo, Giovanni; Benecchi, Magda; Arcangeletti, Maria Cristina; Medici, Maria Cristina; De Conto, Flora; Montecchini, Sara; Neri, Alberto; Scaroni, Patrizia; Gandolfi, Stefano; Chezzi, Carlo

    2013-10-01

    This report describes two cases of Acremonium sp. endophthalmitis, occurring in two patients who underwent cataract surgery on the same day in the same operating room of our hospital ophthalmology clinic. Diagnosis of fungal endophthalmitis was established by the repeated isolation of the same fungal agent from vitreous washing, acqueous fluid and intraocular lens samples and by its identification on the basis of morphological and molecular features. The cases reported in this study emphasize the need for clinical microbiology laboratories to be prepared to face the diagnosis of uncommon infectious diseases such as exogenous fungal endophthalmitis by Acremonium, and to enhance the awareness of surgeons and clinicians of this occurrence.

  5. Acute Upper Gastrointestinal Bleeding in a Tertiary Care Centre of Nepal.

    Science.gov (United States)

    Paudel, M S; Kc, S; Mandal, A K; Poudyal, N S; Shrestha, R; Paudel, B N; Chaudhary, S

    2017-01-01

    AUGIB is characterized by hematemesis or melena or both. Peptic ulcers and variceal bleed account for majority of cases. Use of proton pump inhibitors in current era is associated with a gradual reduction in burden of peptic ulcer disease. We conducted this study to look into the cause of AUGIB in our community. We studied 100 patients in one year period who presented to us with hematemesis or melena. The study was conducted in department of Gastroenterology, Bir hospital, Kathmandu. We identified the culprit lesions by upper gastrointestinal endoscopy. The average age of patients with AUGIB was 51.6 years with 59 (59%) males. Duodenal ulcers are most common 29 (29%), followed by varices 23 (23%) and gastric ulcers 14 (14%). More than one lesion was identified in 38 (38%) patients. Patients with variceal bleed were more likely to present with hematemesis alone as compared to those with ulcer bleed (P=0.005). Variceal bleed patients presented earlier to the hospital (P=0.005), had lower MAP at presentation (P=0.0002), had lower hemoglobin level (P=0.0001) and higher serum creatinine level at presentation (P=0.001). Patients with variceal bleed were more likely to have consumed alcohol 20 (86.9%) and patients with ulcer bleed were more likely to be smokers 29 (67.4%) or consume tobacco 14 (32.5%) (P=0.006). Ulcer related bleeding is still the most common cause of AUGIB. Many patients with AUGIB have more than one lesions identified during upper gastrointestinal endoscopy.

  6. Incident reporting by acute pain service at a tertiary care university hospital

    Directory of Open Access Journals (Sweden)

    Aliya Ahmed

    2015-01-01

    Conclusion: Reporting of untoward incidents and their regular analysis by APS is recommended to ensure high-quality patient care and to provide guidance in making teaching strategies and guidelines to improve patient safety.

  7. Evaluation of series of 177 cases of acute gynaecological emergencies in tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Vrunda Choudhary

    2016-06-01

    Conclusions: Accurate clinical and laboratory evaluation are essential in gynecological emergencies. There should be a high index of suspicion for early detection and early intervention to reduce morbidity and mortality. [Int J Reprod Contracept Obstet Gynecol 2016; 5(6.000: 1700-1704

  8. Clinical, echocardiographic and angiographic correlation of acute coronary syndrome in women at a tertiary care centre

    Directory of Open Access Journals (Sweden)

    Chetana Krishnegowda

    2016-07-01

    Conclusions: Women clinically present with atypical symptoms that resulted in significant delay to reach hospital. Novel risk factors like HsCRP and homocysteine may improve risk detection in women with CAD. Identifying and targetting lifestyle risk factors. Diabetes mellitus in particular is the key to reduction in CAD in women. [Int J Res Med Sci 2016; 4(7.000: 2683-2691

  9. Propofol for pediatric colonoscopy: the experience of a large, tertiary care pediatric hospital.

    Science.gov (United States)

    Cohen, Shlomi; Glatstein, Miguel M; Scolnik, Dennis; Rom, Liat; Yaron, Ayala; Otremski, Sorina; Ben-Tov, Amir; Reif, Shimon

    2014-01-01

    Successful colonoscopy includes full visualization of the terminal ileum, especially in inflammatory bowel disease when ileal biopsy is essential. In children, higher levels of anxiety and lack of cooperation often necessitate a deeper level of sedation. The aim of this study was to evaluate the effectiveness of propofol compared with midazolam and fentanyl for colonoscopy, and in accomplishing ileal and cecal intubation in particular. This was a retrospective cohort study comparing the rates of successful colonoscopy in patients receiving propofol with those receiving midazolam/fentanyl. Complete, successful, colonoscopy to the terminal ileum was achieved in 78% of propofol patients compared with 66% of the midazolam/fentanyl group (P=0.004). Endoscopy reaching the cecum, but not the terminal ileum, was achieved in 78% of propofol patients and 66% of midazolam/fentanyl patients. The use of propofol was associated with a statistically significant increase in the rate of successful colonoscopy reaching the terminal ileum.

  10. Clinico-epidemiological study of pityriasis versicolor in a rural tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Nazeema Tabaseera

    2014-08-01

    Full Text Available Background: The study was conducted to know the incidence of pityriasis versicolor in relation to age, sex, seasons and occupation in a rural set up. Methods: A total of 105 patients of pityriasis versicolor were clinically evaluated and confirmed mycologically at central lab in a tertiary care hospital in South India. The obtained data was recorded and analysed accordingly. Results: Male preponderance was observed in the study. Disease was most pronounced in younger age group (21-30 years especially students. 61.9% of patients sought medical advice on cosmetic grounds while 38% had pruritis. Chest was the commonest site of affection followed by neck and back. Conclusion: Early identification of the yeast by simple laboratory techniques would help prevent recurrences, systemic complications and cosmetological problems which are high especially among the students and younger age groups. [Int J Res Med Sci 2014; 2(4.000: 1438-1440

  11. Male Fertility and Reduction in Semen Parameters: A Single Tertiary-Care Center Experience

    Directory of Open Access Journals (Sweden)

    D. Milardi

    2012-01-01

    Full Text Available Background. Infertility is both a clinical and a public problem, affecting the life of the couple, the healthcare services, and social environment. Standard semen analysis is the surrogate measure of male fertility in clinical practice. Objective. To provide information about the relationship between semen parameters and spontaneous conception. Methods. We evaluated retrospectively 453 pregnancies that occurred among 2935 infertile couples evaluated at an infertility clinic of a tertiary-care university hospital, between 2004 and 2009. Results. Normal semen analysis was present only in 158 patients; 295 subfertile patients showed alterations in at least one seminal parameter. A reduction in all seminal parameters was observed in 41 patients. Etiological causes of male infertility were identified in 314 patients. Conclusion. Our data highlights the possibility of a spontaneous conception with semen parameters below WHO reference values. Therefore, we support the importance of defining reference values on a population of fertile men. Finally, we analyzed the related ethical issues.

  12. DISTRIBUTION OF CONGENITAL HEART DISEASES AT TERTIARY CARE CENTER: SINGLE CENTER EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Vaishali

    2016-02-01

    Full Text Available BACKGROUND The current study was undertaken at a tertiary care center, Bhopal, MP, India, with the objective of establishing frequency of occurrence of congenital heart diseases by echocardiography. MATERIALS AND METHOD 10,000 consecutive cases undergoing Echo Color Doppler in the Cardiology Department Hamidia Hospital, Bhopal, between 1st Jan 2009 and July 2011 were analysed. Echo CD was performed by consultant cardiologist using Acuson Aspen Color Doppler machine following the ASE guidelines. RESULTS AND CONCLUSIONS In the present study out of 10,000consecutive cases undergoing echo 648 were identified to having congenital heart diseases. Isolated VSD (30.5%, isolated ASD (23.6% PDA (9% and TOF (8.3% were commonest defect observed. Most common congenital heart disease found in the present study is VSD and is most prevalent in males and is highest among 0-5 yrs.

  13. A study of assessment of patient safety climate in tertiary care hospitals.

    Science.gov (United States)

    Chakravarty, Abhijit; Sahu, Anupam; Biswas, Manash; Chatterjee, Kaustuv; Rath, Subrata

    2015-04-01

    Medical errors are being detected with increasing frequency in healthcare environment, in many cases leading to patient harm. Measurement and improvement of patient safety climate has been identified as a strategic effort towards addressing this vital issue. Safety Attitude Questionnaire (SAQ), validated by previous research was administered to 300 respondents in three tertiary care hospitals of India, the respondents representing various categories of healthcare workers and variations in safety scale score was analyzed by various statistical tools. No variation was observed in the Patient Safety Index score among the study hospitals. However, significant variations were observed among different categories of healthcare workers across dimensions of Teamwork, Perception of Management and Stress Recognition. Multiple Regression models identified Teamwork and Perception of Management to have significant correlation with Patient Safety Index Score. Patient Safety Climate can be effectively assessed and such assessment utilized for focused improvement efforts towards safety in healthcare organizations.

  14. [An outbreak of scabies in a tertiary-care hospital from a crusted scabies case].

    Science.gov (United States)

    Elgueta N, Andrea; Parada E, Yolanda; Guzmán G, Wilma; Molina C, Paula; González A, Patricia

    2007-08-01

    In February 2005 we performed an epidemiological study of an outbreak of scabies in a tertiary-care hospital which started from a crusted scabies case. We detected 10 secondary cases, 8 in healthcare workers and 2 in hospitalized patients. The attack rate was 4.1%. In contrast to previously described outbreaks, the crusted scabies case was recognized at admission. The outbreak causes were: lacking adherence to contact precautions, long stay of the primary case in the hospital ward and delay of specific treatment. The main control measures were: alerting the hospital services about the outbreak, performing epidemiologic surveillance, coordinating with the Hospital Direction and the Occupational Health Department, education of healthcare workers in control measures, implementation of isolation measures and treatment of cases and contacts with 5% permethrin topical lotion.

  15. A Clinical Study of Blunt Ocular Trauma in a Tertiary Care Centre

    Directory of Open Access Journals (Sweden)

    Shobha G Pai

    2013-08-01

    Full Text Available Purpose: To analyze blunt eye injuries with respect to mode of injury, sites involved and outcome. Method: This was a retrospective study of 32 patients with blunt ocular trauma from 2010 to 2012 in a tertiary care centre. Patient data, mode and extent of injury, management and outcome was noted and analyzed. Result: The commonest age of presentation was 10-20 years (28.125% and the commonest mode of injury was road traffic accident (28.125%. The most commonly involved structure was conjunctiva (84.375%, followed by lid and adnexa (62.5%. Anterior segment involvement included corneal epithelial defect (7 cases, hyphaema (4 cases, iritis (3 cases and anterior dislocation of lens (1 case. Posterior segment involvement included vitreous haemorrhage (1 case and commotio retinae (2 cases. Conclusion: This study reinforces that blunt trauma can cause any extent of damage to ocular structures and the final visual outcome is dependent on the structures injured.

  16. A STUDY OF TRAUMATIC BRAIN INJURIES AT A TERTIARY CARE HOSPITAL IN KARNATAKA, SOUTH INDIA

    Directory of Open Access Journals (Sweden)

    Hariprakash

    2014-04-01

    Full Text Available OBJECTIVE: To analyze the causes, various risk factors and treatment outcomes of traumatic brain injuries in a tertiary care hospital. METHOD: A Retro-prospective study from January 2012 till August 2013 (20months was conducted at a rural medical college Hospital. Also data was retrieved from medical records on demographics, clinical, radiological and outcome status. RESULTS: A total of 788 TBI were admitted. Mean age of patients was 35.47 years, 88.83% percent were male; 72% of all the victims were in the age 15-45 years, overall fatality was 4.3 %; males were higher among fatal cases; Road traffic injuries were the commonest injury mechanism (93.65%. CONCLUSION: Trauma is the leading cause of death and disabilities worldwide, especially in children and young adults. Minor head injury constituted to about 60.4% and severe head injury constituted to about 12.18%.

  17. Distribution of HIV among pregnant women visiting a tertiary care hospital in Kathmandu, Nepal

    Directory of Open Access Journals (Sweden)

    Manish Rijal

    2014-09-01

    Full Text Available Objective: To explore the distribution of HIV among the pregnant women visiting a tertiary care hospital in Kathmandu. Methods: A total of 1 440 blood samples from pregnant women were collected and tested for antiHIV antibodies using rapid screening assay kits and ELISA in Paropakar Maternity and Women ’s Hospital during May to November, 2011. Results: The overall sero-prevalence of HIV among pregnant women was 0.62%, the prevalence being highest (1.4% in age group 35-39 years old, and during second trimester of gestation (0.75%. Similarly, it was found to be highest among the illiterates (1.92%, commercial sex worker (10.00% and those having multiple sexual partners (30.00%. Conclusions: Sero-prevalence of HIV infection was higher among the pregnant women of Kathmandu.

  18. Tooth agenesis in patients referred to an Irish tertiary care clinic for the developmental dental disorders.

    LENUS (Irish Health Repository)

    Hashem, Atef A

    2010-01-01

    PURPOSE: This study was carried out to determine the prevalence, severity and pattern of hypodontia in Irish patients referred to a tertiary care clinic for developmental dental disorders. MATERIALS AND METHODS: Details of 168 patients with hypodontia referred during the period 2002-2006 were entered in a database designed as a national record. Tooth charting was completed using clinical and radiographic examinations. The age of patients ranged from 7-50 years, with a median age of 20 years (Mean: 21.79; SD: 8.005). RESULTS: Hypodontia referrals constituted 65.5% of the total referrals. Females were more commonly affected than males with a ratio of 1.3:1. The number of referrals reflected the population density in this area; the majority were referrals from the public dental service. Mandibular second premolars were the most commonly missing teeth, followed by maxillary second premolars and maxillary lateral incisors; maxillary central incisors were the least affected. Symmetry of tooth agenesis between the right and left sides was an evident feature. Slightly more teeth were missing on the left side (n = 725) than on the right side (n = 706) and in the maxillary arch (n = 768) as compared to the mandibular arch (n = 663). Some 54% of patients had severe hypodontia with more than six teeth missing; 32% had moderate hypodontia, with four to six teeth missing. The most common pattern of tooth agenesis was four missing teeth. CONCLUSION: Hypodontia was a common presentation in a population referred to this tertiary care clinic. The pattern and distribution of tooth agenesis in Irish patients appears to follow the patterns reported in the literature.

  19. Tetanus immunization: perception of residents in a tertiary care teaching hospital in Western India

    Directory of Open Access Journals (Sweden)

    Dhande Priti P, Beri Shirish G, Patel Hardik R

    2013-04-01

    Full Text Available Background: Prevention of tetanus is far easier than its treatment where mortality is very high. Most cases of tetanus occur due to lack of proper vaccination against the disease and incomplete immunization on exposure. Residents in a tertiary care teaching hospital constitute the first contact physicians for patients. Aim: To assess the perception about Tetanus immunization among residents in a tertiary care teaching hospital of Pune city. Methodology: A pre tested questionnaire was used to assess the knowledge & recommendations about tetanus immunization among randomly selected 157 residents. Results: 73.25% residents were not aware of the number of doses of tetanus vaccine recommended for children under the age of 16 years. Around 50% residents were not aware of the recommended number of doses of tetanus vaccine for adults over the age of 16 years and during pregnancy. Nearly 60% of the residents considered the wound after every injury to be tetanus prone. 75.8% of residents thought burn injuries to be prone to the development of tetanus while 13.4% and 36.9% of the residents did not consider animal bite and human bite to be tetanus prone respectively. 99.4% residents considered tetanus toxoid administration in wound with rusted iron. The knowledge regarding tetanus immunization in relation to the wound categories depending on the immunization status of the patients was very poor amongst the residents. Conclusion: Better awareness and adherence of tetanus prophylaxis recommendations is needed in residents who are the first tier of health care providers in teaching hospitals.

  20. Microbiological burden in air culture at various units of a tertiary care government hospital in Nepal

    Directory of Open Access Journals (Sweden)

    Binaya Sapkota

    2016-01-01

    Full Text Available Background The environmental matrices (water, air, and surfaces play a vital role as reservoirs of Legionella spp. and Pseudomonas aeruginosa (Pseudomonas spp.. Hence, hospital environment control procedures are effective measures for reducing nosocomial infections. Aims This study was carried out to explore the profiles of microorganisms in air culture at various wards/units of a tertiary care hospital in Nepal. Methods A descriptive cross-sectional study was carried out at various wards/units of a tertiary care hospital in Nepal between January and September 2015 to explore the microbiological burden in inanimate objects. Each week one ward or unit was selected for the study. Bed, tap, the entire room, trolley, computer, phone, rack handles, table, chair, door, stethoscope, oxygen mask, gown, cupboard handles, and wash basins were selected for air culture testing. Ten different wards/units and 77 locations/pieces of equipment were selected for air culture by employing a simple random sampling technique. Information about the organisms was entered into the Statistical Package for the Social Sciences (SPSS Version 22 (IBM: Armonk, NY and descriptive analyses were carried out. Results Staphylococcus aureus (S. aureus, Micrococcus, coagulase negative staphylococcus (CONS, Bacillus, Pseudomonas aeruginosa, yeast, and Acinetobacter were the most commonly detected organisms. In the postoperative ward, S. aureus was the most frequently detected microorganism. Micrococcus was detected in four out of 10 locations. In the x-ray unit, S. aureus was detected in three out of four locations. Conclusion S. aureus, Micrococcus, CONS, Bacillus, Pseudomonas, yeast, and Acinetobacter were the most common organisms detected.

  1. Inhalant dependence: Data from a tertiary care center in South India

    Directory of Open Access Journals (Sweden)

    Janardhanan C Narayanaswamy

    2012-01-01

    Full Text Available Background: This study aims to understand the sociodemographic and clinical profile of inhalant abusers seeking treatment from a tertiary care psychiatric hospital in South India. Materials and Methods: The clinical charts of patients who utilized the psychiatric services of a tertiary care center in India for over 10 years were examined for the study. Results: The sample had an urban predominance, was mostly unemployed, and was all male. Most of them had an adolescent age of onset of inhalant use (mean - 16.23 years. All patients reported the use of volatile solvents as inhalants. One other substance dependence was identified in more than half of the sample. The psychiatric comorbidity included psychosis and depression. A comparison was made between patients who presented with inhalant dependence only (I and inhalant-dependent individuals who also used other psychoactive substances apart from nicotine (IP. The inhalant-only group (I had an earlier mean age at onset of substance use as compared to the IP group. All patients in the I group reported withdrawal symptoms compared to 77% of patients in the (IP group (P=0.048. The IP group reported a significantly higher occurrence of aggression (54.5 vs. 19%, P=0.02, externalizing symptoms (77.3 vs. 42.9%, P=0.03, and attention-deficit hyperactivity disorder (ADHD (50 vs. 14.3%, P=0.02. Conclusion: Inhalant dependence is a serious health problem in adolescent subjects and is associated with high comorbidity of other substance dependence, psychiatric disorder, and externalizing spectrum disorder. There is a need for community-based prospective studies in this area from India.

  2. Prevalence of Ventilator Acquired Pneumonia in Organophosphorus Poisoning Patients in Tertiary Care Hospital

    Directory of Open Access Journals (Sweden)

    Merry Raphael

    2015-11-01

    Full Text Available Background: Ventilator associated pneumonia (VAP is a major cause of poor outcome among patients in the intensive care units (ICU world-wide. OP poisoning patients are very susceptible to respiratory associated problems especially respiratory muscle paralysis. Such patients generally need ventilation support which has high chances of getting VAP. Objective: To find out the Prevalence, causative organisms and treatment pattern of VAP in OP poisoning patients in tertiary care hospital in South India. Methods: A retrospective study was conducted in a tertiary care teaching hospital of South India from 2008 to 2013, total of 500 patients were enrolled for the study and data was collected from the medical records in a suitable designed case record form. Information regarding demographical details, severity assessment, type of pneumonia acquired, causative organisms for VAP, complications, treatment and outcome measures of patients was recorded. Data was entered in SPSS 20.0 and analyzed for the results. Results and Conclusion: The mean age of the Patients admitted was 33.31 ± 14.5 years and majority of them were found to be males (69.4% and (30.6% were females. Among the study population, 54 (10.8% patients acquired VAP. The most common organisms found to have caused pneumonia were gram negative organisms such as Pseudomonas aeruginosa (1.2%, Klebsiella pneumoniae (1.0% and Acinobacter (0.6%. The most commonly used antibiotics in the treatment of VAP were beta-lactam antibiotics like Cephalosporins (56.1%, Penicillins (31.9%. Respiratory problems are common in OP poisoning patients and hence are very susceptible to VAP. Proper screening and identification of organisms in the early stage with appropriate antibiotics will help in better outcome.

  3. Admission experiences of psychiatric patients in tertiary care: An implication toward Mental Health Care Bill, 2013

    Science.gov (United States)

    Ramachandra; Poreddi, Vijayalakshmi; Ramu, Rajalakshmi; Selvi, Sugavana; Gandhi, Sailaxmi; Krishnasamy, Lalitha; Suresh, B. M.

    2017-01-01

    Background: Coercion is not uncommon phenomenon among mental health service users during their admission into psychiatric hospital. Research on perceived coercion of psychiatric patients is limited from India. Aim: To investigate perceived coercion of psychiatric patients during admission into a tertiary care psychiatric hospital. Materials and Methods: This was a cross-sectional descriptive survey carried out among randomly selected psychiatric patients (n = 205) at a tertiary care center. Data were collected through face-to-face interviews using structured questionnaire. Results: Our findings revealed that participants experienced low levels of coercion during their admission process. However, a majority of the participants were threatened with commitment (71.7%) as well as they were sad (67.8%), unpleased (69.7%), confused (73.2%), and frightened (71.2%) with regard to hospitalization into a psychiatric hospital. In addition, the participants expressed higher levels of negative pressures (mean ± standard deviation, 3.76 ± 2.12). Participants those were admitted involuntarily (P > 0.001), diagnosed to be having psychotic disorders (P > 0.003), and unmarried (P > 0.04) perceived higher levels of coercion. Conclusion: The present study showed that more formal coercion was experienced by the patients those got admitted involuntarily. On the contrary, participants with voluntary admission encountered informal coercion (negative pressures). There is an urgent need to modify the Mental Health Care (MHC) Bill so that treatment of persons with mental illness is facilitated. Family member plays an important role in providing MHC; hence, they need to be empowered. PMID:28149089

  4. Admission experiences of psychiatric patients in tertiary care: An implication toward Mental Health Care Bill, 2013

    Directory of Open Access Journals (Sweden)

    Ramachandra

    2017-01-01

    Full Text Available Background: Coercion is not uncommon phenomenon among mental health service users during their admission into psychiatric hospital. Research on perceived coercion of psychiatric patients is limited from India. Aim: To investigate perceived coercion of psychiatric patients during admission into a tertiary care psychiatric hospital. Materials and Methods: This was a cross-sectional descriptive survey carried out among randomly selected psychiatric patients (n = 205 at a tertiary care center. Data were collected through face-to-face interviews using structured questionnaire. Results: Our findings revealed that participants experienced low levels of coercion during their admission process. However, a majority of the participants were threatened with commitment (71.7% as well as they were sad (67.8%, unpleased (69.7%, confused (73.2%, and frightened (71.2% with regard to hospitalization into a psychiatric hospital. In addition, the participants expressed higher levels of negative pressures (mean ± standard deviation, 3.76 ± 2.12. Participants those were admitted involuntarily (P > 0.001, diagnosed to be having psychotic disorders (P > 0.003, and unmarried (P > 0.04 perceived higher levels of coercion. Conclusion: The present study showed that more formal coercion was experienced by the patients those got admitted involuntarily. On the contrary, participants with voluntary admission encountered informal coercion (negative pressures. There is an urgent need to modify the Mental Health Care (MHC Bill so that treatment of persons with mental illness is facilitated. Family member plays an important role in providing MHC; hence, they need to be empowered.

  5. Benign Prostatic Hyperplasia: Health Seeking Behaviour of patients at a tertiary care hospital.

    Directory of Open Access Journals (Sweden)

    Aman Deep

    2010-03-01

    Full Text Available BackgroundBenign Prostatic Hyperplasia is a widely prevalent conditionaffecting elderly men throughout the world. With increasinglife expectancy, there has been a rise in the percentage ofelderly men and so for this disease across the globe. There islack of information about health seeking behaviour of patientswith Benign Prostatic Hyperplasia. Therefore the study wasdesigned with the objectives of assessing health-seekingbehaviour and the effect of literacy on it among adult andolder subjects suffering from Benign Prostatic Hyperplasiaattending a tertiary care hospital.MethodA series of 81 patients suffering from Benign ProstaticHyperplasia above the age of 50 years, attending surgical OutPatient Department of a tertiary care hospital in Delhi, wereassessed for their health seeking behaviour using a pre-testedand a modified questionnaire designed for assessing healthseeking behaviour.ResultsPositive health seeking behaviour of patients was observed in44%, who reported to a doctor within a month of noticingtheir problem. A greater proportion of the literates was awareabout the symptoms suggestive of enlarged prostate andconsulted a qualified health care practitioner as their firstaction. More literates approached the higher level of healthcare facility on being referred and had maximum faith inallopathic system of medicine. Also, lesser number of literateshad performed pooja (Hindi word for worship or othertraditional rituals for relief of their problems.ConclusionWe concluded that majority of subjects suffering fromBenign Prostatic Hypertrophy were not aware of theirdisease and their health-seeking behaviour was poor andcould be related to literacy. Our data highlights the needfor public awareness program targeting the younger malepopulation so that early detection and treatment can beoffered.

  6. Assessment of medication errors and adherence to WHO prescription writing guidelines in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Dilnasheen Sheikh

    2017-06-01

    Full Text Available The objective of the study is to assess the medication errors and adherence to WHO prescription writing guidelines in a tertiary care hospital. A prospective observational study was carried out for a period of 8 months from June 2015 to February 2016 at tertiary care hospital. At inpatient department regular chart review of patient case records was carried out to assess the medication errors. The observed medication errors were assessed for level of harm by using NCCMERP index. The outpatient prescriptions were screened for adherence to WHO prescription writing guidelines. Out of 200 patients, 40 patients developed medication errors. Most of the medication errors were observed in the age group above 61 years (40%. Majority of the medication errors were observed with drug class of antibiotics 9 (22.5% and bronchodilators 9 (22.5%. Most of the errors were under the NCCMERP index category C. Out of 545 outpatient prescriptions, 51 (9.37% prescriptions did not have prescriber’s name and all of the prescriptions lack prescriber’s personal contact number. Eighteen prescriptions did not have patient’s name and 426 (78.2% prescriptions did not have patient’s age. The prevalence of medication errors in this study was relatively low (20% without any fatal outcome. Omission error was the most frequently observed medication errors 31 (77.5%. In the present study, the patient’s age was missing in 78.2% of the prescriptions and none of the prescriptions had patient’s address and the drug names were not mentioned by their generic names.

  7. Neonatal Hearing Screening Programme (NHSP): At A Rural Based Tertiary Care Centre.

    Science.gov (United States)

    Sharma, Yojana; Mishra, Girish; Bhatt, Sushen H; Nimbalkar, Somashekhar

    2015-12-01

    Deafness is the most common curable childhood handicap. It is a well recognised fact that unidentified hearing impairment can adversely affect optimal speech and language development and therefore academic, social and emotional development. Universal neonatal hearing screening programmes are implemented in many developed countries. However it is still in its early stage in India. The incidence of hearing impairment in India is 1-6 per thousand newborns screened (Paediatrics 19:155-165, 1998; Indian J Paediatr 74(6):545-549, 2007; Status of Disability in India, pp 172-185 2000). To determine the incidence of permanent hearing loss of moderate to evere variety in neonates taking care in a tertiary care rural based hospital in Gujarat. It was a non randomised observational study done for duration of 3 years. All neonates born in Shri Krishna Hospital underwent screening using two stage protocols with DPOAE test and final confirmation done with BERA. Total 2534 neonates were screened out of them 52 failed and 2482 (97.94 %) neonates passed in the 1st DPOAE test with 2.05 % refer rate. Total 7 (2 per 1000) neonates were detected with hearing impairment. 10 % neonates had one or other high risk factor. Out of high risk neonates, 1.8 % were diagnosed with hearing impairment in high risk group. Overall the follow-up rate was 72.7 %. Hospital based universal hearing screening of new born before discharge is feasible at a rural based tertiary care centre. Non specialist staff is invaluable in achieving a satisfactory referral rate with two stage hearing screening protocol. However, more efficacious tracking and follow up system is needed to improve the follow up rate for diagnosis.

  8. Profile of nicotine use among alcohol dependent patients visiting a tertiary care center in north India

    Directory of Open Access Journals (Sweden)

    Rizwana Quraishi

    2014-01-01

    Full Text Available Background: Use of tobacco among alcohol dependent population is quite frequent. This co-morbidity increases the risk for various diseases. Understanding the pattern of tobacco use with co-morbid alcohol use may help in planning appropriate prevention/treatment strategies. The study aimed at examining the profile and pattern of nicotine use among alcohol dependent patients visiting a tertiary care treatment center in North India. Materials and Methods: Male patients fulfilling diagnostics and statistical manual of mental disorder fourth edition, criteria for nicotine and alcohol diagnostics and statistical dependence, attending the out-patient department of the tertiary care treatment center were recruited after obtaining informed consent. The socio-demographic profile, drug use history, nicotine associated health problems and general health problem were recorded. Motivation to stop tobacco use was assessed qualitatively using the direct questions about their interest and intentions to quit. Results: A total of 150 subjects were included in the study. The mean age of the study sample was 37.6 ± 10.44 years. Tobacco was reported as the gateway drug in 90% of the cases. Exclusive bidi use reported in 42% of the subjects. Mean duration of bidi and co-morbid alcohol use was higher than cigarette or smokeless tobacco use. Self-reported health problems associated with nicotine use and general health was reported by 41% and 39% of the subjects. Unsuccessful past quit attempts was present in 85% cases. More than 90% of subjects remained interested in quitting the tobacco use. An increased liver enzyme (aspartate transaminase, alanine transaminase and gamma-glutamyl transferase were observed in 43, 32 and 47% of the cases. Conclusion: The results suggest the nicotine and alcohol dependent patients represent a separate population requiring higher attention from the treating physician.

  9. Swine flu outbreak 2015-Paediatric Experience in a Tertiary Care Centre.

    Directory of Open Access Journals (Sweden)

    Dr. Anuya Chauhan

    2016-12-01

    Full Text Available Background & Aim: To study and analyse the clinical profile and outcome of children admitted with Influenza A positive cases at our Tertiary Care Centre in 2015. Materials & Methods: Prospective study conducted in a tertiary care centre (Civil Hospital B. J. Medical College, Ahmedabad from Jan 2015 to March 2015. 340 Children presenting with clinical features compatible with category C were admitted and 199 patients having laboratory confirmed influenza A (H1N1 were included in our study. Details regarding clinical features, examination findings, investigations, complications and treatment were recorded and analysed in a systemic manner. Results: Study showed that highest incidence of influenza A was seen in 1-3 years age group (41.7% Male-female ratio was 1.18:1 indicating similar affection of both sexes. Maximum patients presented within first 3 days of illness (53.2% with fever (82.9% followed by dry cough (74.6% and sore throat (52.7% as presenting symptoms. Leucopenia (79.4% was the most common laboratory finding and lobar pneumonia (81.1% was the most common radiological finding followed by bronchopneumonia (18.9%. Conjunctivitis (20.1% and otitis media (6.03% were the common complications. Mortality rate in our set up was 6.5% (13 out of 199; with maximum from 1-3 year age group (46.1%, most common cause being ARDS (46.1%. Conclusion: The outbreak of influenza A (H1N1 2015 predominantly affected young population with significant morbidity and mortality. With the efforts of healthcare authorities worldwide, we have still not lost the race against fighting this virus.

  10. Assessment of adverse drug events among patients in a tertiary care medical center.

    Science.gov (United States)

    Johnston, Philip E; France, Daniel J; Byrne, Daniel W; Murff, Harvey J; Lee, Byron; Stiles, Renee A; Speroff, Theodore

    2006-11-15

    Specific patient and clinical characteristics associated with an increased risk of sustaining an adverse event (AE) were identified. AE reports for patients in a 658-bed tertiary care medical center between January 1, 2000, and June 30, 2002, were analyzed. The data collected from each report included medical record number, patient sex, patient age, clinical service, date of occurrence, diagnoses, type of error, suspected medication, and severity of the AE. A three-stage logistic regression model with high-risk indicators was used to evaluate key indicators of the most vulnerable patient populations. The number of control patients and those with AEs totaled 60,206. This population was then randomly split into two equal groups of patients: the training data set (n = 30,103) and the validation data set (n = 30,103). AEs occurred in a higher percentage of patients who were age or =60 years than in other groups. A higher percentage of AEs were reported in men than women, but the groups were not significantly different when comparing those with an AE and those without an AE. Asian Indian patients demonstrated a high rate of AEs, but this may be a statistical artifact, reflecting their very small percentage in the study. Evaluation of admission sources revealed that doctors' offices, clinic referrals, and local hospital transfers accounted for higher rates of AEs than other sources. Certain age groups, diagnoses, admission sources, types of insurance, and the use of specific medications or medication classes were associated with increased AE rates at a tertiary care medical center.

  11. Clinical Profile of Children and Adolescents Attending the Behavioural Paediatrics Unit OPD in a Tertiary Care Set up

    Science.gov (United States)

    Jayaprakash, R.

    2012-01-01

    Background: There are limited studies on the clinical profile of children attending child guidance clinic under Paediatric background. Aims: To study clinical profile of Children & adolescents attending the Behavioural Paediatrics Unit (BPU) OPD under department of Paediatrics in a tertiary care set up. Methods: Monthly average turnover in the…

  12. Quality of anticoagulation control among patients with atrial fibrillation: An experience of a tertiary care center in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Sarah M. Alyousif

    2016-10-01

    Conclusion: Quality of anticoagulation in patients with AF receiving medical care in a tertiary care hospital was suboptimal, with nearly 40% of the time spent outside the therapeutic range. Methods to improve anticoagulation control among patients with AF should be implemented.

  13. Avoidable iatrogenic complications of urethral catheterization and inadequate intern training in a tertiary-care teaching hospital.

    LENUS (Irish Health Repository)

    Thomas, Arun Z

    2009-10-01

    To examine the magnitude of potentially avoidable iatrogenic complications of male urethral catheterization (UC) within a tertiary-care supra-regional teaching hospital, and to evaluate risk factors and subjective feeling of interns in our institution on the adequacy of training on UC.

  14. Has the National Health Insurance improved the inequality in the use of tertiary-care hospitals in Korea?

    Science.gov (United States)

    Kim, Sujin; Kwon, Soonman

    2014-12-01

    To improve financial protection against catastrophic illness, the Korean government expanded the benefit coverage of the National Health Insurance (NHI) for cancer patients in 2005. This paper examined whether the policy has reduced income-inequality in the use of tertiary care hospitals. We evaluated the effect of the policy on income-inequalities in outpatient visits and inpatient admissions to tertiary care hospitals, based on triple difference estimators. Using nationwide claims data of the NHI from 2002 to 2010, we compared cancer patients as a treatment group with liver disease and cardio-cerebrovascular disease as control groups and the lower-income with the highest-income group. Before the introduction of the policy, lower-income cancer patients utilized less inpatient and outpatient services in tertiary care hospitals than high-income patients did. After the benefit coverage was expanded, while the incidence and total number of inpatient admissions to tertiary care hospitals increased among cancer patients compared with liver diseases, lower-income cancer patients experienced a greater increase than those of higher-income did compared with both diseases. The use of outpatient services increased more in cancer patients than those of both diseases; however, the gap between the highest- and the lowest-income rarely decreased, except the incidence of visits when compared to liver disease. Our findings indicated that the expanded NHI benefits coverage partially improved income-related inequalities in inpatient admissions to tertiary-care hospital, but not in outpatient visits. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  15. An observational study of umbilical cord clamping practices of maternity care providers in a tertiary care center.

    Science.gov (United States)

    Hutton, Eileen K; Stoll, Kathrin; Taha, Natalie

    2013-03-01

    Severing the umbilical cord at birth is likely the oldest intervention, the timing of which remains fraught with controversy. Emerging evidence suggests benefit in delaying cord clamping for both term and preterm infants. The objective of this study was to investigate actual cord clamping time and circumstances at a large tertiary care center in Canada. We used a stopwatch to time the interval from the time the infant was born as far as the umbilicus until the time that the umbilical cord was clamped before cutting. We reported on timing of the umbilical cord clamping overall and by practitioner group (obstetrician, midwife, and family practitioner). A total of 98 women and their practitioners consented to be observed at the British Columbia Women's Hospital and Health Center, Vancouver, Canada. More than one-half (56.2%) of all infants had their umbilical cord clamped within 15 seconds. The median (5th, 95th percentile) clamping time in seconds for the full sample was 12 (4, 402) with practitioner subgroups as follows: obstetricians (12 [3, 107]), family physicians (19 [6, 325]), and midwives (81 [6, undefined]). The median clamping time was likely to be longer when the birth occurred spontaneously, no umbilical cord blood was collected, and no birth or neonatal complications occurred. In our sample taken in 2006 to 2007, most infants had umbilical cords clamped immediately after the birth, with more than one-half clamped within 15 seconds of birth. Since the time of our study, delayed umbilical cord clamping for the healthy term newborn has become a part of recommended management of third stage of labor and resuscitation guidelines. It would be informative to repeat a study like this one to determine compliance with the current standards of care. © 2013, Copyright the Authors Journal compilation © 2013, Wiley Periodicals, Inc.

  16. Surveillance of musculoskeletal injuries and disorders in a diverse cohort of workers at a tertiary care medical center.

    Science.gov (United States)

    Pompeii, Lisa A; Lipscomb, Hester J; Dement, John M

    2008-05-01

    The purpose of this study was to investigate the incidence of work-related musculoskeletal (MSK) injuries and disorders among a dynamic cohort of health care workers, including direct care providers and support services, employed at a tertiary care medical center. Human resources data were used to define the cohort and time at risk. Workers' compensation (WC) records (1997-2003) were utilized to identify work-related MSK claims. Poisson regression was used to generate gender specific rate ratios and 95% confidence intervals (CI) of MSK injuries among workgroups. MSK injuries resulted equally ( approximately 30% each) from lift/push/pull of equipment, patient handling, and slip/trip/falls. Injury rates and their mechanisms varied substantially by occupational group, gender, and race. Even with declining injury rates over time, black workers had rates 2.5 times higher than other workers and women had rates 1.8 times higher than men. Male and female nurses' aides, housekeepers, and radiology technicians had among the highest rates of injury, while lost workdays rates were highest for male and female nurses' aides, female housekeepers, and male patient transporters. Differential risk associated with work tasks in highly segregated work populations can contribute to disparities in health, and the patterns we observed partly reflect the high concentration of female and black workers in occupations with increased physical demands. While the greatest public health impact will be achieved by implementing prevention strategies among large workgroups with high injury rates, public health efforts must not ignore smaller, often segregated, workgroups identified in this study as high risk. (c) 2008 Wiley-Liss, Inc.

  17. Evaluation of the appropriateness of imipenem/cilastatin prescription and dosing in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Kabbara WK

    2015-03-01

    Full Text Available Wissam K Kabbara, George T Nawas, Wijdan H RamadanDepartment of Pharmacy Practice, School of Pharmacy, Lebanese American University, Byblos, Lebanon Background: Imipenem/cilastatin is an antibacterial agent of the carbapenem class of β-lactams that is known to have an extremely wide spectrum of activity against Gram-positive, Gram-negative, aerobic, anaerobic, and even multidrug-resistant strains. The objective of this study was to evaluate the appropriate use of imipenem/cilastatin in a local tertiary care hospital. The study assessed the indication both empirically and after the culture results were available, the dose and dose adjustment in renal failure, as well as the incidence of seizure in hospitalized patients receiving imipenem/cilastatin. Methods: This observational study was conducted in a tertiary care hospital over a 3-month period. The treatment of 100 patients with imipenem/cilastatin was evaluated both empirically and after culture results were available. Analysis of the appropriateness of imipenem/cilastatin indication, dose, and monitoring of seizure frequency was based on the package insert, updated published guidelines, and clinical judgment. Results: Patients from internal medicine and intensive care units comprised approximately 50% of the population in the study. The patients received imipenem/cilastatin mainly for urinary tract infections (27% or for sepsis of an unknown focus (22%. The use of imipenem/cilastatin empirically was appropriate in 97.2% (n=69/71 of the cases, and its use postculture in 86% of the cases. There were 29% of the patients who were not started on imipenem/cilastatin empirically. Four patients out of the 29 patients (13.8% who were not started on imipenem/cilastatin empirically inappropriately received imipenem/cilastatin post-culture results. Thirty-three patients (33% were not dosed appropriately, 30 of whom had renal impairment and creatinine clearance fluctuations. Only one patient developed a

  18. DRUG UTILIZATION STUDY OF URINARY TRACT INFECTIONS IN MEDICINE DEPARTMENT IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Rajat

    2014-11-01

    Full Text Available : BACKGROUND: The WHO in 1977 provided the proper definition of Drug Utilization. It has been defined as the marketing, distribution, prescription and use of drugs in society with special emphasis on the resulting medical and social consequences. Urinary tract infection (UTI is caused by pathogenic invasion of the urinary tract which leads to an inflammatory response of the urothelium. Urinary tract infections are common burden in patients with diabetes mellitus. Cystitis, ascending infection leading to pyelonephritis, impaired leucocyte function, recurrent vaginitis, emphysematous complications and renal/perinephric abscesses are well recognized in this group of patients if glycemic control is poor. The present study was undertaken to identify the common pathogens and drug sensitivity pattern of the isolate among patients who attended the medicine outpatients department so as to guide empirical treatment. OBJECTIVES: To evaluate prescription pattern of antibiotics in UTI in medicine department in a tertiary care hospital. Study of type of patients along with type of UTI major symptoms, precipitating factors, evaluation of uropathogens. To analyze rationality among the prescriptions. METHODS AND MATERIALS: This prospective, observational and analytical study was done to assess the antibiotics prescribed in UTI in medicine department in a tertiary care hospital. Gender distribution, age wise distribution, type of patients (outpatients, inpatients, type of UTI (complicated, uncomplicated, presenting symptoms, lab investigations related to UTI, microorganisms isolated from urine culture, antibiotics prescribed for UTI, precipitating factors for UTI, route of drug administration, adjuvant drugs along with antibiotics for UTI and outcome of the treatment were evaluated. Patients receiving antibiotic therapy in UTI of either gender of age >18 years, visiting medicine department were included. Approval from the institutional ethics committee was

  19. CLINICAL, BIOCHEMICAL AND HISTOPATHOLOGICAL PROFILE OF ADULT NEPHROTIC SYNDROME PATIENTS IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Krishnamoorthy

    2015-09-01

    Full Text Available BACKGROUND: The nephrotic syndrome is recognized as an independent entity of renal disease for over half a century . 1 Causes of nephrotic syndrome varies with age, time period, geographical location and race. In children, minimal change nephrotic syndrome is the commonest 2 ; however, membranous nephropathy is most frequent in adults . 3 As it commonly affects the younger age group and is associated with high morbidity and mortality, there is a need to understand and diagnose the disease at an early stage. Hence, this study has been done to identify the clinical presentation, biochemical parameters and histopathology associated with nephrotic syndrome in adults and its subtypes. OBJECTIVE: To study the clinical, biochemical and histopathological profile of patients with Adult Nephrotic Syndrome admitted in our tertiary care hospital. METHODS: Prospective study of 100 patients with Adult Nephrotic Syndrome admitt ed in our tertiary care hospital were screened with facial puffiness and pedal edema. They were tested for urine proteinuria, urine protein creatinine ratio or 24 hour urine protein estimation. Later renal biopsy was done for all patients to stratify the subtypes. RESULTS: In this study, males were predominantly affected. Most common presenting complaints were facial puffiness and pedal edema. Systolic BP was increased in 96% of patients and diastolic BP was elevated in 50% of patients. Serum LDL and TGL were elevated in nephrotic syndrome. In young patients less than 40 years Focal Segmental Glomerulosclerosis (FSGS is the commonest type, then Membrano Proliferative Glomerulo Nephritis (MPGN and Minimal Change Disease (MCD. In individuals more than 40 years, membranous nephropathy was predominantly seen followed by FSGS. CONCLUSION: There is a changing trend in primary nephrotic syndrome and FSGS was found to be the commonest subtype. Male preponderance was noticed and also FSGS was found to be more common in younger adults. Most

  20. Smoking behaviour among young doctors of a tertiary care hospital in North India

    Directory of Open Access Journals (Sweden)

    Muneer A. Bhat

    2014-06-01

    Full Text Available Background: Tobacco use is one of the biggest public health threats the world has ever faced. There are more than one billion smokers in the world. Almost half of the worlds children breathe air polluted by tobacco. Aim of current study was to study the smoking trends among young doctors in a tertiary care institute in north India. Methods: A descriptive observational cross-sectional epidemiological study was conducted among 250 doctors of a tertiary care Hospital in Jammu and Kashmir (Sheri Kashmir Institute of Medical Sciences, SKIMS during the two months of February-March, 2014. The predesigned tool adopted during data collection was a questionnaire that was developed at the institute with the assistance from the faculty members and other experts. Results: Among 250 participants, (20% were smokers; among smokers, (76% were regular smokers and (24% were occasional smokers. Majority of smokers were in the age group of 21-30 years (80% and started smoking between 11-20 years (70%. All of them were male (100%. No significant difference was observed among urban and rural students. Among smokers, majority (60% was in the practice of smoking for last 6 months to 1 year and 26% smoked for <6 months; and (14% smoked for more than 5 years .It was found more than half of the responding (60% students used to smoke 5-9 cigarettes per day; 14% is <5 and 26% consumed 10 or more per day .Among smokers, peer pressure was found in 80% cases. ( and #967;2 = 107, P <0.001. Among smokers, almost 20% had other addiction and among non-smokers only 5% had .Effect of parental smoking was significantly higher in smokers than non-smoker ( and #967;2 = 66.2, P <0.001 .It was seen that peer pressure was the most important risk factor (60% of initiation of smoking habit followed by parental influence (20%. Majority (78.4% had no intention to quit in the next 6 months. Lack of Incentive (36.36% and Addiction (27.27% were the main reasons for not quitting. Conclusion: We

  1. ANALYSIS OF MATERNAL MORTALITY IN A TERTIARY CARE C ENTRE: A 5 YRS RETROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Shabana

    2013-03-01

    Full Text Available ABSTRACT: AIMS : This study aimed to study the determinants, commo n causes and possible prevention of maternal mortality. MATERIALS AND METHODS: Maternal mortalities in Department of Obstetrics and gynecology, Gandhi medi cal college, Sultania Zanana Hospital, Bhopal during 5 year period from Jan 2007- Dec 2011 were studied. The individual records of all maternal deaths occurring during the study peri od of 5 years were extracted from patient’s case notes and hospital record registers. Total deli veries for the period were extracted from the delivery registers. RESULTS : In the year 2007-2011 total live births were 43,68 3 of which 338 mothers died giving cumulative maternal mortality r atio of 773.75 per 1,00,000 live births. Among 338 total maternal deaths, the maximum deaths were in the age group 20-30 years (88.16%.The death rate of mothers from rural areas was higher (65.68%.The highest number of maternal death occurred among multigravidae (46. 74% . A total of 91.72% of maternal death occurred in unbooked patients. Most were referred patients (74.55%. Most of them were illiterate (61.8%.76.62% patients died within 24 ho urs of admission.33.13% women died in antenatal period while 64.49% died in postnatal perio d. Direct obstetric causes of death accounted for 76.03% of all maternal deaths. Among the direct causes 39.64% died due to hypertensive disorder of pregnancy, 18.93% due to hem orrhage. Indirect causes accounted for 23.96% in which anemia (8.57%, malaria (3.55% hepa titis (2.66% were the leading causes . CONCLUSIONS : This study has shown higher maternal mortality du e to being a tertiary care hospital based study where more complicated and refe rred cases are admitted. Most maternal deaths can be prevented by providing care at grass r oot level, linkage between primary, secondary and tertiary care, strengthening of refer ral services and instituting emergency obstetric services.

  2. Integrated complex care coordination for children with medical complexity: A mixed-methods evaluation of tertiary care-community collaboration

    Directory of Open Access Journals (Sweden)

    Cohen Eyal

    2012-10-01

    Full Text Available Abstract Background Primary care medical homes may improve health outcomes for children with special healthcare needs (CSHCN, by improving care coordination. However, community-based primary care practices may be challenged to deliver comprehensive care coordination to complex subsets of CSHCN such as children with medical complexity (CMC. Linking a tertiary care center with the community may achieve cost effective and high quality care for CMC. The objective of this study was to evaluate the outcomes of community-based complex care clinics integrated with a tertiary care center. Methods A before- and after-intervention study design with mixed (quantitative/qualitative methods was utilized. Clinics at two community hospitals distant from tertiary care were staffed by local community pediatricians with the tertiary care center nurse practitioner and linked with primary care providers. Eighty-one children with underlying chronic conditions, fragility, requirement for high intensity care and/or technology assistance, and involvement of multiple providers participated. Main outcome measures included health care utilization and expenditures, parent reports of parent- and child-quality of life [QOL (SF-36®, CPCHILD©, PedsQL™], and family-centered care (MPOC-20®. Comparisons were made in equal (up to 1 year pre- and post-periods supplemented by qualitative perspectives of families and pediatricians. Results Total health care system costs decreased from median (IQR $244 (981 per patient per month (PPPM pre-enrolment to $131 (355 PPPM post-enrolment (p=.007, driven primarily by fewer inpatient days in the tertiary care center (p=.006. Parents reported decreased out of pocket expenses (p© domains [Health Standardization Section (p=.04; Comfort and Emotions (p=.03], while total CPCHILD© score decreased between baseline and 1 year (p=.003. Parents and providers reported the ability to receive care close to home as a key benefit. Conclusions Complex

  3. Postnatal counseling on exclusive breastfeeding using video - experience from a tertiary care teaching hospital, south India.

    Science.gov (United States)

    Adhisivam, B; Vishnu Bhat, B; Poorna, Rachel; Thulasingam, Mahalakshmy; Pournami, Femitha; Joy, Rojo

    2017-04-01

    Adequate antenatal counseling combined with postnatal lactation support is likely to improve exclusive breastfeeding rates. To assess the impact of a postnatal video based health education program in promoting exclusive breastfeeding among primiparous mothers. This interventional study was done in a tertiary care teaching hospital, south India. Primiparous mothers in one postnatal ward (group A) received routine lactation counseling. A similar group of primiparous mothers in another postnatal ward (group B) were administered a video based health education program on exclusive breastfeeding in the local language Tamil in addition to the routine lactation counseling. The exclusive breastfeeding rates of these two groups of mothers were compared. Their knowledge and perceptions after intervention were also compared using a pretested questionnaire. Among 878 primiparous mothers, 94% fed colostrum and 43% initiated breastfeeding within one hour of delivery. Correct attachment was noted with 96% and 13% had lactation issues. Group B had marginally better exclusive breastfeeding rate at six months but not statistically significant. Mothers in group B had a statistically significant better knowledge score post-intervention compared to those in Group A. Use of gripe water was more in group A compared to group B. The video based health education program when combined with routine lactation counseling improved the knowledge regarding exclusive breastfeeding among postnatal primiparous mothers better than with routine lactation counseling alone. However, both interventions had similar effect on exclusive breastfeeding rate at six months.

  4. An epidemiological study of road traffic accident cases admitted in a tertiary care hospital.

    Science.gov (United States)

    Pathak, S M; Jindal, A K; Verma, A K; Mahen, A

    2014-01-01

    Road traffic accidents are a leading cause of mortality and morbidity globally. In India, more than a million are injured annually and about a lakh are killed in road traffic accidents.(1) It causes the country to lose around 55,000 crores annually which is 2-3% of Gross Domestic Production (GDP).(2) This cross sectional study was conducted to elucidate the role of various factors involved in road traffic accidents. Road traffic accident cases admitted to a tertiary care hospital between 01 Oct 2009 and 28 Feb 2011 were included in the study. A total of 182 patients were studied. Information was collected through questionnaire, hospital records and on-site visit. OPD cases, comatose patients and deaths were excluded. Two-wheelers were the commonest vehicle involved in vehicular accidents. Most accidents happened at a speed of 40-60 km/h (37.9%). Most of the patients were aged between 20 and 30 years. Majority had a driving experience of less than 5 years. Monsoons witnessed 46.7% cases. Most cases occurred between 6 and 10 pm. Among severe injuries, the commonest was lower limb fractures (19.8%). There are multiple factors associated with road traffic accidents which due to the lack of road safety measures in the country are playing their role. It is the need of the hour to address this issue and formulate comprehensive, scientific and practical rules and regulations as well as evaluate its enforcement.

  5. Red Cell Alloimmunization to Rhesus Antigen Among Pregnant Women Attending a Tertiary Care Hospital in Oman

    Directory of Open Access Journals (Sweden)

    Tamima Al-Dughaishi

    2016-01-01

    Full Text Available Objectives: The detection of maternal alloimmunization against red cell antigens is vital in the management of hemolytic disease of the fetus and newborn. We sought to measure the presence of allosensitization to Rhesus D (RhD antibodies in antenatal women attending a tertiary care hospital and assess the fetal outcome in sensitized women. Methods: We conducted a retrospective review of pregnant Omani women who registered at the Sultan Qaboos University Hospital between June 2011 and June 2013. Pregnant women were tested for ABO blood type and were screened for RhD antigen and antibodies at their first antenatal clinic visit. In women who tested positive for the RhD antibodies, an antibody titer was performed to evaluate the severity of their case. Results: Data was available on 1,251 pregnant women who were managed and delivered at Sultan Qaboos University Hospital. The prevalence of RhD negative pregnant women was 7.3%. Blood group O was the most common followed by A, B, and AB. The rate of RhD negative alloimmunization was 10%, and anti-D was the most common antibody detected. There were no stillbirths or neonatal deaths. Postnatal transfusion was necessary for only one baby. Conclusions: The prevalence of RhD negativity was comparable to other Asian countries. Previous RhD alloimmunization and history of miscarriages were the most common maternal medical history.

  6. Cytopathology of neoplastic meningitis: A series of 66 cases from a tertiary care center

    Directory of Open Access Journals (Sweden)

    Gurdeep Singh

    2013-01-01

    Full Text Available Background: Neoplastic meningitis (NM is a condition characterized by leptomeningeal involvement by metastatic carcinoma. Detection of exfoliated malignant cells in cerebrospinal fluid (CSF due to meningeal metastasis is frequently associated with diverse neurologic presentations. Materials and Methods: In this retrospective study of all cases of NM diagnosed in CSF samples over a 20-year period at a tertiary care referral center, the cytomorphologic features were reviewed. Results: Sixty six cases of NM were identified of which 36 already had an established diagnosis of malignancy while in 30 patients, there was no previously known tumor. The most common known primary in the former group was breast followed by ovary. Single cell pattern, cellular cannibalism, moderate cytoplasm and rounded nuclei were seen in breast and lung tumors. Papillary architecture and cytoplasmic vacuolation were seen in the ovarian primaries. Melanin pigment was seen in malignant melanoma. Conclusion: CSF cytology is an important tool for diagnosis of NM. Cytomorphologic features helped in diagnosis and for prediction of the primary site. Correct identification of this condition is important as it has therapeutic and prognostic implications.

  7. Prevalence of Clostridium difficile infection among the patients attending a tertiary care teaching hospital.

    Science.gov (United States)

    Segar, Lavanya; Easow, Joshy M; Srirangaraj, Sreenivasan; Hanifah, Mohammad; Joseph, Noyal M; Seetha, K S

    2017-01-01

    Clostridium difficile, a most important nosocomial enteric pathogen, is recognized globally as responsible for antibiotic-associated diarrhea and colitis. It is associated with considerable morbidity and mortality due to widespread use of antibiotics. The study was done to determine the prevalence of C. difficile infection (CDI) among the patients attending a tertiary care teaching hospital in Puducherry. We performed a prospective cohort study in Mahatma Gandhi Medical College and Research Institute. Around 150 patients were evaluated along with the patient details. C. difficile toxin detection was done as per the standard algorithm using the C. Diff Quik Chek Complete® assay (TECHLAB, Blacksburg, VA, USA). Analysis was done using statistics software (SPSS 16.0, SPSS Inc., Chicago, IL, USA). The prevalence of CDI was found to be 4%. More toxin-positive cases were between 50 and 60 years of age, and there was no difference in gender. Intensive Care Unit showed more toxin-positive cases; however, there was no significant association between the occurrence of CDI and the primary diagnosis of the patients. The prevalence of CDI in our hospital was found to be 4%, which was relatively lower compared to other Indian studies. However, awareness of the risk factors may assist in identifying patients at higher risk for CDI, guide implementation of appropriate preventive measures, and modulate potential intervention measure during management.

  8. Healthcare-seeking behavior of patients with epileptic seizure disorders attending a tertiary care hospital, Kolkata

    Directory of Open Access Journals (Sweden)

    Abhik Sinha

    2012-01-01

    Full Text Available Introduction : Neurological diseases are very important causes of prolonged morbidity and disability, leading to profound financial loss. Epilepsy is one of the most important neurological disorders Healthcare seeking by epilepsy patients is quite diverse and unique. Aims and Objectives: The study was conducted among the epilepsy patients, to assess their healthcare-seeking behavior and its determinants. Materials and Methods: Three hundred and fifteen epilepsy patients, selected by systematic random sampling, in the neuromedicine outpatient department of a tertiary care hospital were interviewed with a predesigned, pretested, semi-structured proforma. Results and Conclusion: More than 90% sought healthcare just after the onset of a seizure. The majority opted for allopathic medicine and the causes for not seeking initial care from allopaths were ignorance, faith in another system, constraint of money, and so on. A significant association existed between rural residence and low social status of the patients with initial care seeking from someone other than allopaths. No association was found among sex, type of seizure, educational status of the patients, and care seeking. The mean treatment gap was 2.98 ± 10.49 months and the chief motivators were mostly the family members. Patients for anti epileptic drugs preferred neurologists in urban areas and general practitioners in rural areas. District care model of epilepsy was proposed in the recommendation.

  9. STUDY OF ECG AND ECHOCARDIOGRAPHIC FINDINGS IN COPD PATIENTS IN A TERTIARY CARE CENTRE

    Directory of Open Access Journals (Sweden)

    Ramakrishna

    2016-03-01

    Full Text Available COPD is a major cause of death worldwide. Early identification of the complications, particularly pulmonary hypertension and right ventricular dysfunction can prevent or delay long-term complications. AIM OF THE STUDY To study ECG and Echocardiographic profile among COPD patients and study their importance in the management of COPD. MATERIALS AND METHODS We have studied 103 (N=103 patients diagnosed as COPD in our tertiary care centre. We categorized them into mild (FEV1/FVC80% predicted, Moderate (FEV1/FVC1 was seen in 4.44%. Atrial ectopics were seen in 18.55% and ventricular ectopics were seen in 3.09%. Right axis deviation was seen in 5.55% and no ECG changes in 39.17%. Echocardiogram showed consistent abnormal findings in 94%. Pulmonary arterial hypertension was seen in 94.84%, RV hypertrophy was seen in 26.82%. Cardiac arrhythmias and cardiac failure were seen in 8.24% each. ECG and Echocardiography can identify early pulmonary hypertension and right ventricular dysfunction. Proper institution of therapy can prevent long-term complications of severe pulmonary hypertension and right heart failure and can prolong the life and improve quality of life among COPD patients.

  10. Drug utilisation study in a tertiary care center: Recommendations for improving hospital drug dispensing policies

    Directory of Open Access Journals (Sweden)

    Niti Mittal

    2014-01-01

    Full Text Available Drug therapy accounts for a major portion of health expenditure. A useful strategy for achieving cost efficient healthcare is drug utilisation research as it forms the basis for making amendments in drug policies and helps in rational drug use. The present observational study was conducted to generate data on drug utilization in inpatients of our tertiary care hospital to identify potential targets for improving drug prescribing patterns. Data was collected retrospectively from randomly selected 231 medical records of patients admitted in various wards of the hospital. WHO Anatomical Therapeutic Chemical/Defined Daily Dose methodology was used to assess drug utilisation data and drug prescriptions were analysed by WHO core drug indicators. Antibiotics were prescribed most frequently and also accounted for majority of drug costs. The prescribed daily dose for most of the antibiotics corresponded to defined daily dose reflecting adherence to international recommendations. Brand name prescribing and polypharmacy was very common.78% of the total drugs prescribed were from the National List of Essential Medicines 2003. Restricting the use of newer and costlier antibiotics, branded drugs and number of drugs per prescription could be considered as targets to cut down the cost of drug therapysignificantly.

  11. Seroprevalence of syphilis in patients attending a tertiary care hospital in Southern India

    Institute of Scientific and Technical Information of China (English)

    Sadia Khan; GodfredAntony Menezes; Rahul Dhodapkar; Belgode Narasimha Harish

    2014-01-01

    To report our experience with two tests, anti-cardiolipin antibody test [venereal disease reasearch laboratory (VDRL) test] and specific treponemal test (Treponema pallidum hemagglutination assay), used for screening antenatal, high risk cases and cases from sexually transmitted infection in a tertiary care hospital from January 2006 till December 2008. Methods: A total of 14639 samples received from various patient groups including antenatal cases, patients attending sexually transmitted disease (STD) clinic, blood donors and HIV positive patients were screened. Results: Among the 14639 samples collected, 103 were positive by VDRL test. Of these 89 cases were confirmed by quantitative VDRL test and Treponema pallidum hemagglutination assay. The cumulative seroprevalence over two years was found to be 0.61% in this study. The syphilis seroprevalence reduced from 0.88% in 2006 to 0.40% in 2008. Among the various sub-populations studied, patients attending the sexually transmitted infection clinic showed a seroprevalence of 2.62%. The seroprevalence decreased significantly from 4.00% in 2006 to 1.39% in 2008. Conclusions: Our study showed a statistically significant declining rate of syphilis in STD clinics as well as the overall seroprevalence. These findings could be interpreted as indicators of improved programmes for prevention and management of STDs.

  12. Seroprevalence of syphilis in patients attending a tertiary care hospital in Southern India

    Institute of Scientific and Technical Information of China (English)

    Sadia; Khan; Godfred; Antony; Menezes; Rahul; Dhodapkar; Belgode; Narasimha; Harish

    2014-01-01

    Objective:To report our experience with two tests,anti-cardiolipin antibody test[venereal disease reasearch laboratory(VDRL) test]and specific treponemal test(Treponema pallidum hemagglutination assay),used for screening antenatal,high risk cases and cases from sexually transmitted infection in a tertiary care hospital from January 2006 till December 2008.Methods:A total of 14639 samples received from various patient groups including antenatal cases,patients attending sexually transmitted disease(STD) clinic,blood donors and HIV positive patients were screened.Results:Among the 14639 samples collected,103 were positive by VDRL test.Of these 89 cases were confirmed by quantitative VDRL test and Treponema pallidum hemagglutination assay.The cumulative seroprevalence over two years was found to be 0.61%in this study.The syphilis seroprevalence reduced from 0.88%in 2006 to 0.40%in 2008.Among the various sub-populations studied,patients attending the sexually transmitted infection clinic showed a seroprevalence of 2.62%.The seroprevalence decreased significantly from 4.00%in 2006 to1.39%in 2008.Conclusions:Our study showed a statistically significant declining rate of syphilis in STD clinics as well as the overall seroprevalence.These findings could be interpreted as indicators of improved programmes for prevention and management of STDs.

  13. Rising trends of syphilis in a tertiary care center in North India

    Directory of Open Access Journals (Sweden)

    Sunil Sethi

    2015-01-01

    Full Text Available Background and Objectives: Syphilis is a classical sexually transmitted disease (STD, caused by Treponema pallidum subsp. pallidum. In this retrospective study, we analyzed trends of syphilis prevalence in patient groups attending our tertiary care center. Materials and Methods: The data was obtained by reviewing laboratory records of the STD laboratory from January 1, 2006 to December 31, 2011. Cases positive by both Venereal Disease Research Laboratory (VDRL and Treponema pallidum particle agglutination (TPPA tests were analyzed for seroprevalence of syphilis in different groups, and to analyze the rising or falling trends, if any. Results: A total of 28,920 serum samples were received in the 6-year study period for VDRL testing, of which 972 (3.4% were found to be reactive. Of these, 1722 sera were also submitted for TPPA testing, 374 (21.7% of which were positive. A total of 375 samples were submitted for both tests, indicating biological false positivity of 0.27%. A rising trend, though not statistically significant, was observed in pregnant women, drug users and patients from wards/out-patient departments, while a statistically significant rise in prevalence of syphilis was found in HIV-positive individuals. A falling trend (not statistically significant was observed in STD clinic attendees. Conclusion: An increasing trend of syphilis was observed during the study period when all groups were analyzed together, especially in HIV-seropositive individuals, which calls for continued and sustained efforts for case detection, treatment, and preventive measures to contain the disease.

  14. Free living amoebae in water sources of critical units in a tertiary care hospital in India

    Directory of Open Access Journals (Sweden)

    S Khurana

    2015-01-01

    Full Text Available Background: Isolation of free-living amoebae (FLA is reported sparsely from water taps, ventilators, air conditioners, haemodialysis units and dental irrigation systems of hospitals worldwide. Their prevalence in hospital environment especially in wards having immunocompromised patients may pose a risk to this group of susceptible population as they may cause disease themselves or may carry pathogens inside them. No study from India has performed such surveillance. Objective: To evaluate extent of FLA contamination in water sources of bone marrow transplant (BMT intensive care unit (ICU, transplant ICU, haemodialysis unit and high dependency unit in a tertiary care hospital in India. Materials and Methods: A total of hundred samples including fifty each of tap water samples and swabs from mouth of taps used for drinking, bathing and hand washing purposes in these units were collected according to standard procedure. Samples were inoculated onto non-nutrient agar plates at room temperature followed by morphological confirmation. Molecular identification including polymerase chain reaction (PCR and sequencing was performed in culture positive samples. Results: Four tap water samples and ten swab samples showed growth of trophozoites and cyst formation. Morphologically, four amoebae resembled Acanthamoeba spp. which was further confirmed by PCR and sequencing showed them to be of T3 and T4 genotypes. Conclusion: The presence of these FLA in hospital water sources emphasises the urgent need of implementing effective preventive measures. Further studies are required to estimate the true prevalence of FLA in Indian hospitals by taking larger number of samples.

  15. Drug-induced diseases (DIDs: An experience of a tertiary care teaching hospital from India

    Directory of Open Access Journals (Sweden)

    Vishal R Tandon

    2015-01-01

    Full Text Available Background & objectives: Drug-induced diseases (DIDs are well known but least studied. Data on DIDs from India are not available. Hence, this retrospective cross-sectional study was undertaken using suspected adverse drug reaction (ADR data collected form Pharmacovigilance Programme of India (PvPI to evaluate profile of DIDs over two years, in a tertiary care teaching hospital from north India. Methods: The suspected ADRs in the form of DID were evaluated for drug and disease related variables and were classified in terms of causality. Results: DID rate was 38.80 per cent. Mean duration of developing DIDs was 26.05 ± 9.6 days; 25.16 per cent had more than one co-morbid condition. Geriatric population (53.99% accounted for maximum DIDs followed by adult (37.79% and paediatric (8.21%. Maximum events were probable (93.98% followed by possible (6.04%. All DIDs required intervention. Gastritis (7.43%, diarrhoea (5.92%, anaemia (4.79%, hypotension (2.77%, hepatic dysfunction (2.69%, hypertension (1.51%, myalgia (1.05%, and renal dysfunction (1.01% were some of the DIDs. Anti-tubercular treatment (ATT, anti- retroviral treatment (ART, ceftriaxone injection, steroids, non-steroidal anti-inflammatory drugs, antimicrobials and anticancer drugs were found as commonly offending drugs. Interpretation & conclusions: Our findings show that DIDs are a significant health problem in our country, which need more attention.

  16. Drug utilization study in a burn care unit of a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Santoshkumar R Jeevangi

    2011-03-01

    Full Text Available Objective: To evaluate drug utilization and associated costs for the treatment of patients admitted in burn care unit of a tertiary care hospital. Methods: A prospective cross sectional study was conducted for a period of 15 months at Basaweshwara Teaching and General Hospital (BTGH, Gulbarga and the data collected was analyzed for various drug use indicators. Results: A total of 100 prescriptions were collected with 44% belonging to males and 56% to females. The average number of drugs per prescription ranged from 4.5 to 9.5. 9.5% of generics and 92% of essential drugs were prescribed. The opioid analgesics and sedatives were prescribed to all the patients who were admitted in burn care unit. The (Defined daily dose DDD/1 000/day for amikacin (359 was the highest followed by diclofenac sodium (156, pantoprazole (144, diazepam (130, ceftazidime (124, tramadol (115, ceftriaxone (84 and for paracetamol (4 which was the lowest. Conclusions: Significant amount of the money was spent on procurement of drugs. Most of the money was spent on prescribed antibiotics. The prescription of generic drugs should be promoted, for cost effective treatment. Hence the results of the present study indicate that there is a considerable scope for improvement in the prescription pattern.

  17. The prevalence of depression among elderly warded in a tertiary care centre in Wilayah Persekutuan.

    Science.gov (United States)

    Sherina, M S; Rampal, L; Hanim, M Arfah; Thong, P L

    2006-03-01

    Depression is characterized by symptoms like disturbance in behavior, cognition and mood. This is commonly known to affect people aged 60 years and above especially those who are also afflicted with illnesses. The objectives of this study were to determine the prevalence of depression and its associated factors among the elderly in a tertiary care centre in Wilayah Persekutuan. A cross sectional study design was done. Stratified cluster sampling method was used to select the respondents. All elderly patients were selected from the orthopaedic, surgical, gynaecology and medical wards in a government hospital in Wilayah Persekutuan. A 30-item Geriatric Depression Scale questionnaire was used as a screening instrument. Out of the 246 elderly subjects, 198 were interviewed giving a response rate of 80.5%. The results showed that 54% of the elderly respondents were found to have depressive symptoms. Age (p=0.022), sex (p=0.008), ethnicity (p=0.022) and functional disabilities in bathing (p=0.001), grooming (p=0.007), dressing (p= 0.007), using the toilet (p=0.002), transferring from bed to chair and back (p=0.000), mobility (p=0.000) and climbing stairs (p=0.000) were all found to be significantly associated with depression among the elderly respondents. The outcome of this study will have an important impact on the implementation of the health policy for the elderly patients admitted to hospitals.

  18. Increasing prevalence of infectious diseases in asylum seekers at a tertiary care hospital in Switzerland.

    Science.gov (United States)

    Bloch-Infanger, Constantine; Bättig, Veronika; Kremo, Jürg; Widmer, Andreas F; Egli, Adrian; Bingisser, Roland; Battegay, Manuel; Erb, Stefan

    2017-01-01

    The increasing number of refugees seeking asylum in Europe in recent years poses new challenges for the healthcare systems in the destination countries. The goal of the study was to describe the evolution of medical problems of asylum seekers at a tertiary care centre in Switzerland. At the University Hospital Basel, we compared all asylum seekers during two 1-year time periods in 2004/05 and 2014/15 concerning demographic characteristics and reasons for referrals and hospitalizations. Hundred ninety five of 2'544 and 516 of 6'243 asylum seekers registered at the national asylum reception and procedure centre Basel were referred to the University Hospital Basel in 2004/05 and 2014/15, and originated mainly from Europe (62.3%, mainly Turkey) and Africa (49.1%, mainly Eritrea), respectively. Median age was similar in both study periods (26.9 and 26.2 years). Infectious diseases in asylum seekers increased from 22.6% to 36.6% (pasylum seekers required isolation precautions with median duration of 6-9.5 days in both study periods. The changing demography of asylum seekers arriving in Switzerland in the current refugee crisis has led to a shift in disease patterns with an increase of infectious diseases and the re-emergence of migration-associated neglected infections. Physicians should be aware of these new challenges.

  19. KNOWLEDGE AND ATTITUDE OF PUERPERAL WOMEN TOWARDS FAMILY PLANNING PRACTICES IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Atmaja Nair

    2017-01-01

    Full Text Available BACKGROUND India is the second most populous country in the world after China. In an effort to stabilize the population, National Family Welfare Program was launched in 1951. There has been an increase in contraceptive prevalence and a reduction in total fertility rate since then. For better results, contraceptive use should start right from the post partum period. This also significantly reduces maternal and infant mortality rates. AIM To assess the knowledge and attitude about contraception in post-partum women in a tertiary care teaching hospital in North Kerala. MATERIALS AND METHODS This cross sectional study was conducted in the Department of Obstetrics and Gynaecology, IMCH, Govt. Medical College, Kozhikode, Kerala, between January 2016 and March 2016, using a prestructured questionnaire, in postpartum women. Their knowledge and attitude about contraception was assessed. RESULTS A total of 1500 postpartum women were included in the study. 80% were aware of some method of contraception. This knowledge increased with increasing education, parity and better socioeconomic class. Major source of information was health worker (46.67%. But only 18.33% had practiced any method of contraception before and 44% only showed willingness to use any contraception. The major reason for non-acceptance of contraception was the need for more children. CONCLUSION Low prevalence seen in the use of contraception can be overcome by promoting spacing methods like PPIUCD, injectables and pills. The couple should be counselled together to alleviate the anxiety in the husband.

  20. CARDIOVASCULAR COMPLICATIONS IN SYSTEMIC LUPUS ERYTHEMATOSUS : A STUDY IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Purushottam Rao

    2015-08-01

    Full Text Available INTRODUCTION: Systemic Lupus Erythematosus is an autoimmune disorder in which organs and cells undergo damage mediated by tissue - binding auto antibodies and immune complexes 1 . Systemic Lupus Erythematosus is a multigenic disease . 1 People of all sexes, all ages and all ethnic groups are susceptible. Lupus nephrits, infection and thromboembolism contribute for mortality. Cardiac manifestations are not uncommon in systemic lupus erythematosus. It involves all the layers of the heart, pericardium, myocardium and endocardium as well as coronary arteries. AIM AND OBJECTIVES: To find out the prevalence of cardiac manifestations in patients with Systemic Lupus Erythematosus. METHODOLOGY: The study was conducted in t he Department of Medicine, Andhra Medical College, King George Hospital, Visakhapatnam, Andhra Pradesh. It is a tertiary care hospital. It was a study done on a selected population of Systemic Lupus Erythematosus based on the 1997 update of the 1982 Americ an College of Rheumatology classification criteria for Systemic Lupus Erythematosus. RESULTS: In this study consisting of fifty patients, changes suggestive of cardiac disease were seen in 74% of patients. CONCLUSION: Systemic lupus erythematosus is a mult isystem disease. Prevalence of cardiac disease is not uncommon . Pericarditis or pericardial effusion is the most common followed by valvular heart disease

  1. Carbapenem Resistance among Enterobacter Species in a Tertiary Care Hospital in Central India

    Directory of Open Access Journals (Sweden)

    Atul Khajuria

    2014-01-01

    Full Text Available Objective. To detect genes encoding carbapenem resistance among Enterobacter species in a tertiary care hospital in central India. Methods. Bacterial identification of Enterobacter spp. isolates from various clinical specimens in patients admitted to intensive care units was performed by routine conventional microbial culture and biochemical tests using standard recommended techniques. Antibiotic sensitivity test was performed by standard Kirby Bauer disc diffusion technique. PCR amplification and automated sequencing was carried out. Transfer of resistance genes was determined by conjugation. Results. A total of 70/130 (53.84% isolates of Enterobacter spp. were found to exhibit reduced susceptibility to imipenem (diameter of zones of inhibition ≤13 mm by disc diffusion method. Among 70 isolates tested, 48 (68.57% isolates showed MIC values for imipenem and meropenem ranging from 32 to 64 mg/L as per CLSI breakpoints. All of these 70 isolates were found susceptible to colistin in vitro as per MIC breakpoints (<0.5 mg/L. PCR carried out on these 48 MBL (IP/IPI E-test positive isolates (12 Enterobacter aerogenes, 31 Enterobacter cloacae, and 05 Enterobacter cloacae complex was validated by sequencing for beta-lactam resistance genes and result was interpreted accordingly. Conclusion. The study showed MBL production as an important mechanism in carbapenem resistance in Enterobacter spp. and interspecies transfer of these genes through plasmids suggesting early detection by molecular methods.

  2. Development of hospital formulary for a tertiary care teaching hospital in south India

    Directory of Open Access Journals (Sweden)

    D′Almeida R

    2007-01-01

    Full Text Available Formulary is a continually revised compilation of pharmaceuticals (plus important ancillary information that reflects the current clinical judgment of medical staff. Kasturba Hospital is a 1400 bedded tertiary care teaching hospital with different specialties, having more than 3000 brands and ancillary products in use. The hospital does not have a formulary of any kind. Present study involved development of a formulary for the hospital and comparing it with WHO Model Formulary. Monographs of the drugs were prepared as per the recommendation of Pharmacy and Therapeutic Committee of the hospital. Prepared hospital formulary consisted of 476 generic drugs of various categories and 95 fixed dose combinations. Availability of brands varied from single to many. About 75 medicines recommended by the essential medicine list were not present in the prepared hospital formulary. The drugs to be avoided or used with caution in renal failure, hepatic failure and in pregnancy were categorized and included in the formulary as additional information. The prepared hospital formulary was recommended for implementation in the hospital, which could thereby help as a tool to promote rational drug use.

  3. Utilization of potentially inappropriate medications in elderly patients in a tertiary care teaching hospital in India

    Directory of Open Access Journals (Sweden)

    Binit N Jhaveri

    2014-01-01

    Full Text Available Aim: To evaluate the use of potentially inappropriate medicines in elderly inpatients in a tertiary care teaching hospital. Materials and Methods: Retrospective analysis was performed for cases of elderly patients admitted between January 2010 and December 2010. Data on age, gender, diagnosis, duration of hospital stay, treatment, and outcome were collected. Prescriptions were assessed for the use of potentially inappropriate medications in geriatric patients by using American Geriatric Society Beer′s criteria (2012 and PRISCUS list (2010. Results: A total of 676 geriatric patients (52.12% females were admitted in the medicine ward. The average age of geriatric patients was 72.69 years. According to Beer′s criteria, at least one inappropriate medicine was prescribed in 590 (87.3% patients. Metoclopramide (54.3%, alprazolam (9%, diazepam (8%, digoxin > 0.125 mg/day (5%, and diclofenac (3.7% were the commonly used inappropriate medications. Use of nonsteroidal anti-inflammatory drugs (NSAIDs in heart and renal failure patients was the commonly identified drug-disease interaction. According to PRISCUS list, at least one inappropriate medication was prescribed in 210 (31.06% patients. Conclusion: Use of inappropriate medicines is highly prevalent in elderly patients.

  4. Treatment pathways of extrapulmonary patients diagnosed at a tertiary care hospital in Delhi, India

    Directory of Open Access Journals (Sweden)

    Manoj Grover

    2014-01-01

    Full Text Available Background: In order to put extrapulmonary tuberculosis patients early on treatment, it is important to study pathways, which these patients adopt in for seeking treatment. Materials and Methods: In order to study the treatment pathways of extrapulmonary patients and assess appropriate points for intervention, a cross-sectional study was conducted in chest clinic of a tertiary care hospital in Delhi. Results: Factors associated with longer paths included reason for going to first health facility (nearness and known provider, availing more than one health facilities, presenting symptoms of fever, joint pain, nodular skin swelling and skin lesion. Self-referral to the chest clinic was associated with shorter paths. Lower level of education, occupation, non-serious perception of the disease and visiting five health facilities were significantly associated with patient delay of more than 3.5 weeks. Symptoms of fever, joint pain and skin lesion, visiting private health facility first, availing more than two health facilities and travelling distance of more than 100 km to reach chest clinic were significantly associated with the health facility delay of more than 4.5 weeks. Conclusions: Increasing public awareness, training of private practitioners and capacity building of government facilities will help in reducing delay.

  5. Understanding Health Seeking Behavior Of Health Care Professionals In Tertiary Care Hospitals In Pakistan.

    Science.gov (United States)

    Bana, Shazia; Yakoob, Javed; Jivany, Nourin; Faisal, Asima; Jawed, Humeira; Awan, Safia

    2016-01-01

    Health seeking behaviour refers to the behaviour of people towards seeking their own health through provided health services. The medical professionals are at a higher risk of avoiding health seeking behaviour because they believe they are aware of the diseases and their symptoms as well as the pharmaceutical management of the disease. The aim of this study was to understand the healthcare seeking behaviour of nurses and doctors as well as the factors affecting it in hospitals of a major city in a developing country. A cross-sectional study was designed and a self-report questionnaire was distributed to healthcare workers at four tertiary care hospitals from July, 2012 to December, 2014. A total of 1015 participants responded. There were 234 (23%) doctors, 664 (65%) nurses, 60 (6%) pharmacist and 57 (6%) paramedical staff. The doctors 194 (83%) had a greater access to medical facilities compared to nurses 278 (42%) (phealth compared to doctors 102 (44%) (phealth check-ups compared to doctor 234 (100%) (pseek healthcare when they get sick. Self-medication is common in both groups.

  6. Rising trends of syphilis in a tertiary care center in North India.

    Science.gov (United States)

    Sethi, Sunil; Mewara, Abhishek; Hallur, Vinaykumar; Prasad, Amber; Sharma, Kusum; Raj, Atul

    2015-01-01

    Syphilis is a classical sexually transmitted disease (STD), caused by Treponema pallidum subsp. pallidum. In this retrospective study, we analyzed trends of syphilis prevalence in patient groups attending our tertiary care center. The data was obtained by reviewing laboratory records of the STD laboratory from January 1, 2006 to December 31, 2011. Cases positive by both Venereal Disease Research Laboratory (VDRL) and Treponema pallidum particle agglutination (TPPA) tests were analyzed for seroprevalence of syphilis in different groups, and to analyze the rising or falling trends, if any. A total of 28,920 serum samples were received in the 6-year study period for VDRL testing, of which 972 (3.4%) were found to be reactive. Of these, 1722 sera were also submitted for TPPA testing, 374 (21.7%) of which were positive. A total of 375 samples were submitted for both tests, indicating biological false positivity of 0.27%. A rising trend, though not statistically significant, was observed in pregnant women, drug users and patients from wards/out-patient departments, while a statistically significant rise in prevalence of syphilis was found in HIV-positive individuals. A falling trend (not statistically significant) was observed in STD clinic attendees. An increasing trend of syphilis was observed during the study period when all groups were analyzed together, especially in HIV-seropositive individuals, which calls for continued and sustained efforts for case detection, treatment, and preventive measures to contain the disease.

  7. PREVALENCE OF DIABETES MELLITUS IN TUBERCULOSIS PATIENT: A TERTIARY CARE CENTRE STUDY FROM CENTRAL INDIA

    Directory of Open Access Journals (Sweden)

    Bhupendra Kumar

    2014-07-01

    Full Text Available INTRODUCTION: The coexistence of diabetes and tuberculosis is common and challenge to the community. Diabetes predisposes to tuberculosis and treatment often become complicated. Though the prevalence of tuberculosis is decreasing due to success of combination chemotherapy but coexistence of diabetes with tuberculosis poses a threat to success of anti-tubercular program. India has huge burden of the both diabetes and tuberculosis. We did a prospective study to know the prevalence of diabetes in tuberculosis patients in a tertiary care hospital. MATERIAL AND METHOD: We recruited the patient with tuberculosis in department of general medicine and department of TB and Chest. We screened them for diabetes with fasting blood sugar. RESULTS: Out of total 419 patients who were included in the study 135 patients were found to be diabetic. A prevalence of 32.2% was found in the study. CONCLUSION: The prevalence of diabetes in tuberculosis is very high as compared to that of general population. We recommend that the entire tubercular patients should be screened for diabetes and vice versa at the time of diagnosis, and effective management of both diseases will leads to improve treatment outcome.

  8. Clonal diversity of New Delhi metallobetalactamase-1 producing Enterobacteriaceae in a tertiary care centre

    Directory of Open Access Journals (Sweden)

    M Shanthi

    2013-01-01

    Full Text Available Purpose: New Delhi metallobetalactamase-1 (NDM-1 production is a major mechanism of resistance to carbapenems among the Enterobacteriaceae and is a cause for concern in the field of microbial drug resistance. This study was performed to detect NDM-1 in Enterobacteriaceae and to determine the clonal relatedness of NDM-1 producing Escherichia coli and Klebsiella pneumoniae isolated from patients admitted in a tertiary care centre. Materials and Methods: A total of 111 clinically significant Enterobacteriaceae isolates, resistant to cephalosporin subclass III were screened for carbapenemase production by the modified Hodge test. Minimum inhibitory concentration to imipenem and meropenem was determined and interpreted according to Clinical Laboratory Standards Institute 2011 criteria. Presence of bla NDM-1 was detected by polymerase chain reaction. To ascertain clonal relatedness, random amplification of polymorphic deoxyribonucleic acid (RAPD was carried out for representative NDM-1 producers. Results : bla NDM-1 was detected in 64 study isolates, of which 27 were susceptible to carbapenems. RAPD revealed a high degree of clonal diversity among NDM-1 producers except for a small clustering of isolates in the neonatal intensive care unit. Conclusion: There is extensive clonal diversity among the NDM-1 producing E. coli and K. pneumoniae. Hence, antibiotic selection pressure rather than horizontal transfer is probably an important operating factor for the emergence of NDM-1. This calls for increased vigilance, continuous surveillance and strict enforcement of antibiotic policy with restricted use of inducer drugs.

  9. Enteric Opportunistic Parasitic Infections among HIV-Seropositive Patients at Tertiary Care Teaching Hospital

    Directory of Open Access Journals (Sweden)

    Sangeeta D Patel

    2015-09-01

    Full Text Available Background: Enteric opportunistic parasitic infections are the major source of diarrheal disease in developing countries mainly in Human Immunodeficiency virus (HIV infected patients. Objective: The study was to detect enteric parasites causing diarrhea and their association with immune status in HIV-seropositive patients. Methods: The present study was conducted in tertiary care teaching Hospital, Baroda between January 2006 to January 2007 involving 100 Human Immunodeficiency virus (HIV positive patients. Stool was examined for enteric parasites by microscopy with special staining methods. Results: A total of 100 HIV sero-positive patients with and without diarrhea were included in the study. Of the 100 patients, the protozoan parasitic infection was found in 28% (28/100. Out of 100 patients, 50 had diarrhea in which parasitic infection was 24 (48% and 4 (4/50 protozoal parasites positive cases did not have diarrhea. A significant difference (p<0.05 was observed in the level of infection of intestinal protozoan between the HIV seropositive with diarrhea and HIV-seropositive without diarrhea. Conclusion Enteric opportunistic parasitic infections were detected in 28% among HIV-seropositive patients. Early detection of enteric parasitic infections will help in the management and to improve the quality of life for HIV-infected individuals. [Natl J Med Res 2015; 5(3.000: 190-193

  10. Pediatric referrals to psychiatry in a Tertiary Care General Hospital: A descriptive study

    Directory of Open Access Journals (Sweden)

    Bheemsain Tekkalaki

    2017-01-01

    Full Text Available Background: Children with chronic physical illnesses frequently have psychiatric comorbidities, which often go un-noticed and may lead to more resource utilization and morbidity. Pediatric liaison services can be effectively used to bridge this gap. Literature on pediatric liaison services is sparse. Aims: To study the referral patterns, reasons for referrals, psychiatric diagnoses and interventions in children and adolescents referred to psychiatry department in a tertiary care hospital. Materials and Methods: A retrospective chart analysis of all children and adolescents below 19 years of age, referred to psychiatry department from 2010 to 2015, was done. Data was collected and statistical analysis was done. Results: Two hundred and nine subjects were included in the study. Mean age of sample was 12.15 (±4.20 years, with about 66.02% being males. About 54.06% of the participants were referred from pediatricians. Almost three fourth (72.25% of children had no diagnosable physical illness. Intellectual disability (19.62% was the most common psychiatric diagnosis, followed by depressive disorders (14.35%, and dissociative disorders (12.92%. Conclusions: In our study, majority of the referrals were the adolescent males from pediatric department. Intellectual disability, depressive disorder, and stress-related disorders were the common diagnoses. The fact that three-fourth of the referred children had no physical illness implies lack of awareness, stigma toward mental illness, and pathway of care.

  11. A LONGITUDINAL DESCRIPTIVE STUDY ON RETINOPATHY OF PREMATURITY IN A TERTIARY CARE CENTRE IN SOUTH INDIA

    Directory of Open Access Journals (Sweden)

    Mary

    2016-04-01

    Full Text Available BACKGROUND To find out the incidence of threshold Retinopathy of Prematurity, its association with birth weight and gestational age and outcome of management in a tertiary care centre. MATERIALS AND METHODS A longitudinal descriptive study by retrospective analysis of records. Screening was done for all neonates of 30 weeks gestational age, 11.1% of infants were >1500 grams of birth weight. Threshold retinopathy was not seen above 35 weeks of gestational age and 1860 grams birth weight. All infants improved with treatment and vascularisation extended to periphery. None of them progressed to stage 4 or 5. CONCLUSION Only 4.10% of the screened babies needed treatment and was in par with the standards of developed countries. Even with high standards of neonatal care in our centre, larger and heavier babies developed severe retinopathy. Being an institutional based small group study, this cannot be considered as a representation of the whole country and it is the limitation of this study. Correct identification of the threshold disease and prompt management will prevent severe visual disability in children and prevent them from being a burden to the family and society

  12. Disinfection of stethoscopes: Gap between knowledge and practice in an Indian tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Anshu Jain

    2013-01-01

    Full Text Available Context: Stethoscopes are used primarily to assess the health of patients and are one of the most commonly used medical devices. Thus, are the prominent tools for the spread of health-care associated infections (HAIs. Aims: The study was conducted to assess the knowledge and awareness about handling of the stethoscope and cleaning practices followed among the healthcare workers (HCWs. Materials and Methods: A total of 80 participants were included during a 4-month study period at a tertiary care hospital in Ujjain. A semi-structured questionnaire was distributed to HCWs and the surface of the diaphragm of their stethoscopes were swabbed for bacteriological analysis using standard techniques. Results: Out of total 80 stethoscopes, 69 (86% were found to be contaminated with at least one type of microorganism. Pseudomonas aeruginosa was the most predominant bacterial species found on 58 stethoscopes, followed by Bacillus subtilis (n = 21 and Staphylococcus spp. (n = 16. Out of total 10 S. aureus isolated, 3 were methicillin-resistant S. aureus ( MRSA. Majority (97% of the HCWs had good knowledge about the topic, but only 22 (27% reported to apply it in the practice. Conclusions: Our study confirmed that majority of the stethoscopes were contaminated with microorganisms. Besides having knowledge about the importance of cleaning the stethoscopes, lower percentage of HCWs reported to follow it in practice. Thus, the authors recommend regularization of reminders such as circulars, motivating posters for the HCWs to clean the diaphragm of the stethoscopes.

  13. Assessment of cost of illness for diabetic patients in South Indian tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Leelavathi D Acharya

    2016-01-01

    Full Text Available Background: The impact of diabetes on health-care expenditures has been increasingly recognized. To formulate an effective health planning and resource allocation, it is important to determine economic burden. Objective: The objective of this study is to assess the cost of illness (COI for diabetic inpatients with or without complications. Methodology: The study was conducted in the medicine wards of tertiary care hospital after ethical approval by the Institutional Ethical Committee. A total of 116 each diabetic with or without complications were selected and relevant data were collected using COI questionnaire and data were analyzed using SPSS version 20. Mann–Whitney U test is used to assess the statistical significant difference in the cost of treatment of diabetes alone and with complications'. P ≤ 0.05 was considered statistically significant. Results: Total COI includes the cost of treatment, investigation, consultation fee, intervention cost, transportation, days lost due to work, and hospitalization. The median of total COI for diabetic care without any complication was Rs. 22,456.97/- per patient per annum and with complication was Rs. 30,634.45/-. Patients on dialysis had to spend 7.3 times higher, and patients with cardiac intervention had to spend 7.4 times higher than diabetic patients without any complication. Conclusion: Treatment costs were many times higher in patients with complications and with cardiac and renal interventions. Complications in diabetic patients will increase the economic burden to family and also to the society.

  14. PATTERN OF MORBIDITY AND MORTALITY IN PRETERM NEWBORNS IN A TERTIARY CARE TEACHING HOSPITAL

    Directory of Open Access Journals (Sweden)

    Sumit

    2015-08-01

    Full Text Available OBJECTIVE: To study the morbidity and the mortality patterns in inborn preterm newborns admitted in NICU at a tertiary care teaching hospital. DESIGN: Retrospective study. The medical records of all the inborn preterm neonates (G. age ≤36W+6 days who were admitted to the NICU were analyzed by using a pre - set proforma. SETTINGS: Neonatal Intensive Care Unit (NICU, Department of Pediatrics, Adesh Institute of Medical Science & Research Institute (AIMSR Bathinda, Punjab. The study was carried out over a period of 2 years from J anuary 2012 to December 2014. PARTICIPANTS: 80 preterm neonates who were born in AIMSR and were admitted with some illness to the NICU. OUTCOME: The patterns of the morbidity and the mortality among the preterm neonates who were admitted to the NICU. ‘Survival’ was defined as the discharge of a live neonate/ infant from the hospital. RESULTS: A total of 80 premature inborn infants were analyzed for the complications they encountered after birth while admitted in NICU. Out of 80 premature babies, 32 (40% were male and 48 (60% were female babies. Mean gestational age was and Mean birth weight was. Neonatal hyper - bilirubinemia , HMD/RDS and Neonatal sepsis were the commonest causes of morbidity. Among 80 premature babies 15(18.7% died. The highest mortality was seen in babies those weighing less than 800 grams (100%. Male mortality is 34.4% and female mortality is 8.3%.

  15. Analysis of endoscopic management of occluded metal biliary stents at a single tertiary care center.

    Science.gov (United States)

    Rogart, Jason N; Boghos, Ara; Rossi, Federico; Al-Hashem, Hashem; Siddiqui, Uzma D; Jamidar, Priya; Aslanian, Harry

    2008-10-01

    A significant number of self-expandable metal stents (SEMSs) placed to palliate malignant biliary obstruction will occlude. Few data exist as to what constitutes optimal management. Our purpose was to review the management and outcomes of patients with biliary SEMS occlusion. Retrospective chart review at a single tertiary care hospital. From January 1999 to October 2005, a total of 90 patients had SEMSs placed for malignant biliary obstruction, and 27 of these occluded. Technical success of treating SEMS occlusion, stent patency and need for reintervention, and incremental cost analysis. A total of 60 ERCPs were performed to treat SEMS occlusions in 27 patients. The success rate was 95%; however, 52% of patients eventually required more than 1 intervention. Placing a second SEMS through the existing SEMS (n = 14) provided the lowest reocclusion rate (43% vs 55% and 100%), the longest time to reintervention (172 days vs 66 and 43 days, P = .03), and a trend toward longer survival (285 days vs 188 and 194 days) compared with plastic stent and mechanical balloon cleaning, respectively. Incremental cost analysis showed both uncovered SEMSs and plastic stents to be cost effective strategies. Small number of patients, retrospective study. Treatment of biliary SEMS occlusion with SEMS insertion provides for longer patency and survival, decreases the number of subsequent ERCPs by 50% compared with plastic stents, and is cost-effective.

  16. Pattern of Pediatric Dermatoses in a Tertiary Care Hospital of Western Nepal

    Directory of Open Access Journals (Sweden)

    Yogesh Poudyal

    2016-01-01

    Full Text Available Pediatric dermatoses are one of the most common presentations in a dermatology clinic and reflect the health and hygiene status of children. The incidence and severity of these skin lesions are influenced by geographical area, seasonal and cultural factors, and socioeconomic status. This study was done to show the prevalence of different pediatric dermatoses in a tertiary care hospital of Western Nepal. Chart reviews of children aged one day to 17 years, presenting to Universal Medical College Teaching Hospital, Nepal, from 1 September 2014 to 30 august 2015, were done. Descriptive analysis and two-sided chi-square test were done. Among 23992 patients visiting the dermatology outpatient department (OPD, 5398 (22.5% were of pediatric age groups (male/female: 1.2/1; most of them belonged to young teens and teenagers (n=3308; 61.3%. Three most common dermatoses were fungal infections (18.5%, eczema (14.4%, and acne (10.1%. Fungal infections (n=653; 65.4% and acne (n=284; 51.9% were common in males, whereas eczema (n=402; 51.7% was more common in females. Fungal infection (P<0.001, eczema (P<0.001, pigmentation disorders (P<0.001, and acne (P<0.01 were significantly more during summer, while scabies was more in winter (P<0.001. Dermatophytosis, pyoderma, and warts comprised frequently occurring fungal, bacterial, and viral infections, respectively.

  17. STUDY OF CLINICAL PROFILE OF PATIENTS PRESENTING WITH SEXUAL PRECOCITY TO A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Binoy Kumar Mohanty

    2016-07-01

    Full Text Available BACKGROUND Precocious puberty is a common paediatric endocrine disorder seen in clinical practice. OBJECTIVE To study the various aetiologies and clinical presentations of patients presenting with sexual precocity to a tertiary care hospital. DESIGN Cross sectional study. MATERIAL AND METHODS We collected and analysed the clinical data including hormonal status of 24 consecutive patients who presented to our department from January 2014 to December 2015 for evaluation of sexual precocity. RESULTS Most of the patients presenting to us had evidence of precocious puberty (n=16, followed by premature adrenarche (n=5 and premature thelarche (n=3 respectively. The females outnumbered males in our study (68.75% of total cases. Females presenting with central precocious puberty had no appreciable cause (idiopathic in majority (85.72% of cases. While, males presenting with central precocious puberty had an organic cause (60% in majority of cases. CONCLUSIONS Precocious puberty is more common among females as compared to males. Organic lesion must be ruled out in all patients presenting with central precocious puberty especially in males.

  18. A descriptive analysis of patients presenting to psychosexual clinic at a tertiary care center

    Directory of Open Access Journals (Sweden)

    Rohit Verma

    2013-01-01

    Full Text Available Background: Psychosexual problems are very common presentation, be it with psychiatric or physical illness but there are very few studies available on psychosexual disorders especially in the Indian context. Indian society is deeply ingrained in customs and several misconceptions, myths, prejudices, and social taboos are attached to sex which makes it further very difficult to tackle. Objectives: The aim of this current study was to descriptively analyze the nature of sexual disorders in a tertiary care center. Materials and Methods: The current retrospective chart review included 698 consecutive subjects seeking treatment for their psychosexual problems at the Sexual Clinic, Department of Psychiatry, Dr. Ram Manohar Hospital, New Delhi (between 2006 and 2010. Results: This study observed erectile dysfunction (ED (29.5%, Premature ejaculation (PME (24.6%, Dhat syndrome (DS (18.1%, and ED with PME (17.5% as the common sexual dysfunctions leading to treatment seeking. DS was the major complaint among younger and unmarried individuals. We observed more married individuals seeking treatment for sexual disorders. Conclusions: These findings provide important information on a relatively under-researched area.

  19. The spectrum of leukodystrophies in children: Experience at a tertiary care centre from North India

    Directory of Open Access Journals (Sweden)

    Sheffali Gulati

    2016-01-01

    Full Text Available Objective: The objective of this study is to retrospectively collect and then describe the clinico-radiographical profile of confirmed cases of leukodystrophy who presented over a 5-year period to a tertiary care teaching hospital in North India. Materials and Methods: The case records of 80 confirmed cases of leukodystrophy were reviewed and the cases have been described in terms of their clinical presentation and neuroimaging findings. Results: The cases have been grouped into five categories: Hypomyelinating, demyelinating, disorders with vacuolization, cystic, and miscellaneous. The commonest leukodystrophies are megalencephalic leukoencephalopathy with subcortical cysts (MLC, Pelizaeus-Merzbacher disease (PMD, and metachromatic leukodystrophy (MLD. A notable proportion of hypomyelinating disorders were uncharacterized. Conclusions: Leukodystrophies at this point of time have no definite cure. They have a progressively downhill clinical course. Early diagnosis is imperative for appropriate genetic counseling. A simplified approach to diagnose common leukodystrophies has also been provided. It is important to develop a registry, which can provide valuable epidemiological data to prioritize research in this field, which has many unanswered questions.

  20. Maternal and Neonatal Outcomes of Women with Preeclampsia and Eclampsia at a Tertiary Care Center

    Directory of Open Access Journals (Sweden)

    Hediye Dağdeviren

    2015-12-01

    Full Text Available Aim: Preeclampsia is a multisystem disorder of unknown etiology and one of the leading causes of maternal, fetal and neonatal mortality and morbidity. Adverse outcomes can be improved by early identification of the disease and timely referral to a tertiary center. The aims of this study were to evaluate the outcomes of preeclampsia-eclampsia cases and share our experiences in a tertiary center. Methods: The study conducted by retrospectively analyzing the data of 350 women who gave birth between 2008 and 2013 at a tertiary care center. Results: The mean age of the enrolled women was 35 years, the mean gestational age at delivery-36 weeks, the mean birth weight-2.73 kg, and the mean platelet count was 204.000/ mm3. The incidence of preterm deliveries was 66.6%. Severe preeclampsia was noted in 29.4% of cases. Neonatal intensive care unit admissions were seen in 10.6% of cases. A total of 22.9% of these women had vaginal deliveries, while the other 77.1% underwent cesarean section. High systolic blood pressure and elevated serum alanine and aspartate aminotransferase values had significant independent effects of differentiating between mild and severe preeclampsia. Conclusion: Fetomaternal morbidity and mortality rates associated with hypertensive disorders are alarming, especially in developing countries. As such, the high-risk obstetric population should be screened earlier in pregnancy. A system allowing early referral in these cases should be created. (The Medical Bulletin of Haseki 2015; 53:143-6

  1. Dengue fever in patients admitted in tertiary care hospitals in Pakistan.

    Science.gov (United States)

    Munir, Muhammad Arif; Alam, Syed Ejaz; Khan, Zareef Uddin; Saeed, Quaid; Arif, Ambreen; Iqbal, Rizwan; Saqib, Muhammad Arif Nadeem; Qureshi, Huma

    2014-05-01

    To assess the gaps in the diagnosis and management of dengue fever cases. The retrospective descriptive analytical study was done with a case record analysis of patients with dengue fever admitted from January to December 2010 at five tertiary care hospitals in different Pakistani cities. Using a questionnaire, information was gathered on demography, haematological profile, management, use of blood and platelet transfusions and the outcome. For comparison, data of serologically-confirmed dengue patients from a private laboratory in Islamabad was collected to see the age, gender and month-wise distribution of cases tested over the same period. SPSS 16 was used for statistical analysis. Out of the 841 confirmed dengue cases, 514 (79%) were males and 139 (21%) females. The overall mean age was 31.3 +/- 14.0 years. Dengue fever was seen in 653 (78%) and dengue haemorrhagic fever (DHF) in 188 (22%) patients. Most cases were between 20 and 49 years of age. A gradual increase in dengue fever and dengue haemorrhagic fever was seen from August, with a peak in October/November. Tourniquet test was done only in 20 (2.3%) cases, out of which 11 (55%) were positive and 9 (45%) were negative. Serial haematocrit was not done in any case. Total deaths were 5 (0.6%). Most cases were seen in October/November with the majority being in the 20-39 age group. Tourniquet test and serial haematocrit were infrequently used. No standard national guidelines were employed.

  2. PREVALENCE OF HEPATITIS B INFECTION IN A TERTIARY CARE HOSPITAL, NORTH EAST REGION OF INDIA

    Directory of Open Access Journals (Sweden)

    Arun

    2014-09-01

    Full Text Available : BACKGROUND: HBV Virus is one of the major health problems in India. Hepato cellular carcinoma due to HBV infection is 5th most frequent cancer in world wide. About 30% population has serological evidence of current or past infection with HBV. In the natural history of HBV infection, the most important event is HBeAg, Seroconversion is characterized by loss of HBeAg and development of antibody against HBeAg. AIMS: The aim of the study was to determine sero prevalence of hepatitis B infection among different age, sex groups and to understand the risk factors that define the development of HBsAg. DESIGN - The study design was based on clinical evaluation and serological testing. METHODS: The study was conducted in the Department of Microbiology of a tertiary care hospital, G.B. Panth Hospital. Agartala, West Tripura during the period over 5 years, 2001 – 2005.In this retrospective study, total 21, 121 numbers of patients serum were examined by ELISA method to detect the Hepatitis B surface antigen in different categories of patient as a marker of infection. out of 21, 121 patients, 1044 number of cases were seropositive showing the prevalence rate 4.94% in compared with hepatitis B virus infection in India is 4%. Details clinical history, age, sex, risk factors were recorded carefully. -

  3. STUDY OF CLINICAL AND ENDOCRINE PROFILE OF PATIENTS WITH PITUITARY TUMOURS ATTENDING A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Binoy Kumar Mohanty

    2016-07-01

    Full Text Available BACKGROUND Pituitary tumours are relatively common endocrine tumours. They can present with symptoms related to hormone excess or hormone deficiency. They can also present with compressive symptoms like visual problems and headache. OBJECTIVE To study the various clinical presentations and endocrine profile of patients presenting with pituitary tumours to a tertiary care hospital. DESIGN Cross sectional study. MATERIAL AND METHODS We collected and analysed the clinical data including hormonal status of 33 consecutive patients who presented to our department from March 2014 to February 2016 for evaluation of pituitary tumours. RESULTS Majority of the subjects studied belonged to 40-50 years group (33.34%.The most common type of pituitary tumour in our population was non-functioning pituitary tumours (45.45%. The next common cause was somatotroph adenoma (27.27% followed by prolactinoma (15.15% and corticotroph adenomas (12.13%. There was significant male predominance (60.60% among total cases. Among all patients, headache (54.54% was most common presentation followed by features related to hormone excess (51.51%. CONCLUSIONS Pituitary tumours can present with variety of symptoms. A detailed endocrine workup is essential in each case to reach at correct diagnosis. In our cohort, non-functioning pituitary tumour was the most common tumour subtype.

  4. SPECTRUM OF THYROID LESIONS-HISTOMORPHOLOGICAL PATTERNS - EXPERIENCE AT A TERTIARY CARE CENTRE

    Directory of Open Access Journals (Sweden)

    Neelala Neelaveni

    2016-08-01

    Full Text Available BACKGROUND Thyroid gland is unique among endocrine organs. Thyroid tumours are the most common endocrine tumours which affect females more frequently at age range of 30-60 years most of which are benign. Malignant neoplasms of thyroid are not uncommon with follicular pattern lesions. Fine Needle Aspiration Biopsy is itself not a reliable method to differentiate between benign and malignant follicular tumours. Surgical resection helps in accurate diagnosis of these tumours. AIMS AND OBJECTIVES To study the distribution of lesions according to age, sex and with clinicohistomorphological correlation. MATERIALS AND METHODS This study is a retrospective and prospective analysis of thyroid swellings received at our tertiary care centre during the period of two and half years between January 2013 and June 2015 in the age range of 6 years to 78 years. A total of 148 specimens received during the period were analysed for clinical and histomorphological features. Immunohistochemistry was done for diagnosis of difficult cases. RESULTS Out of total 148 cases, most common clinical presentation was multinodularity in 67 cases (45%, solitary nodules in 54 (36%. Out of benign lesions-84 (57% were nodular hyperplasias, 5 cases (3% of colloid cyst. Malignant lesions composed 32 cases, PTC constituted 25 cases (18%, 3 (2% cases of medullary carcinoma of thyroid, anaplastic carcinoma of thyroid diagnosed (0.5%. CONCLUSION Our study over a period of two and half years of thyroidectomies showed female preponderance. The most common lesion amongst benign lesions was nodular hyperplasia and papillary carcinoma was commonest in malignancies.

  5. CLINICAL AND PATHOLOGICAL PRESENTATIONS OF BRONCHOGENIC CARCINOMA IN A TERTIARY CARE CENTRE

    Directory of Open Access Journals (Sweden)

    Vishwanath V

    2016-06-01

    Full Text Available BACKGROUND Lung cancer is presently the most common malignant disease (13% of all cancers and the leading cause of cancer deaths (19% of all cancer deaths in the world in all age groups and in both sexes. It is the leading cause of cancer deaths in developed as well as in developing countries. OBJECTIVE The present study was conducted to study the various clinical and pathological presentations of bronchogenic carcinoma. MATERIALS AND METHODS A total of 82 patients with histologically proven bronchogenic carcinoma, hospitalized between 2012 and 2014 at a tertiary care centre, Pune, India, were analysed. RESULT Out of a total of 82 diagnosed cases, average age was 61 years, nearly 80.0% were males. Smoking was the risk factor in 63.41%. About 2% of female patients were smokers. Six (7.3% patients were <40 years of age at the time of diagnosis. Fiberoptic bronchoscopy (75.60% was found to be the most efficient diagnostic procedure. Histologically, adenocarcinoma, squamous cell carcinoma, non-small cell carcinoma and small cell carcinoma were seen in 57.31%, 24.39%, 9.75% and 6.09% cases, respectively. Distant metastases to organs like nodes, liver, adrenals and bones were present in 67%. CONCLUSION This study shows that adenocarcinoma is the most common type of lung cancer and clinical and radiological suspicion should lead to the prompt diagnosis and management.

  6. Prognostic indicators of poor outcome in horses with laminitis at a tertiary care hospital

    Science.gov (United States)

    Orsini, James A.; Parsons, Corrina Snook; Capewell, Linda; Smith, Gary

    2010-01-01

    This retrospective study investigated the factors associated with a poor outcome (death by euthanasia or from other causes) in horses treated for laminitis at a tertiary care hospital. Cases (n = 247) were defined as patients with laminitis that were euthanized or that died of other causes during hospitalization. Controls (n = 344) were patients with laminitis that survived to be discharged from the hospital. In the final multivariate analysis, the factors significantly associated with an increased risk for death and their respective odds ratios (OR) were as follows: Thoroughbred (OR = 1.57); racehorse (OR = 1.76); treatment with flunixin meglumine (OR = 1.76); vascular pathology (OR = 2.12); distal displacement of the third phalanx (OR = 2.68); pneumonia (OR = 2.87); and lameness of Obel grade II (OR = 2.99), grade III (OR = 9.63), or grade IV (OR = 20.48). The use of glue-on shoes significantly reduced the risk for death (OR = 0.36). PMID:20808574

  7. BACTERIAL SPECTRUM AND PATTERN OF ANTIMICROBIAL SENSITIVITY AMONG OUTPATIENTS WITH PNEUMONIA IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Sushma

    2015-04-01

    Full Text Available OBJECTIVES: To outline the spectrum of bacteria causing pneumonia and the pattern of antimicrobial sensitivity in outpatients with pneumonia in a tertiary care hospital in Himachal Pradesh. METHODS: Sputum of 108 immuno competent pneumonia patients attending outpatient departments of Medicine and Pulmonary medicine of Dr. R. P. Government Medical College , Kangra at Tanda was sent for Gram staining and culture and sensitivity testing. RESULTS: Commensals were detected in most of the cases (32 , 29.6% followed by Staphylococcus aureus in 17(15.7% and Streptococcus pneumoniae in 16(14.8%. This was followed by three Gram negative organisms namely E Coli (11 , 10.2% , Pseudomonas (10 , 9.2% and Klebsiella (8 , 7.2%. No growth was obtained in 7(6.5% and other organisms were isolated in 7(6.5% specimens. Staphylococcus aureus was sensitive to vancomycin , clindamycin , cefoxitin , azithromycin and cotrimoxazole. Streptococcus pneumoniae was found to be sensitive to vancomycin , clindamycin , gentamicin , azithromycin , penicillin , cotrimoxazole , amoxicillin +clavulanic acid. Klebsiella was found to be sensitive to imipenem , azithromycin , ciprofloxacin , gentamicin and amoxicillin +clavulanic acid. E coli was sensitive to imipenem , gentamicin and amoxicillin +clavulanic acid. Pseudomonas aeruginosa was found to be sensitive to gentamicin , cefta zidime , imipenem , ticarcillin and piperacillin. CONCLUSION: Staphylococcus aureus and Streptococcus pneumoniae are the commonest organism causing pneumonia. Streptococcus pneumoniae is resistant to many antibiotics. Azithromycin can be the first line therapy for pneumonia.

  8. Family caregivers in public tertiary care hospitals in Bangladesh: risks and opportunities for infection control.

    Science.gov (United States)

    Islam, M Saiful; Luby, Stephen P; Sultana, Rebeca; Rimi, Nadia Ali; Zaman, Rashid Uz; Uddin, Main; Nahar, Nazmun; Rahman, Mahmudur; Hossain, M Jahangir; Gurley, Emily S

    2014-03-01

    Family caregivers are integral to patient care in Bangladeshi public hospitals. This study explored family caregivers' activities and their perceptions and practices related to disease transmission and prevention in public hospitals. Trained qualitative researchers conducted a total of 48 hours of observation in 3 public tertiary care hospitals and 12 in-depth interviews with family caregivers. Family caregivers provided care 24 hours a day, including bedside nursing, cleaning care, and psychologic support. During observations, family members provided 2,065 episodes of care giving, 75% (1,544) of which involved close contact with patients. We observed family caregivers washing their hands with soap on only 4 occasions. The majority of respondents said diseases are transmitted through physical contact with surfaces and objects that have been contaminated with patient secretions and excretions, and avoiding contact with these contaminated objects would help prevent disease. Family caregivers are at risk for hospital-acquired infection from their repeated exposure to infectious agents combined with their inadequate hand hygiene and knowledge about disease transmission. Future research should explore potential strategies to improve family caregivers' knowledge about disease transmission and reduce family caregiver exposures, which may be accomplished by improving care provided by health care workers. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

  9. Nosocomial tuberculosis exposures at a tertiary care hospital: a root cause analysis.

    Science.gov (United States)

    Uppal, Navjeet; Batt, Jane; Seemangal, Julie; McIntyre, Susan A; Aliyev, Nemat; Muller, Matthew P

    2014-05-01

    Exposure of health care workers (HCWs) to patients with active TB continues to occur despite implementation of TB control policies. We conducted a root-cause analysis of TB exposures at a tertiary care hospital. Clinical and management details of all confirmed cases identified in 2011 were summarized. Cases were independently reviewed by an expert panel that determined the type (ie, delay in initiating, incorrect use of or premature removal of control measures), preventability, and root cause(s) of each error (exposure). Fifteen cases were reviewed. Ten errors were identified in 7 (47%) cases. Cases associated with errors were older than those without errors (68 y vs 40 y; P = .037). Most cases (12/15) were foreign born. A delay in initiating airborne precautions accounted for 70% (7/10) of the errors. The expert panel determined that 80% (8/10) of the errors were preventable or possibly preventable. The most common root causes were failure to consider TB and failure to obtain and interpret imaging. Advanced age, atypical presentation, and presence of comorbid illnesses were common among the preventable cases. TB control policies do not prevent all exposures. Our findings suggest that consideration of TB in elderly patients with risk factors, even if their signs and symptoms can be explained by an alternative diagnosis or are atypical, followed by a review of imaging studies, can further reduce this risk. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  10. Incidence of surgical site infection in postoperative patients at a tertiary care centre in India.

    Science.gov (United States)

    Akhter, M Siddique J; Verma, R; Madhukar, K Premjeet; Vaishampayan, A Rajiv; Unadkat, P C

    2016-04-01

    A prospective observational was carried out to calculate the incidence of surgical site infections (SSI) along with the main risk factors and causative organisms in postoperative patients at a tertiary care setting in Mumbai. A total number of 1196 patients between June 2011 to March 2013 admitted to the general surgical ward or surgical ICU of our hospital were included in the study. Post laproscopy patients and organ space SSIs were excluded. Patient data were collected using a preformed pro forma and a wound Southampton score tabulated and checked repeatedly until suture removal of patient. Regular follow-up was maintained until at least 30 days postoperatively. The study showed a SSI rate of 11%. Risk factors associated with a higher incidence of SSI were found to be age (>55 years), diabetes mellitus (especially uncontrolled sugar in the perioperative period), immunocompromised patients (mainly HIV and immunosuppressive therapy patients), surgeon skill (higher in senior professors compared with junior residents), nature of the cases, (emergency surgeries), placement of drains, wound class (highest in dirty wounds), type of closure (multilayer closure), prolonged duration of hospital stay, longer duration of surgery (>2 hours), type of surgery (highest in cholecystectomy). The highest rates of causative organisms for SSIs found were Staphylococcus aureus, Escherichia coli and Klebsiella ssp. Prevention of SSIs requires a multipronged approach with particular emphasis on optimising preoperative issues, adhering religiously to strict protocols during the intraoperative period and addressing and optimising metabolic and nutritional status in postoperative period.

  11. The Effects of Elimination of Gate-Keeping on Tertiary Care and the Social Insurance System

    Directory of Open Access Journals (Sweden)

    Nazan Savaş

    2011-03-01

    Full Text Available The aim was to investigate the effects of elimination of gatekeeping on a university hospital and Social Insurance Institute (SII. Electronic records of 2006-2007 were analyzed. The mean outpatient visits was 273.8±69.9 before the gate-keeping elimination, it was 471.8±114.7 after the gate-keeping elimination (p<0.001. The increased rate of visits were in the department of cardiology (95.4% followed by respiratory medicine (33.3%, orthopedics (22.6%, neurology (16.1% and gynecology (11.4%. Also the most frequent diagnoses changed in these departments. The most frequent diagnoses before and after elimination were as follows; hypertension in comparison to anxiety disorders after elimination in cardiology, chronic obstructive lung disease compared to myalgia in respiratory medicine, fracture follow up compared to joint pain in orthopaedics, epilepsy compared to dizziness in neurology and infertility compared to vaginitis in gynecology. SII has paid 10.67 fold higher dues after elimination for these 7 departments and diagnoses. Consequently; elimination of the gate-keeping can easily be applied to tertiary care and can increase health expenditures.

  12. FACTORS PREDICTING MORBIDITY IN PATIENTS WITH DENGUE FEVER IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Muhammad Imran Hasan Khan

    2013-02-01

    Full Text Available Introduction: Dengue virus (DENV affects over half the world’s population in 112 countries, and dengue fever (DF is the second largest arthropod borne infectious global hazard after malaria with complications like Dengue Hemorrhagic Fever (DHF and Dengue Shock Syndrome (DSS accounting for significant morbidity and mortality world over. Pakistan is significantly affected with DENV infection and to-date no study identifying risk factors associated with complications of DF has been done. Methods: 997 confirmed cases of DF were collected in a tertiary care hospital in Lahore, Pakistan and their clinical and biochemical data were collected. Univariate, multivariate and logistics regression analysis was performed to identify risk factors associated with development of DHF and DSS. Results: Bleeding OR 70.7 (CI 38.4-129.9, deranged liver function test OR 1.9 (CI 0.97-0.99, platelet count on admission less than 50,000 x109/L OR 0.16 (CI 0.13-0.19, presence of urinary red blood cells OR 1.4 (CI 0.179-0.900 and presence of urinary protein OR 1.1 (CI 0.191-0.974 were related to development of DHF and DSS.

  13. STUDY OF CLINICAL PRESENTATIONS OF PATIENTS WITH HYPERPROLACTINAEMIA VISITING A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Binoy Kumar Mohanty

    2016-06-01

    Full Text Available BACKGROUND Hyperprolactinaemia is one of the common endocrine disorders seen in clinical practice. It may result due to various causes and elucidating the exact cause is necessary to formulate the right therapy. OBJECTIVE To study the various aetiologies and clinical presentation of patients presenting with hyperprolactinaemia to a tertiary care hospital. DESIGN Cross-sectional study. MATERIAL AND METHODS We collected and analysed the clinical data including hormonal status of 74 consecutive patients who presented to our department from June 2015 to May 2016 for evaluation of hyperprolactinaemia. RESULTS Majority of the subjects studied belonged to 20-29 years group (47.29% followed by 30-39 years age group (24.32%. The most common cause in our population was due to drug-induced causes (35.13%. The next common causes included idiopathic group (20.4% followed by pituitary adenomas (16.21%. There was significant female predominance (83.78% among total cases. Among women who presented with hyperprolactinaemia, menstrual irregularity (69.35% followed by galactorrhoea (35.48% were the most common presentations. CONCLUSIONS Hyperprolactinaemia is frequently seen among women who presented with either menstrual irregularity or galactorrhoea or both. Drug-induced hyperprolactinaemia is the most common cause seen in our study population.

  14. Using standardized insulin orders to improve patient safety in a tertiary care centre.

    Science.gov (United States)

    Doyle, Mary-Anne; Brez, Sharon; Sicoli, Silvana; De Sousa, Filomena; Keely, Erin; Malcom, Janine C

    2014-04-01

    To standardize insulin prescribing practices for inpatients, improve management of hypoglycemia, reduce reliance on sliding scales, increase use of basal-bolus insulin and improve patient safety. Patients with diabetes were admitted to 2 pilot inpatient units followed by corporate spread to all insulin-treated patients on noncritical care units in a Canadian tertiary care multicampus teaching hospital. Standardized preprinted insulin and hypoglycemia management orders, decision support tools and multidisciplinary education strategies were developed, tested and implemented by way of the Model for Improvement and The Ottawa Model for Research Process. Clinical and balance measures were evaluated through statistical process control. Patient safety was improved through a reduction in hypoglycemia and decreased dependence on correctional scales. Utilization of the preprinted orders approached the target of 70% at the end of the test period and was sustained at 89% corporately 3 years post-implementation. The implementation of a standardized, preprinted insulin order set facilitates best practices for insulin therapy, improves patient safety and is highly supported by treating practitioners. The utilization of formal quality-improvement methodology promoted efficiency, enhanced sustainability, increased support among clinicians and senior administrators, and was effective in instituting sustained practice change in a complex care centre. Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.

  15. Screening for body dysmorphic disorder in a dermatology outpatient setting at a tertiary care centre

    Directory of Open Access Journals (Sweden)

    Fibin Thanveer

    2016-01-01

    Full Text Available Context: A distressing pre-occupation with an imagined or slight defect in appearance with a marked negative effect on the patient's life is the core symptom of body dysmorphic disorder (BDD. Aim: To screen the patients attending a dermatology clinic at a tertiary care centre for BDD using the BDD-dermatology version (DV questionnaire. Settings and Design: This cross-sectional study enrolled 245 consecutive patients from the dermatology outpatients clinic. Methods: The demographic details were collected and the DV of BDD screening questionnaire was administered. A 5-point Likert scale was used for objective scoring of the stated concern and patients who scored ≥3 were excluded from the study. Statistical Analysis Used: The results were statistically analysed. Differences between the groups were investigated by Chi-square analysis for categorical variables, and Fisher exact test wherever required. Results: A total of 177 patients completed the study, and of these, eight patients screened positive for BDD. The rate of BDD in patients presenting with cosmetic complaints was 7.5% and in those with general dermatology, complaints were 2.1%, with no significant difference between the two groups (P = 0.156. Facial flaws (62.5% were the most common concern followed by body asymmetry (25%. Conclusion: The rates of BDD found in this study are comparable but at a lower rate than that reported in literature data.

  16. Retrospective analysis of nosocomial infections in an Italian tertiary care hospital.

    Science.gov (United States)

    Mancini, Alessio; Verdini, Daniele; La Vigna, Giorgio; Recanatini, Claudia; Lombardi, Francesca Elena; Barocci, Simone

    2016-07-01

    Nosocomial infections are one of the leading causes of morbidity and mortality in hospitalized patients. Studies of their prevalence in single institutions can reveal trends over time and help to identify risk factors. The aim of this study was to investigate the nosocomial infections trend and identify the prevalence of predominant bacterial microorganisms and their drug resistance patterns in an Italian tertiary care hospital. Infections were classified according to the Centres for Disease Control and Prevention definitions. A retrospective study was carried out from March 2011 to June 2014, based on the bacterial isolate reports of a hospital located in Central Italy. During the 40-month study period, a total of 1547 isolates were obtained from 1046 hospitalized patients and tested for their antibiotic sensitivity. The most common isolates belonged to the Enterobacteriaceae family (61.7%), followed by Enterococcus species (12.4%), Pseudomonas species (10.7%) and S. aureus (10.0%). The incidence density rate of nosocomial infections was 7.4 per 1000 patient days, with a significant difference among the 3 annual infection rates (Pinfection prevalence rate was found in Internal Medicine Unit (41.3%), followed by Intensive Care Units (12.4%), Surgical Units (9.0%,) and Cardiology (7.1%).

  17. Prevalence of intestinal parasites and bacteria among food handlers in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    D A Zaglool

    2011-01-01

    Full Text Available Objectives: The aim of this work is to determine the prevalence of intestinal parasites and bacteria among the food handlers. Materials and Methods: Two hundred food-handlers were subjected to a cross-sectional study working in the kitchen of a tertiary care hospital, i.e., Alnoor Specialist Hospital, Makkah, Saudi Arabia from February 2 to 27, 2009. The stool samples were examined for intestinal parasites following direct microscopic examination, formol ether concentration (Ritchie, and staining with modified acid fast staining techniques. For enteropathogenic bacteria samples were inoculated onto MacConkey′s agar, deoxycholate citrate agar, xylose lysine deoxycholate agar as per the World Health Organization protocol. Fingernail materials were examined microscopically for enteropathogenic bacteria and parasites. Results: The majority (80% of the food-handlers were young adults aged from 22 to 42 years. No intestinal parasites were detected from fingernail contents. Forty six (23% stool specimens were positive for intestinal paraͼsites. Giardia lamblia 18 (9% was most frequent among the 10 different types of detected intestinal parasites followed by Entamoeba histolytica 9 (4.5%. No pathogenic bacteria were detected in all stool samples, whereas finger nails showed isolation of microorganisms as coagulase-negative staphylococci 79 (39.5%, followed by Staphylococcus aureus 35 (17.5%. Conclusion: The findings emphasized the importance of food handlers as potential sources of infections and suggested health institutions for appropriate hygienic and sanitary control measures.

  18. Rising trends of syphilis in a tertiary care center in North India

    Science.gov (United States)

    Sethi, Sunil; Mewara, Abhishek; Hallur, Vinaykumar; Prasad, Amber; Sharma, Kusum; Raj, Atul

    2015-01-01

    Background and Objectives: Syphilis is a classical sexually transmitted disease (STD), caused by Treponema pallidum subsp. pallidum. In this retrospective study, we analyzed trends of syphilis prevalence in patient groups attending our tertiary care center. Materials and Methods: The data was obtained by reviewing laboratory records of the STD laboratory from January 1, 2006 to December 31, 2011. Cases positive by both Venereal Disease Research Laboratory (VDRL) and Treponema pallidum particle agglutination (TPPA) tests were analyzed for seroprevalence of syphilis in different groups, and to analyze the rising or falling trends, if any. Results: A total of 28,920 serum samples were received in the 6-year study period for VDRL testing, of which 972 (3.4%) were found to be reactive. Of these, 1722 sera were also submitted for TPPA testing, 374 (21.7%) of which were positive. A total of 375 samples were submitted for both tests, indicating biological false positivity of 0.27%. A rising trend, though not statistically significant, was observed in pregnant women, drug users and patients from wards/out-patient departments, while a statistically significant rise in prevalence of syphilis was found in HIV-positive individuals. A falling trend (not statistically significant) was observed in STD clinic attendees. Conclusion: An increasing trend of syphilis was observed during the study period when all groups were analyzed together, especially in HIV-seropositive individuals, which calls for continued and sustained efforts for case detection, treatment, and preventive measures to contain the disease. PMID:26692604

  19. Prevalence and associated factors of polypharmacy among adult Saudi medical outpatients at a tertiary care center

    Directory of Open Access Journals (Sweden)

    Salih Bin Salih

    2013-01-01

    Full Text Available Objective: The objective of this study was to assess the prevalence of polypharmacy (PP and the associated factors in medical outpatients. Materials and Methods: A cross-sectional, observational, descriptive study was carried out in adult medical outpatients attending internal medicine clinics at King Abdulaziz Medical City, Riyadh, Saudi Arabia from 1 March 2009 to 31 December 2009. PP was defined as the concomitant use of ≥5 medications daily. The number of medications being currently taken by patient was recorded. Effect of patients′ age, gender, educational level, number of prescribers, disease load and disease type on PP was assessed by multivariate analysis using Statistical Package for Social Sciences Incorporated (SPSS Inc Version 18. Results: Out of 766 patients included in the study, 683 (89% had PP. The mean number of prescribed medications, oral pills and doses was 8.8, 9.6 and 12.1, respectively. Factors significantly associated with PP included age (≥61 years, disease load and the number of prescribers. Gender had no impact on PP while education beyond primary education significantly decreased PP. Hypertension, diabetes mellitus and dyslipidemia alone and as a cluster increased PP. Conclusion: We found an extremely high level of PP in medical outpatients at our tertiary care center. The impact of PP on medication compliance and control of underlying diseases in Saudi Arabia is unknown and needs to be studied at different levels of care.

  20. Bacteriology of neonatal septicaemia in a tertiary care hospital of northern India

    Directory of Open Access Journals (Sweden)

    Roy I

    2002-01-01

    Full Text Available To study the bacteriology of neonatal septicaemia in a tertiary care hospital of Northern India we prospectively enrolled all the suspected cases of neonatal septicaemia, which were not on antimicrobials. One to two millilitre of blood from these neonates was cultured in brain heart infusion broth. Out of 728 cases, 346 (47.5% were positive on blood culture. The most frequent offender was Klebsiella spp. (24.5% followed by Enterobacter spp. (22.8%. There was an overall predominance of gram negative organisms. Coagulase negative staphylococci (CONS were more frequently isolated (16.5% than Staphylococcus aureus (14%. More than 89% of the Staphylococci isolated were resistant to penicillin. None were resistant to vancomycin or teicoplanin. More than 95% of enterobacteria were resistant to anti gram negative penicillin group of drugs and more than 40% were resistant to extended spectrum cephalosporins. Ciprofloxacin and amikacin resistance was infrequent. Thus, initial therapy in our hospital may be aimed at Gram negative organisms and amikacin and ciprofloxacin may be used as first line drugs.

  1. Magnetic resonance neurography in the management of peripheral trigeminal neuropathy: experience in a tertiary care centre

    Energy Technology Data Exchange (ETDEWEB)

    Cox, Brian; Chhabra, Avneesh [UT Southwestern Medical Center, Department of Radiology, Dallas, TX (United States); Zuniga, John R. [UT Southwestern Medical Center, Department of Oral and Maxillofacial Surgery, Surgery, Neurology and Neurotherapeutics, Dallas, TX (United States); Panchal, Neeraj [University of Pennsylvania, Department of Oral Maxillofacial Surgery, Philadelphia, PA (United States); Cheng, Jonathan [UT Southwestern Medical Center, Department of Plastic Surgery, Dallas, TX (United States)

    2016-10-15

    This tertiary care experience examines the utility of magnetic resonance neurography (MRN) in the management of peripheral trigeminal neuropathies. Seventeen patients with clinically suspected peripheral trigeminal neuropathies (inferior alveolar nerve and lingual nerve) were imaged uniformly with 1.5-T examinations. MRN results were correlated with clinical and surgical findings in operated patients and the impact on clinical management was assessed. Clinical findings included pain (14/17), sensory changes (15/17), motor changes (2/17) and palpable masses (3/17). Inciting events included prior dental surgery (12/17), trauma (1/17) and idiopathic incidents (4/17). Non-affected side nerves and trigeminal nerves in the intracranial and skull base course were normal in all cases. Final diagnoses on affected sides were nerve inflammation (4/17), neuroma in continuity (2/17), LN transection (1/17), scar entrapment (3/17), infectious granuloma (1/17), low-grade injuries (3/17) and no abnormality (3/17). Associated submandibular gland and sublingual gland oedema-like changes were seen in 3/17 cases because of parasympathetic effects. Moderate-to-excellent MRN-surgical correlation was seen in operated (8/17) patients, and neuroma and nerve transection were prospectively identified in all cases. MRN is useful for the diagnostic work-up of suspected peripheral trigeminal neuropathy patients with significant impact on clinical management and moderate-to-excellent correlation with intra-operative findings. (orig.)

  2. PATTERN OF TRAUMA AT A GOVERNMENT TERTIARY CARE TEACHING HOSPITAL OF HARYANA

    Directory of Open Access Journals (Sweden)

    Surender

    2014-06-01

    Full Text Available OBJECTIVE: To study the pattern of trauma related surgical emergencies in a government tertiary care public hospital in Haryana. DESIGN: Prospective analysis of patients reported during period of June 2010. SETTING: Accident and Emergency Department, Pt. B.D. Sharma PGIMS, Rohtak. RESULT: A total of 1501 patients reported during the study period and out of which most common mode of trauma were road side accidents (62.23%. Among all patients mostly (57.76% were non referred. Male patients (78.22% outnumbered female patients (21.78%. Most common injury was soft tissue injury of limbs (22.88% and most of the patients (85.25% were managed conservatively. Orthopedic operations were most commonly performed procedure in all operated patients. Mortality of trauma in accident and emergency department during the study period was 1.99%. CONCLUSION: The study revealed that commonest affected populations in trauma were of productive age group. Therefore it is the need of hour to persuade health system administrators to set up some education program to increase the awareness of families and teenagers regarding trauma

  3. Mucormycosis in patients without cancer: a case series from A tertiary care hospital in South India.

    Science.gov (United States)

    Ghafur, A; Shareek, P S; Senthur, Nambi P; Vidyalakshmi, P R; Ramasubramanian, V; Parameswaran, Ashok; Thirunarayan, M A; Gopalakrishnan, R

    2013-05-01

    Mucormycosis (Zygomycosis) is a life-threatening infection. We attempted to analyse clinical features and risk factors of Mucormycosis cases in a tertiary care referral institution in India, in patients without underlying malignancy. We retrospectively analyzed data of patients diagnosed as having Mucormycosis over a 10 year period of 2000-2010. Patients with a histopathology report and/or a Microbiology report of Zygomycetes or Mucor from a biopsy specimen were included in the study. Out of the 27 cases, rhino-orbital/rhino-cerebral involvement occurred in 12 (44.4%) patients, pulmonary involvement in 3 (11.1%) cases, soft tissue involvement in 11 (40.7%) cases and gastrointestinal involvement in one patient (3.7%). Diabetes mellitus is the main risk factor, followed by renal failure and trauma. Mean ESR value of these patients was 118 mm/1 hour. Mean WBC count was 20 x 10(9)/L, and neutrophil count 82%. The mean absolute neutrophil count (ANC) was 16.8 x 10(9)/L. The interesting finding in our study was the presence of neutrophilic leucocytosis and high ESR in most of the patients. In a predisposed individual, especially in a diabetic, in countries with high environmental fungal burden; presence of high ESR and neutrophilic leucocytosis with a compatible clinical presentation should raise suspicion of Mucormycosis.

  4. Palliative care in advanced cancer patients in a tertiary care hospital in Uttarakhand

    Directory of Open Access Journals (Sweden)

    Manisha Bisht

    2008-01-01

    Full Text Available Aim: Advanced cancer, irrespective of the site of the cancer, is characterized by a number of associated symptoms that impair the quality of life of patients. The management of these symptoms guides palliative care. The present study aims to describe the symptoms and appropriate palliation provided in patients with advanced cancer in a tertiary care hospital in Uttarakhand. Methods: This was an observational study. A total of 100 patients with advanced cancer were included in the study. The data obtained from the patients included symptoms reported by the patients, currently prescribed treatments and the site of cancer. Results: The average number of symptoms reported per patient was 5.33 ± 0.67 (mean ± SE. The most common symptoms were pain, weakness/fatigue, anorexia, insomnia, nausea/vomiting, dyspnea, constipation and cough. Polypharmacy was frequent. Patients consumed approximately 8.7 ± 0.38 (mean ± SE drugs on average during the 2-month period of follow-up. Conclusion: The result gives insight into the varied symptomatology of patients with advanced cancer. Polypharmacy was quite common in patients with advanced cancer, predisposing them to complicated drug interactions and adverse drug reactions.

  5. Characteristics of patients presenting to the vascular emergency department of a tertiary care hospital: a 2-year study

    Directory of Open Access Journals (Sweden)

    Kotsikoris Ioannis

    2011-11-01

    Full Text Available Abstract Background The structure of health care in Greece is receiving increased attention to improve its cost-effectiveness. We sought to examine the epidemiological characteristics of patients presenting to the vascular emergency department of a Greek tertiary care hospital during a 2-year period. We studied all patients presenting to the emergency department of vascular surgery at Red Cross Hospital, Athens, Greece between 1st January 2009 and 31st December 2010. Results Overall, 2452 (49.4% out of 4961 patients suffered from pathologies that should have been treated in primary health care. Only 2509 (50.6% needed vascular surgical intervention. Conclusions The emergency department of vascular surgery in a Greek tertiary care hospital has to treat a remarkably high percentage of patients suitable for the primary health care level. These results suggest that an improvement in the structure of health care is needed in Greece.

  6. Pattern of use of antibiotics in hospitalized patients in the medicine department of a tertiary care hospital

    OpenAIRE

    2015-01-01

    Background: (1) To assess pattern of antibiotic use among in-patients of medicine unit in a tertiary care hospital, (2) to determine the frequency of adverse drug reactions (ADR) among the inpatients receiving antibiotics in medicine unit. Methods: The study was prospective and based on the daily review of patient records for 2 months (June, July) of study period, including all the inpatients of medicine unit 1 receiving antimicrobials. The general information of the patients, infection, a...

  7. Reasons for discarding whole blood and its components in a tertiary care teaching hospital blood bank in South India

    OpenAIRE

    Suresh B; Sreedhar Babu KV; Arun R; Chandra Mouli P; Jothibai DS

    2015-01-01

    Introduction: Each unit of blood is precious and has to be utilized properly with minimal discards. The aim of this study was to find out the reasons for discarding blood and blood components. Materials and Methods: We retrospectively studied all whole blood and blood components collected during January 2013 to June 2014 at our tertiary care teaching hospital blood bank in South India. Results: Of the 5261 whole blood bags, 298 (5.7%) were discarded. Of these, 146 (49%) were discarded b...

  8. Anxiety among people living with HIV/AIDS on antiretroviral treatment attending tertiary care hospitals in Lucknow, Uttar Pradesh, India

    OpenAIRE

    Mukesh Shukla; Monika Agarwal,; Jai Vir Singh; Anand Kumar Srivastava

    2016-01-01

    Background: One of the major health challenges faced by India is the rapid growth of HIV/AIDS and its impact upon human life. Co-morbidities like anxiety are often overlooked while providing ART services to HIV/AIDS patients. Therefore the present study was conducted to assess the anxiety and associated factors among PLHA (People Living with HIV/AIDS) on antiretroviral treatment attending tertiary care hospitals in Lucknow. Methods: Hospital and #8209;based cross-sectional study was conduc...

  9. A cross-sectional evaluation of computer literacy among medical students at a tertiary care teaching hospital in Mumbai (Bombay)

    OpenAIRE

    T S Panchabhai; N S Dangayach; Mehta, V S; C V Patankar; N. N. Rege

    2011-01-01

    Background: Computer usage capabilities of medical students for introduction of computer-aided learning have not been adequately assessed. Aim: Cross-sectional study to evaluate computer literacy among medical students. Settings and Design: Tertiary care teaching hospital in Mumbai, India. Materials and Methods: Participants were administered a 52-question questionnaire, designed to study their background, computer resources, computer usage, activities enhancing computer skills, and attitudes...

  10. Assessment of WHO/INRUD core drug use indicators in two tertiary care hospitals of Bahawalpur, Punjab, Pakistan

    OpenAIRE

    Atif, Muhammad; Sarwar, Muhammad Rehan; Azeem, Muhammad; Umer, Danial; Rauf, Abdul; Rasool, Arslan; Ahsan, Muhammad; Scahill, Shane

    2016-01-01

    Background Medicines are a main therapeutic intervention provided within hospitals and their proper use in the outpatient setting is important for patients and the community. The objective of this study was to evaluate drug use patterns in the outpatient departments (OPDs) of two tertiary care hospitals (Bahawal Victoria Hospital and Civil Hospital) in the Bahawalpur district of the Punjab province of Pakistan by employing the standard World Health Organization/International Network of Ration...

  11. Prescription audit study in a tertiary care hospital using the anatomical therapeutic chemical and defined daily dose classification concept

    Directory of Open Access Journals (Sweden)

    Ajay Kumar Gupta

    2014-10-01

    Conclusions: This study was undertaken in a government tertiary care hospital which gives insight into the day to day functioning status of our health care delivery system. It is an opportunity on self-assessment in further improving the health care delivery by implementing measures which economizes on scarce health care budget as well as minimizing the common prescription errors. [Int J Basic Clin Pharmacol 2014; 3(5.000: 889-901

  12. A descriptive study on evaluation of bio-medical waste management in a tertiary care public hospital of North India

    OpenAIRE

    Kumar, Rajiv; Gupta, Anil Kumar; Aggarwal, Arun Kumar; Kumar, Ashok

    2014-01-01

    Background Proper management of Biomedical waste (BMW) generated in a healthcare facility is one of the most important functions of a healthcare worker (HCW) as its improper management not only poses risk to human beings and environment, but may also invite legal action against HCW as well as hospital administration. This study was carried out to evaluate quality of BMW management in 1100-bedded hospital attached to a tertiary care public institute in North India. Methods A checklist, includi...

  13. Study of prescribing pattern of topical corticosteroids in dermatology out patients department in a tertiary care hospital in India

    OpenAIRE

    Nerurkar, Rajan P.; Manish R. Kokane; Manthan Nikesh Mehta

    2016-01-01

    Background: The selection of rational yet most effective treatment is an art to be learnt by most physicians. The advent of topical glucocorticoids has changed the way inflammatory dermatological conditions are managed. However, there is a constant need to keep a check on these prescriptions for their rationality. The present study was done to review the prescribing pattern of topical corticosteroids in dermatology outpatients at a tertiary care hospital. Methods: This was a prospective ob...

  14. Clinicopathological correlates of primary central nervous system lymphoma: Experience from a tertiary care center in South India

    Directory of Open Access Journals (Sweden)

    Bimal Patel

    2015-01-01

    Full Text Available Background: Primary central nervous system lymphomas (PCNSL constitute a rare group of extranodal non-Hodgkin′s lymphomas (NHLs. Aim: To study the clinical and immunophenotypic profile of patients with a PCNSL who presented between the years 2000 and 2013 in a tertiary care center in South India. Materials and Methods: This was a retrospective study. Demographic and clinical data were obtained from the clinical case records. Inclusion criteria: Cases of PCNSL involving brain. Exclusion criteria: Cases of PCNSL involving the spinal cord, meninges and orbit as well as intravascular large B-cell lymphoma, lymphomas with evidence of systemic disease or secondary lymphomas. Archived slides and tissue blocks were retrieved. All cases had hematoxylin and eosin stained sections and immunohistochemistry for CD20, CD3, and MIB-1. Additional immunohistochemistry was performed for CD10, BCL6, and MUM1 on paraffin blocks with sufficient tissue. Results: There were a total of 73 cases with the mean age of presentation being 45.9 years (range 8-71 years and with a male predominance (male: female (M:F = 2.3:1. Headache was the commonest presenting complaint. The mean duration of symptoms was 10.6 weeks. All patients were immunocompetent. Most tumors were supratentorial in location. Out of 73 cases, 70 presented with a diffuse large B-cell lymphoma (DLBCL, two with a Burkitt′s lymphoma, and one with a lymphomatoid granulomatosis. Only 51 of the DLBCL cases had sufficient tissue for additional studies. Non-germinal center was the most common phenotype seen in 65.7% (33/51 of cases. Germinal center B-cell (GCB phenotype was seen in 18/51 cases (34.3%. Conclusion: DLBCL constituted the majority of PCNSLs and although non-germinal center was the predominant phenotype, more than a third of the cases were of the GCB phenotype. As the germinal center phenotype is known to have a better prognosis, further studies to explore its relevance in the Asian population are

  15. HBV and HIV co-infection: Prevalence and clinical outcomes in tertiary care hospital Malaysia.

    Science.gov (United States)

    Akhtar, Ali; Khan, Amer Hayat; Sulaiman, Syed Azhar Syed; Soo, Chow Ting; Khan, Kashifullah

    2016-03-01

    According to WHO, Malaysia has been classified as a concentrated epidemic country due to progression of HIV infection in the population of injecting drug users. The main objectives of current study are to determine the prevalence of HBV among HIV-positive individuals in a tertiary care hospital of Malaysia and to assess the predictors involved in the outcomes of HIV-HBV co-infected patients. A retrospective, cross-sectional study is conducted at Hospital Palau Pinang, Malaysia. The collection of socio-demographic data as well as clinical data is done with the help of data collection form. Data were analyzed after putting the collected values of required data by using statistical software SPSS version 20.0 and P > 0.05 is considered as significant. Results show that the overall prevalence of HBV was 86 (13%) including 495 (74.5%) males and 169 (25.5%) females among a total of 664 HIV-infected patients. It was observed that there is a high prevalence of HIV-HBV co-infection in males 76 (11.4%) as compared to females 10 (1.5%) (P = 0.002). The median age of the study population was 39 years. The statistical significant risk factors involved in the outcomes of HIV-HBV co-infected patients were observed in the variables of gender, age groups, and injecting drug users. The findings of the present study shows that the prevalence of HBV infection among HIV-positive patients was 13% and the risk factors involved in the outcomes of HIV-HBV co-infected patients were gender, age, and intravenous drug users. © 2015 Wiley Periodicals, Inc.

  16. Plasmablastic lymphoma in HIV patients: Experience at a tertiary care hospital in eastern India

    Directory of Open Access Journals (Sweden)

    S Bishnu

    2015-01-01

    Full Text Available BACKGROUND: Plasmablastic lymphoma (PBL, a rare non-Hodgkin's lymphoma (NHL variant specifically associated with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS, expresses well-differentiated plasma cell markers like CD138, bright CD38, and MUM1; but not conventional B-cell markers. It occurs at unusual sites like oral cavity and orbit, and has poor survival rates. AIMS: This study serves as a review of a clinical experience with six HIV patients with PBL and observes the spectrum of clinical presentations, histopathologies, and 1-year outcomes in PBL patients. MATERIALS AND METHODS: This review of six PBL patients was conducted at a tertiary care hospital in eastern India using relevant radiological, histopathogical, and immunohistological studies. RESULTS: Incidence of PBL among HIV patients was 0.58% (6/1,028. Mean CD4 count at presentation was 125.5 ± 71.1 cells/μL. Sites of involvement included pleura, lung parenchyma, suprarenal gland, pelvic cavity, and retroorbital space (one each. Immunohistopathology of biopsied sample in each patient revealed PBL (positive plasma cell markers MUM-1/IRF4, CD38, and CD138/syndecan; and negative of B-cell markers CD3, CD20, and CD30. Three (60% were positive for Epstein Barr virus (EBV immunoglobulin G (IgG. Five surviving patients received CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone regimen and attained partial remission (PR after six cycles. Subsequently, three patients were started on EPOCH (etoposide, cyclophosphamide, doxorubicin, vincristine, prednisone therapy; two attained near total regression after 6 months (four cycles. Overall, four patients remained alive with good quality of life at the end of 1 year of follow-up. CONCLUSION: PBL in HIV occurs at unusual sites with varying aggressivity. This study is too small to comment on the long-term outcomes of PBL in HIV; however, coadministration of antiretroviral therapy (ART with standard chemotherapy

  17. Clinico-microbiological study of dermatophytosis in a tertiary-care hospital in North Karnataka

    Directory of Open Access Journals (Sweden)

    Tonita M Noronha

    2016-01-01

    Full Text Available Context: The dermatophytoses constitute a group of superficial fungal infections of keratinized tissues, namely, the epidermis, hair, and nails. The distribution and frequency of dermatophytosis and their etiologic agents vary according to the geographic region studied, the socio-economic level of the population, the time of study, the climatic variations, the presence of domestic animals, and age. Aims: The present study was undertaken to assess the clinical profile of dermatophytic infections and to identify the causative fungal species in the various clinical presentations. Settings and Design: This was a hospital-based observational study. Materials and Methods: One hundred and fifty clinically suspected cases of dermatophytosis attending the outpatient department of a tertiary care hospital were included in the study. History was taken, general physical and cutaneous examination was done and details of skin lesions noted. Direct microscopy in 10% KOH (40% KOH for nail and fungal culture on SDA with 0.05% chloramphenicol and 0.5% cycloheximide was done in every case. Statistical Analysis Used: Statistical analysis was done using SPSS 17.0 software. Chi-square test and contingency coefficient test were used as significant tests for analysis. Results: Out of 150 patients studied, majority belonged to the age group of 21–30 years (22.7%. Male-to-female ratio was 1.63:1. Tinea corporis (24.7% was the most common clinical type observed. The overall positivity by culture was 40% and by direct microscopy was 59.3%. Trichophyton mentagrophytes was the predominant species isolated (48.3%. Conclusions: The present study reveals the changing trend in the prevalence of dermatophyte species in this part of Karnataka.

  18. Restricted Parenteral Antibiotics Usage Policy in a Tertiary Care Teaching Hospital in India.

    Science.gov (United States)

    Tiwari, Smita Anand; Ghongane, Balasheb Baburao; Daswani, Bharti Ramchandra; Dabhade, Sangeeta Sanjay

    2017-05-01

    The indoor hospital use of antibiotic irrationally has been a growing concern in the recent past. For the patients and providers of health care services this kind of drug consumption account for a major chunk of the budget. To assess the outcome of restriction on the use of parenteral antibiotics with respect to their utilization and monetary benefits, in a tertiary care hospital in India. Data details were collected regarding drug utilization two months before and after restriction respectively. A total 1605 patient records assessed. Drug utilization was expressed as DDD/100 patient bed days. Use of Carbapenems were restricted to culture positive cases only. Antibiotics started for patients as per clinical judgment were issued for only five days. Culture sensitivity reports verified physically on a special indent form, before every antibiotic issued thereafter. Piperacillin-tazobactum (DDD/100 BD 1.72 before and 1.29 after restrictions) was the commonly used antibiotic. Considering values expressed in DDD/100 BD before and after restriction respectively, substantial decrease in consumption of antibiotics like Imipenem- Cilastin (0.22 to 0.16), meropenem (0.30 to 0.09), piperacillin-tazobactum (1.72 to 1.29), teicoplanin (0.24 to 0.05) and vancomycin (0.69 to 0.40) was observed. An increase in consumption of amoxicillin-clavulanic acid (0.90 to 1.04) and clarithromycin (0.44 to 0.55) noted, pointing to a shift in antibiotic use. Restriction decreased expenditure burden on these antibiotics by INR 1,45,911 (17.31%). Restriction of antibiotics cuts down consumption and benefits hospital budget immensely.

  19. Fast Track Extubation In Adult Patients On Pump Open Heart Surgery At A Tertiary Care Hospital.

    Science.gov (United States)

    Akhtar, Mohammad Irfan; Sharif, Hasanat; Hamid, Mohammad; Samad, Khalid; Khan, Fazal Hameed

    2016-01-01

    Fast-track cardiac surgery programs have been established as the standard of cardiac surgical care. Studies have shown that early extubation in elective cardiac surgery patients, including coronary and non-coronary open-heart surgery patients does not increase perioperative morbidity and mortality. The objective of this observational study was to determine the success and failure profile of fast track extubation (FTE) practice in adult open-heart surgical patients. The study was conducted at cardiac operating room and Cardiac Intensive Care Unit (CICU) of a tertiary care hospital for a period of nine months, i.e., from Oct 2014 to June-2015. All on pump elective adult cardiac surgery patients including isolated CABG, isolated Valve replacements, combined procedures and aortic root replacements were enrolled in the study. Standardized anesthetic technique was adopted. Surgical and bypass techniques were tailored according to the procedure. Success of Fast track extubation was defined as extubation within 6 hours of arrival in CICU. A total of 290 patients were recruited. The average age of the patients was 56.3±10.5 years. There were 77.6% male and 22.4% female patients. Overall success rate was 51.9% and failure rate was 48.1%. The peri-operative renal insufficiency, cross clamp time and CICU stay (hours) were significantly lower in success group. Re-intubation rate was 0.74%. The perioperative parameters were significantly better in success group and the safety was also demonstrated in the patients who were fast tracked successfully. To implement the practice in its full capacity and benefit, a fast track protocol needs to be devised to standardize the current practices and to disseminate the strategy among junior anaesthesiologists, perfusionists and nursing staff.

  20. Prevalence of glucose intolerance in rheumatoid arthritis patients at a tertiary care centre in Haryana.

    Science.gov (United States)

    Rajput, Rajesh; Dangi, Anoop; Singh, Harpreet

    2017-07-20

    Recent studies have shown increasing prevalence of dysglycemia in rheumatoid arthritis (RA) patients. The present study was planned to study the prevalence of pre-diabetes and diabetes in RA patients from a tertiary care centre in Haryana, India. 150 diagnosed cases of rheumatoid arthritis which were on follow up in Rheumatology clinic from last one year and equal number of age, sex matched controls were recruited for the study. FPG, 2h plasma glucose level after 75g oral glucose tolerance test and HbA1c were estimated in all the subjects. In RA patients c-reactive protein (CRP), erythrocyte sedimentation rate (ESR), rheumatoid factor (RF) and Anti-cyclic citrullinated (Anti CCP) antibodies were also measured and disease activity was assessed by using (DAS28 joint counts) and CDAI. Patients with RA had statistically significant higher waist circumference, hip circumference and BMI as compared to control group. Prevalence of glucose intolerance in RA patients and control group was 14.67% and 6.67% respectively which was statistically significant (p=0.025). The prevalence of pre-diabetes was in RA group was not significant statistically. There was higher disease activity in glucose intolerant (GI) RA cases as compared to normal glucose tolerant (NGT) RA cases. The most commonly used drug combination among RA patients was MTX+HCQ+SAAZ (49 patients, 32.67%). Maximum glucose intolerance was observed in patients who were on Non-HCQ drug combinations. There is elevated prevalence of glucose intolerance among RA patients that is related to high disease activity, visceral adiposity and drugs usage. Copyright © 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved.

  1. Coeliac disease in patients with short stature: A tertiary care centre experience.

    Science.gov (United States)

    Singh, Prashant; Sharma, Piyush Kumar; Agnihotri, Abhishek; Jyotsna, Viveka P; Das, Prasenjit; Gupta, Siddhartha Datta; Makharia, Govind K; Khadgawat, Rajesh

    2015-01-01

    We aimed to determine the prevalence of coeliac disease among children with short stature at a tertiary care centre and to define the predictors for coeliac disease, if any, in them. In this retrospective study, we reviewed the case records of children and adolescents with growth retardation attending the Paediatric Endocrinology Clinic from January 2008 to June 2011. All patients underwent the multi-tier stratified diagnostic protocol for complete evaluation of short stature. Coeliac disease was screened using IgA-anti-tissue transglutaminase antibody. The diagnosis of coeliac disease was made on the basis of the modified European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) criteria. Of 432 patients (238 boys) who presented with short stature, 72 (16.7%) had physiological, while 360 (83.3%) had pathological causes. Endocrine causes were growth hormone deficiency (86 patients, 19.9%), hypopituitarism (31, 7.2%), hypothyroidism (22, 5.1%) and others (7, 1.6%). The systemic causes were: coeliac disease (47, 10.9%), haematological diseases (14, 3.2%), renal diseases (11, 2.5%) and others (24, 5.6%). Chronic diarrhoea (OR 15.7, 95% CI 7.8-31.5) and anaemia (OR 4.9, 95% CI 1.9-12.7]) were significant predictors for coeliac disease in patients with short stature. There was a definite response to gluten-free diet in them and the mean (SD) growth velocity measured over at least 6 months of gluten-free diet was 8.1 (3.0) cm/year. Nearly 11% of patients presenting with short stature have coeliac disease. In these patients chronic diarrhoea and anaemia were significant predictors of coeliac disease. Copyright 2015, NMJI.

  2. Prevalence of needle stick injuries among nurses in a tertiary care hospital and their immediate response

    Directory of Open Access Journals (Sweden)

    Jalina Laishram

    2013-10-01

    Full Text Available Context: Needle stick injuries (NSIs are wounds caused by needles in health care setup that accidentally puncture the skin and may result in exposure to blood or other body fluids. NSI is a major occupational health and safety issue faced by health care professionals globally. Nurses have the highest rate of needle stick injury among health care workers. Aims: To determine the prevalence of needle stick injuries (NSIs among the nurses, to determine the association between NSI and selected variables like age, marital status, years in service, educational qualification and to assess the measures undertaken by the respondents after the NSI. Materials and Methods: A cross sectional study was conducted in a tertiary care hospital in Imphal among nurses from October to November 2011. Self-administered questionnaire was used for data collection. Descriptive statistics were used. Chi square test was used to see the association and a P-value of <0.05 was taken as significant. Results: The prevalence of NSI within the last one year was found to be 28.1% (N=86. Of them 49(46.5% had two or more NSIs in the last one year. More than half of the NSIs occurred during intravenous (IV injection, 16.3% during intramuscular (IM injection and only 1.6% during recapping of the needle. Eighty three (96% of them did not were gloves during NSI. Forty (46.5% of them washed the injured part with water and soap as immediate measure. Thirty seven (43% did not report it. Though 251(82% knew about the free availability of Post Exposure Prophylaxis (PEP in the hospital, only 5(5.7% took PEP. Conclusion: Needle stick injury is an important occupational health hazard among the nurses. Reporting to the concerned authorities, screening after NSI and promotion of safety measures should be greatly encouraged.

  3. Platelet audit: Assessment and utilization of this precious resource from a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Saluja K

    2007-01-01

    Full Text Available Background: To assess the appropriate utilization of platelet transfusions [random donor platelets (RDP and single donor platelets (SDP]; a six-month retrospective audit was carried out in a tertiary care hospital. Materials and Methods: A six-month retrospective platelet audit was carried out from May to October 2005 to estimate its preparation, appropriate utilization and wastage rate. Patient′s demographics, transfusion triggers and episodes and ABO and Rh (D group specific or non-group specific transfusions were also assessed. Results: About 5525 units of platelets [PRP-PC, 3,813 (69%; BC-PC, 983 (17.8%; PRP, 648 (11.7% and SDP 81 (1.5%] were prepared and transfused to 853 patients (RDP to 814 patients and SDP to 39 patients in 2,093 transfusion episodes. Adult and pediatric hemato-oncology were the main user specialties utilizing 39.1 and 87.6% of the RDPs and SDPs prepared. Of the patients receiving RDPs, 95% were transfused ABO and Rh (D group specific platelets whereas 100% SDPs transfusions were of group specific platelets. 88% of prophylactic platelet transfusions were appropriate as per the recommended BCSH guidelines. However, 12% of the prophylactic platelets were transfused inappropriately in cardiopulmonary bypass (CPB surgeries with normal platelet counts and no evidence of bleeding related to platelets. Out of 5,444 RDPs prepared 1,585 (29.11% units were not utilized. Conclusions: Regular audit of blood and blood components is a must so that necessary remedial measures can be taken to maximize appropriate and judicious utilization of each component.

  4. Antibiotic prescribing in various clinical departments in a tertiary care teaching hospital in northern India.

    Science.gov (United States)

    Abhijit, Kumar; Jain, Pushpawati; Upadhyaya, Prerna; Jain, Shipra

    2014-05-01

    Antibiotic resistance is not only a problem for the individual patient; it also reduces the effectiveness of established treatment and has become a major threat to public health by increasing the complexity and cost of treatment and reducing the probability of a successful outcome. A prospective cross sectional study was carried out with the aim of identifying prescription pattern of antibiotics in a tertiary care teaching hospital in Northern India. A total of 300 prescriptions were collected, collated and analysed from the indoor patients of MG hospital, Jaipur, India from the department of Medicine, Surgery and Orthopaedics. The prescribing and dispensing details of antibiotics from each prescription were recorded in the tabular form as mentioned in Data Acquisition form. Comparison of antibiotic prescribing practices among all the three departments was made by using Percentage method. Majority of prescriptions (51%) with single drug was prescribed in Medicine department, followed by 16% in surgery and only 2% in Orthopaedics. Prescriptions with 3 drugs were prescribed mostly in Orthopaedics (66%) followed by 46% in Surgery and 10% in Medicine. 51% prescriptions in Orthopaedics department were of Ceftriaxone+ Sulbactam+ Amikacin. Thirty four percent prescriptions in Medicine department were of Ceftriaxone. 18% prescriptions in Surgery department were of Ceftriaxone+ Sulbactam+ Tobramycin. This study clearly highlights the practice of Poly-Pharmacy and injudicious usage of antibiotics in hospital settings. The Government of India is planning to revise the antibiotic policy issued in 2011 and put a ban on over the counter availability of third generation antibiotics. General public awareness and sensitization of doctors and revision of clinical drug policy is the need of the hour to bring the changes at all possible level for the longterm and better clinical outcome in medical practice.

  5. PREVALENCE AND ASSOCIATED RISK FACTORS OF ANAEMIA IN PREGNANCY IN A TERTIARY CARE RURAL HOSPITAL

    Directory of Open Access Journals (Sweden)

    Sridevi

    2015-08-01

    Full Text Available Anaemia is a global public health problem particularly in developing countries. A major contributory factor to maternal and fetal mortality and morbidity. AIM AND OBJECTIVES : To find the prevalence and seve rity of anaemia and evaluate the multiple causal factors among pregnant women. MATERIALS AND METHODS : A cross sectional study was conducted in pregnant women attending outpatient department of Obstetrics and Gynaecology from J uly 1 st 2013 to J une 30 th 2015 Rajah Muthiah Medical College and Hospital , a tertiary care rural hospital in C hidambaram . A pre - designed Performa was utilized to obtain relevant information about demographic and patients’ obstetric characteristics. They were screened for anaemia using cyanmethemoglobin method during their first antenatal visit. RESULTS : The prevalence of anaemia was found to be (1202/1434 83.8% of which mild 27.2%, moderate 60.3% and severe was 12.5% ( A ccording to WHO criteria based on Hb level. Majority were between 20 - 25yrs of age (87861.2% in third trimester (95666.7% were unbooked (91263.5%, illiterate (67747.3% and belonged to low socioeconomic class (109276.1%. Multiparity (92864.7%, pregnancy spacing interval less than 1yr (38841.8%, poor nutrition (6724 6.8% were the most common risk factors. CONCLUSION : In our study, the prevalence rate is still very high in spite of the various preventive strategies as awareness is less among the population . Major factors responsible were multiparity, illiteracy, povert y, late antenatal booking, inadequate spacing between pregnancies. Adequate antenatal care and proper education helps to increase the awareness.

  6. SURGICAL SITE INFECTION FOLLOWING LOWER SEGMENT CAESAREAN SECTION IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Nishi Roshini

    2016-03-01

    Full Text Available AIM OF THE STUDY To identify infection rates and risk factors associated with Surgical Site Infection (SSI following Caesarean Section. DESIGN OF THE STUDY Case control study. PLACE OF STUDY Academic Tertiary Care Obstetrics and Gynaecology Centre with 60 Beds. PATIENTS All women who delivered by caesarean section in Govt. Medical College, Thrissur, during 1st June 2010 to 30th September 2011. METHODS Wound infections were identified during hospital stay using the criteria of the Centres for Disease Control and Prevention, National Nosocomial Infections Surveillance System. A case control study of 50 patients with wound infection after Lower Segment Caesarean Section (LSCS was undertaken between 1st June 2010 and 30th September 2011. The control group comprised of 50 patients selected randomly from among those who had LSCS during the study period with no wound infection. The CDC definition describes three levels of SSI (Superficial incisional, Deep incisional and Organ or Space infection. Comparisons for categorical variables were performed using the X2 or Fisher exact test. Continuous variables were compared using the 2-tailed Student ‘t’ test and p 0.05 was considered significant. RESULTS The overall wound infection rate in the study was 3.5%, (50 among 1410 Lower Transverse CS. Obesity, Hypertension and Poorly Controlled Diabetes are associated with significant risk for development of SSI. The commonest presentation of SSI in LSCS was fever 40 (80% followed by local pain and induration 25 (50%. SSI was detected on 6±3 days. Average duration of hospital stay among SSI was 22.78±10.2 days. Staphylococcus aureus was the commonest pathogen for SSI in our series. The increase in the presence of (Methicillin Resistant Staphylococcus Aureus MRSA (20.83% might alter the pattern of prophylactic antibiotic given preoperatively in the near future. CONCLUSIONS Increased incidence of drug resistant organisms needs proper attention and strategies for

  7. Adverse drug reactions monitoring of psychotropic drugs: a tertiary care centre study

    Directory of Open Access Journals (Sweden)

    Hemendra Singh

    2017-06-01

    Full Text Available Background: Many new psychotropic drugs/ agents have been developed and found to be effective in the treatment of psychiatric disorders. However, these drugs also exhibit adverse drug reactions (ADRs which may affect compliance in psychiatric patients. Hence the present study was aimed at monitoring and assessing ADRs caused by psychotropic drugs. Methods: A hospital based prospective observational study was carried out in the psychiatry outpatient department of a tertiary care teaching hospital for the duration of six months. Two hundred and two patients were included in the study and ADRs were documented using a predesigned data collection form. The causality assessment was carried out as per the criteria of both the World Health Organization- Uppsala Monitoring Centre (WHO-UMC and Naranjo scale. Severity and predictability assessment of ADRs were also performed. Results: A total of 106 ADRs were observed during the study period with majority of them occurring in 25-35 years of age group (40.56%. Weight gain (18.86% followed by sedation (16.03% and insomnia (11.32% were found to be the commonest ADRs. Risperidone (19.8% and escitalopram (12.3% were the drugs responsible for majority of the ADRs. Causality assessment showed that most of ADRs were possible and probable. 94.33% of ADRs were found to be mild and 89% of them were predictable. Conclusion: A wide range of ADRs affecting central nervous and metabolic systems were reported with psychotropic drugs. The study findings necessitate the need for an active pharmacovigilance programme for the safe and effective use of psychotropics.

  8. THE STUDY OF BACTERIAL POPULATION IN AIR SAMPLES OF A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Partha Sarathi

    2014-06-01

    Full Text Available CONTEXT: The bacterial load in different air samples from environment of most hospitals remained undetermined. Any direct correlation between such bacterial load and the nosocomial infection are also lacking. Only higher bacterial load in air of a particular hospital environment may indicate higher risk of airborne cross infections. AIMS: The study is to determine the bacterial presence per unit volume of air, and the factors influencing the bioload. SETTINGS AND DESIGN: The air samples were collected from different locations of our tertiary care hospital, during Jul 2011 to June 2012 with information like room space per patient, number of daily average visitors, system of air circulation and house-keeping quality. METHODS: A specific volume of air was impacted on a plastic strips containing nutrient agar by air sampler La200, Hi-Media. Following incubation for 24 hour bacterial colonies were counted and organisms were identified up to genus level. RESULTS: Mostly Gram positive cocci followed by Gram positive and a few Gram negative bacilli were detected. The highest bacterial load was found in general outdoor premises (2456 CFU/cm, followed by some extremely crowded general wards (573 CFU/cm. The lowest count of such was found in nursery area (94 CFU/cm, where special emphasis was given on cleanliness, room ventilation and visitor’s restriction. Similarly variations in bacterial loads were also noted in different times in a day and in different seasons in a year. The bioload in all tested samples were within permissible limits. CONCLUSIONS: By appropriate measures the aerobic bacterial load in hospital environment can be restricted within optimal level

  9. [Ambient noise comparison in 2 intensive care units in a tertiary care center].

    Science.gov (United States)

    Ornelas-Aguirre, José Manuel; Zárate-Coronado, Olivia; Gaxiola-González, Fabiola; Neyoy-Sombra, Venigna

    2017-04-03

    The World Health Organization has established a maximum noise level of 40 decibels (dB) for an intensive care unit. The aim of this study was to compare the noise level in 2 different intensive care units at a tertiary care center. In an cross-sectional design, the maximum noise level was analyzed within the intensive coronary care unit and intensive care unit with a digital meter. A measurement in 4 different points of each room with 5minute intervals for a period of 60minutes were performed at 7:30, 14:30 and 20:30. Average of the observations were compared with descriptive statistics and Mann-Whitney U. An analysis with Kruskal-Wallis test was performed to average noise. The noise observed in the intensive care unit had an average of 64.77±3.33dB (P=.08); something analogous happened in the coronary intensive care room with an average of 60.20±1.58dB (P=.129). 25% or more of the measurements exceeded up to 20 points the level recommended by the World Health Organization. Noise levels in intensive care wards that were studied exceed the maximum recommended level for a hospital. It is necessary to design and implement actions for greater participation of health personnel in the reduction of ambient noise. Copyright © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

  10. Rising trends of neurocysticercosis: A serological report from tertiary-care hospital in South India

    Science.gov (United States)

    Thamilselvan, Piriyatharisini; Muthuraman, Krishna Raj; Mandal, Jharna; Parija, Subash Chandra

    2016-01-01

    Introduction: Taenia solium is a common two-host parasitic cestode, residing in both humans (definitive) and pigs (intermediate). Invasion of this parasitic cyst into central nervous system leads to a condition known as neurocysticercosis (NCC). The World Health Organization (WHO) considers NCC as one of the “most neglected” tropical zoonotic diseases. The disease is presented with pleomorphic clinical manifestations, of which epilepsy is the most common. Diagnosis of NCC is carried out by serological tests and imaging methods. Only a few studies from Andhra Pradesh, Kerala, Tamil Nadu, and Pondicherry are available regarding the seropositive levels of NCC in South India. Materials and Methods: A descriptive analysis was carried out on NCC suspected patients attending outpatient or inpatient department of different clinics majorly from neurology, medicine, pediatrics, ophthalmology, and skin at Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, a tertiary care hospital in South India. A total of 391 patient samples (either serum or cerebrospinal fluid or urine) for 5 years from January 2011 to December 2015 were taken into the study. Serological investigations such as enzyme-linked immunosorbent assay and enzyme-linked immunoelectro transfer blot were performed for assessing the seropositivity levels of NCC. Results: The overall seropositive cases of NCC in the study population were found to be 32.5% of which positive male cases (59.1%) exceeding females (40.9%). The frequency of adult positive cases (77.2%) was more than that of pediatrics cases (22.8%) with an average of 30.9 years of age. Conclusions: NCC seropositive levels show an increasing trend with the study period. This necessitates a proper attention to the unnoticed spread of the parasitic disease, which affects the quality of life in the community. Quality screening and diagnostic strategy should be implied along with proper awareness for preventive measure practices

  11. Fucntional and Radiological Outcome of Surgical Management of Acetabular Fractures in Tertiary Care Hospital

    Science.gov (United States)

    Taufiq, Intikhab; Najjad, Muhammad Kazim Raheem; Khan, Naveed; Zia, Osama Bin

    2016-01-01

    Purpose Acetabular fractures are mainly caused by trauma and the incidence is rising in developing countries. Initially these fractures were managed conservatively, due to lack of specialized and dedicated acetabulum surgery centres. Our aim is to study the radiological and functional outcomes of surgical management of acetabular fractures in tertiary care hospital. Materials and Methods Total 50 patients were enrolled. The patients with acetabular fractures were enrolled between the years 2012 to 2014. Patients were evaluated clinically with Harris hip score (HHS) and radiologically with Matta outcome grading. The factors examined include age, gender, fracture pattern, time between injury and surgery, initial displacement and quality of reduction on the final outcome. Results There were 34 males and 16 females. Mean age was 44.20±11.65 years while mean duration of stay was 9.28±2.36 days. Duration of follow-up was 24 months. Most common mechanism of injury was motor vehicle accident (n=37, 74.0%). Open reduction and internal fixation of fractures were performed using reconstruction plates. Mean HHS at 24 months was 82.36±8.55. The clinical outcome was acceptable (excellent or good) in 35 (70.0%) cases and not acceptable (fair or poor) in 15 (30.0%) cases. The radiological outcome was anatomical in 39 (78.0%) cases, congruent in 5 (10.0%) cases, incongruent in 6 (12.0%) cases. Conclusion Study results indicated that mechanism of injury, time between injury and surgery, initial degree of displacement and quality of reduction had significant effect on functional as well as radiological outcome. PMID:28097111

  12. HIV counseling and testing in a tertiary care hospital in Ganjam district, Odisha, India

    Directory of Open Access Journals (Sweden)

    M Dash

    2013-01-01

    Full Text Available Background: Human immunodeficiency virus (HIV counseling and testing (HCT conducted at integrated counseling and testing centers (ICTCs is an entry point, cost-effective intervention in preventing transmission of HIV. Objectives: To study the prevalence of HIV among ICTC attendees, sociodemographic characteristics, and risk behaviors of HIV-seropositive clients. Materials and Methods: It was hospital record-based cross-sectional study of 26,518 registered ICTC clients at a tertiary care hospital in Ganjam district, Odisha, India over a 4-year period from January 2009 to September 2012. Results: A total of 1732 (7.5% out of 22,897 who were tested for HIV were seropositive. Among HIV-seropositives, 1138 (65.7% were males, while 594 (34.3% were females. Majority (88.3% of seropositives were between the age group of 15-49 years. Client-initiated HIV testing (12.1% was more seropositive compared to provider-initiated (2.9%. Among discordant couples, majority (95.5% were male partner/husband positive and female partner/wife negative. Positives were more amongst married, less educated, low socioeconomic status, and outmigrants (P<0.0001. Risk factors included heterosexual promiscuous (89.3%, parent-to-child transmission 5.8%, unknown 3.1%, infected blood transfusion 0.8%, homosexual 0.5%, and infected needles (0.5%. Conclusions: There is need to encourage activities that promote HCT in all health facilities. This will increase the diagnosis of new HIV cases. The data generated in ICTC provide an important clue to understand the epidemiology in a particular geographic region and local planning for care and treatment of those infected with HIV and preventive strategies for those at risk especially married, young adults, and outmigrants to reduce new infections.

  13. A prospective study of mucormycosis in north India: experience from a tertiary care hospital.

    Science.gov (United States)

    Bala, Kiran; Chander, Jagdish; Handa, Uma; Punia, Rajpal Singh; Attri, Ashok Kumar

    2015-04-01

    Mucormycosis is an emerging angioinvasive infection caused by the ubiquitous filamentous fungi of the Order Mucorales and class of Mucormycetes. We conducted a prospective study of 38 patients who were diagnosed as having mucormycosis in a tertiary care hospital during January 2010 to June 2011. The cases were analyzed regarding the site of involvement, underlying disease and species of fungi isolated, antifungal susceptibility pattern of the isolates, and outcome of therapy. The mean age of the patients was 40.43 years, with 72% male. Rhino-orbital mucormycosis (61.5%) was the most common presentation followed by cutaneous manifestations (31%), gastrointestinal symptoms (5%), and pulmonary (2.5%). Diabetes mellitus (56%) was the significant risk factor in rhino-orbito-cerebral presentation (OR = 7.55, P = 0.001). Among 23 culture isolates, Rhizopus arrhizus (37.5%) was the most common, followed by Apophysomyces variabilis (29.2%), Lichtheimia ramosa (16.7%), Rhizopus microsporus (4.2%), Rhizomucor pusillus (4.2%), and Apophysomyces elegans (4.2%). Rhizopus arrhizus was most commonly isolated from rhino-orbito-cerebral mucormycosis and Apophysomyces species were generally obtained from cutaneous mucormycosis. In vitro antifungal susceptibility showed that 16 isolates were sensitive to amphotericin B (MIC less than 1 μg/ml), while in contrast, all isolates were found to be resistant to voriconazole (MIC- 0.25 to >8), fluconazole (MIC > 32), flucytosine (MIC > 32). Treatment regimens included antifungal therapy, reversal of underlying predisposing risk factors, and surgical debridement. Combination of surgery and medical treatment with amphotericin B was significantly better (OR = 0.2, P < 0.04) than amphotericin B alone (61.5% vs. 10.3% patient survival). The awareness of fungal diseases amongst clinicians is required to decrease the fatal outcome of disease.

  14. COMPREHENSIVE STUDY OF ILEOSTOMY AT A TERTIARY CARE MEDICAL COLLEGE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Hanuman Singh

    2016-02-01

    Full Text Available BACKGROUND We are working at a tertiary care medical college hospital (Geetanjali Medical College Udaipur (Rajasthan India. Conducted a comprehensive study of ileostomy, its varied indications, types, post-operative morbidity and eventual closure of ileostomy. We also analyse all the different aetiopathologies and all surgical aspects associated with ileostomy. METHODS A total of 30 patients undergoing ileostomy for various causes were studied retrospective over a period of 2 yrs. Stomal and non-stomal related complications were analysed. Reversal of stoma usually performed after 8 weeks and complications of reversal were also recorded. RESULTS Typhoid perforation 9 cases (30% was the most common pathology, followed by blunt trauma abdomen 6 cases (20%, malignancy of colon/rectum 4 cases (13.33%, intestinal obstruction with perforated gangrenous ileum 3 cases (10%, perforated tubercular ileum 3 cases (10%, fulminating necrotic colitis 3 cases (10% and mesenteric vascular thrombosis with gangrenous ileum 2 cases (6.66% were observed. Wound sepsis, excessive effluent, skin excoriation, fluid and electrolyte imbalance and chest complication were the commonest; there were 2 cases (6.66% of minor anastomotic leak, 1 case (3.33% major leak with faecal fistula formation that healed over a period of time. One case (3.33% had a sequential surgical complication as fulminant septicemia, ARDS and multi-organ dysfunction, eventually succumbed in ICU on 30th day. CONCLUSION Ileostomy in various surgical situations has proved to be a life-saving act for the patients and a face saving measure for the surgeon; however, one has to accept the eventual morbidity that continues until an ileostomy closure accomplished.

  15. PREVALENCE OF THYROID DYSFUNCTION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS IN TERTIARY CARE CENTRE

    Directory of Open Access Journals (Sweden)

    Satyanarayana

    2014-04-01

    Full Text Available BACKGROUND: Diabetes mellitus (DM and thyroid dysfunction are the two most common endocrine disorders in clinical practice. The unrecognized thyroid dysfunction may adversely affect the metabolic control and add more risk to an already predisposing scenario for cardiovascular diseases. The objective of this study was to investigate the prevalence of thyroid dysfunction in patients with type 2 diabetes mellitus. OBJECTIVES: To study the prevalence of thyroid dysfunction in type 2 diabetes mellitus in tertiary care hospital. METHODS: This study was conducted in Department of General medicine, ESIC-MC & PGIMSR, Rajajinagar, Bangalore.100 type 2 diabetes patients and 100 non diabetes controls were included in the study. Fasting blood glucose, Glycosylated hemoglobin (HbA1c, triiodothyronine (T3, thyroxine (T4, thyroid stimulating hormone (TSH levels are measured both in case and control groups. RESULTS: Out of 100 patients studied 8 (4% patients had clinical hypothyroidism, 15 (7.5% had subclinical hypothyroidism, 3 (1.5% had clinical hyperthyroidism. Out of 100 controls studied 4 (2% had clinical hypothyroidism, 7 (3.5% had subclinical hypothyroidism, 1 (0.5% had clinical hyperthyroidism. In both the study groups no subjects had subclinical hyperthyroidism. Subclinical hypothyroidism is the frequently found thyroid dysfunction. CONCLUSION: Our study shows that prevalence of thyroid dysfunction is much higher in diabetes patients as compared to non-diabetes controls. We conclude that screening for thyroid dysfunction among patients with diabetes mellitus should be routinely performed considering the prevalence of new cases diagnosed and the possible aggravation the classical risk factors such as hypertension and dyslipidemia, arising from an undiagnosed thyroid dysfunction.

  16. Drug utilization study in the otorhinolaryngology department in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    S. A. Sridevi

    2013-06-01

    Full Text Available Background: Drug utilization is defined by the World Health Organization (WHO as the marketing, distribution, prescription, and use of drugs in society, with special emphasis on the resulting medical, social, and economic consequences. The aim of this study was to evaluate the pattern of prescription and then drug utilization in outpatient (OPD of the Department of Otolaryngology in a tertiary care teaching hospital. Methods: This was a retrospective study conducted at the A.C.S. medical college and hospital, Chennai for a period of 7 months. All the patients who attended the Ear Nose and Throat (ENT OPD were included. The total number who attended the OPD was 10,249 which include 6,956 new cases and 3313 old cases. Results: The antibacterials commonly used were β Lactams (56%, macrolides (14%, fluoroquinolones (12%, aminoglycosides (8%. Among the penicillin group, the commonest drug prescribed was a combination of amoxicillin and clavulanic acid (27%, in cephalosporins was cefixime + clavulanic acid (19%. Aminoglycosides include gentamycin in refractory cases. Fluoroquinolones include ciprofloxacin and levofloxacin. Others Drugs like antihistamines and mucolytics were prescribed in 27%, anti- ulcer drugs in 36% cases, analgesics in 33% cases and herbal medicines in 4%. The average number of drugs used in each prescription was 3.20. All the drugs were prescribed with brand names. The average cost per prescription per day for OPD patients is 37 Rupees. Conclusions: β Lactams were commonly used antibacterials in the otorhinolaryngology department. [Int J Basic Clin Pharmacol 2013; 2(3.000: 306-310

  17. Study of variables affecting critical value notification in a laboratory catering to tertiary care hospital.

    Science.gov (United States)

    Agarwal, Rachna; Chhillar, Neelam; Tripathi, Chandra B

    2015-01-01

    During post-analytical phase, critical value notification to responsible caregiver in a timely manner has potential to improve patient safety which requires cooperative efforts between laboratory personnel and caregivers. It is widely accepted by hospital accreditors that ineffective notification can lead to diagnostic errors that potentially harm patients and are preventable. The objective of the study was to assess the variables affecting critical value notification, their role in affecting it's quality and approaches to improve it. In the present study 1,187 critical values were analysed in the Clinical Chemistry Laboratory catering to tertiary care hospital for neuropsychiatric diseases. During 25 months of study period, we evaluated critical value notification with respect to clinical care area, caregiver to whom it was notified and timeliness of notification. During the study period (25 months), the laboratory obtained 1,279 critical values in clinical chemistry. The analytes most commonly notified were sodium and potassium (20.97 & 20.8 % of total critical results). Analysis of critical value notification versus area of care showed that critical value notification was high in ICU and emergency area followed by inpatients and 64.61 % critical values were notified between 30 and 120 min after receiving the samples. It was found that failure to notify the responsible caregiver in timely manner represent an important patient safety issue and may lead to diagnostic errors. The major area of concern are notification of critical value for outpatient samples, incompleteness of test requisition forms regarding illegible writing, lack of information of treating physician and location of test ordering and difficulty in contacting the responsible caregiver.

  18. Prescription pattern of anti-malarial drugs in a tertiary care hospital

    Institute of Scientific and Technical Information of China (English)

    Santoshkumar R Jeevangi; Manjunath S; Sharanabasappa M Awanti

    2010-01-01

    Objective:To evaluate the prescribing pattern of anti malarial drugs in a tertiary care hospital. Methods:A prospective cross-sectional study was conducted for 6 months of patients visiting in Basaveshwar Teaching and General Hospital, Gulbarga. Data were analyzed for various drug use indicators. Results: A total of 212 prescriptions were collected, with 136 (64.15%) male and 76 (35.85%) female. There were 128 (60.37%) Plasmodium vivax cases and 84 (39.63%) Plasmodium falciparum cases. All Plasmodium vivax cases were treated with chloroquine alone and among these 16 (12.5%) recieved radical treatment with primaquine along with chloroquine. Among 84 patients with Pasmodium falciparum, 40 patients received single drug such as quinine/mefloquinine/artesunate/arteether. Another 44 patients received multidrug regime like, quinine+artesunate (54.54%), quinine+mefloquine (27.27%) and quinine+arteether (18.18%). Chloroquine was not administered to any of the patients with Plasmodium falciparum malaria. The most common adverse effects with chloroquine were anorexia, nausea, vomiting and tinnitus in 9.37%of the cases. With quinine it was nausea and vomiting in 17.64%, tinnitus in 11.76%and hypoglycemia in 2.1%of cases. Conclusions: Our study found the perennial favorites like chloroquine for Plasmodium vivax and quinine for Plasmodium falciparum were the most effective drug. In the severe Plasmodium falciparum cases the artesunate derivatives and combination of artesunate with quinine/mefloquine were most effective with fewer incidences of side effects.

  19. Multidimensional health status of HIV-infected outpatients at a tertiary care center in north India

    Directory of Open Access Journals (Sweden)

    Wig Naveet

    2008-03-01

    Full Text Available Background : Quality of life (QOL scores inform researchers acquainted with such tools about patients′ perception of various domains of their health. The scores provide a useful denominator for clinical trials, especially in chronic diseases with therapeutic side effects, such as HIV. However, in clinical settings, there is a felt need of description of problems commonly perceived by patients. Aim : This study describes the multidimensional health-related issues of HIV-positive patients. Settings and Design : Cross-sectional design with convenient sampling was used to recruit 138 HIV-positive patients at the outpatient section of the Department of Medicine of a tertiary care hospital in north India. Materials and Methods : A structured questionnaire was used to collect information about health-related problems. Identified problems were assessed using a Likert scale for severity. Results : Out of the 20 assessed problems, the patients reported positive for an average of 12.01 ± 3.78 problems. The most prevalent problems were those related to emotions (98.6%, lack of energy (96.4%, and health perception (92.0%. The most distressing problems were ′feeling that health was not good′ (77.5% and ′health was bad′ (75.4%. The number of problems reported was significantly related to weight loss ( P = 0.006 and clinical category ( P = 0.023. A significant correlation was observed between weight loss and problems in social activities ( P < 0.001, pain ( P < 0.001; clinical class ( P < 0.001; tuberculosis, and problems in job and household work ( P = 0.002.Conclusion : Many patients have significant problems in dimensions other than physical. A physician′s awareness about these problems is important for a holistic patient management.

  20. Control of multidrug resistant bacteria in a tertiary care hospital in India

    Directory of Open Access Journals (Sweden)

    Jaggi Namita

    2012-06-01

    Full Text Available Abstract Background The objective of this study was to assess the impact of antimicrobial stewardship programs on the multidrug resistance patterns of bacterial isolates. The study comprised an initial retrospective analysis of multidrug resistance in bacterial isolates for one year (July 2007-June 2008 followed by prospective evaluation of the impact of Antimicrobial Stewardship programs on resistance for two years and nine months (July 2008-March 2011. Setting A 300-bed tertiary care private hospital in Gurgaon, Haryana (India Findings Methods Study Design • July 2007 to June 2008: Resistance patterns of bacterial isolates were studied. • July 2008: Phase I intervention programme Implementation of an antibiotic policy in the hospital. • July 2008 to June 2010: Assessment of the impact of the Phase I intervention programme. • July 2010 to March 2011: Phase II intervention programme: Formation and effective functioning of the antimicrobial stewardship committee. Statistical correlation of the Defined daily dose (DDD for prescribed drugs with the antimicrobial resistance of Gram negatives. Results Phase I intervention programme (July 2008 resulted in a decrease of 4.47% in ESBLs (E.coli and Klebsiella and a significant decrease of 40.8% in carbapenem-resistant Pseudomonas. Phase II intervention (July 2010 brought a significant reduction (24.7% in carbapenem-resistant Pseudomonas. However, the resistance in the other Gram negatives (E.coli, Klebsiella, and Acinetobacter rose and then stabilized. A positive correlation was observed in Pseudomonas and Acinetobacter with carbapenems and cefoperazone-sulbactam. Piperacillin-tazobactam showed a positive correlation with Acinetobacter only. E.coli and Klebsiella showed positive correlation with cefoparazone-sulbactam and piperacillin-tazobactam. Conclusion An antimicrobial stewardship programme with sustained and multifaceted efforts is essential to promote the judicious use of antibiotics.

  1. Histopathological evaluation of surgically treated adult renal tumors: Report from a tertiary care center in India

    Directory of Open Access Journals (Sweden)

    B Datta

    2016-01-01

    Full Text Available Background: This retrospective study was performed in a tertiary care center from India analyzing the histopathological reports and the clinical data of the adult patients admitted in this institute with a diagnosis of renal tumors and had undergone nephrectomy for the disease. Objective: The objective of this study is to determine the relative frequencies of different renal tumors in adults (above the age of 16 years and to analyze the histopathological characters of the tumors. Materials and Methods: In this retrospective study, we have analyzed the histopathology reports along with the demographic and clinical data of the adult patients who had undergone nephrectomy for renal tumors in our institute from January 2005 to December 2011. Results: A total 113 adult patients underwent tumor nephrectomy during the last 7 years in our institute. Mean age of the patients was 54.5 years (range 16-69 years. Male:Female ratio was 1.9:1. Out of 131 cases of adult renal tumors, 91.6% cases were malignant and 8.45 cases were benign tumors. Among the malignant tumors, renal cell carcinoma was the most common type. There were 2 cases of renal primitive neuroectodermal tumors and one case of renal myofibroblastoma in our series. Conclusion: The spectrum of adult renal tumors in this series is consistent with the other series of cases reported by different authors. Only few cases of the renal tumors were diagnosed incidentally among our patients which is just opposite to the rate of renal tumors diagnosed incidentally in the developed countries. Myofibroblastoma, a benign kidney tumor diagnosed in our series is probably the first reported case in the world.

  2. Current status of multidrug resistant tuberculosis in a tertiary care hospital of East Delhi

    Directory of Open Access Journals (Sweden)

    T Sagar

    2013-01-01

    Full Text Available Background and Objective: Multidrug resistant tuberculosis (MDR-TB is caused by infection due to Mycobacterium tuberculosis which is resistant to both isoniazid (INH and rifampicin (RIF. It is caused by selection of resistant mutant strains due to inadequate treatment and poor compliance. MDR-TB is a major public health problem as the treatment is complicated, cure rates are well below those for drug susceptible tuberculosis and patient remains infectious for months despite receiving the best available therapy. The drug susceptibility pattern of M. tuberculosis is essential for proper control of MDR-TB in every health care setting, hence the study was initiated with the aim of studying the prevalence of MDR-TB in patients attending a tertiary care hospital in east Delhi. Materials and Methods: Five hundred and forty-three pulmonary and extrapulmonary samples from suspected cases of tuberculosis received in the mycobacteriology laboratory from November 2009 through October 2010 were investigated for M. tuberculosis. All the samples were subjected to direct microscopic examination for demonstration of acid fast bacilli followed by culture on Lowenstein-Jensen (LJ medium to isolate M. tuberculosis. Identification was done by conventional biochemical methods. Drug susceptibility of isolated M. tuberculosis strains was done by conventional 1% proportion method followed by sequencing of RIF resistant isolates to detect mutations to confirm resistance. Results and Conclusions: M. tuberculosis was isolated from 75 out of 543 suspected cases of pulmonary/extrapulmonary TB. Three of the total 75 M. tuberculosis isolates (4% showed resistance to any one of the first line drugs. Prevalence of MDR-TB was 1.3%. The sequencing of single MDR strain showed mutations at codons 516, 517, and 518. Amplification of rpoB and sequential analysis of the amplicon is a better way of detection of mutation and the evidence of new mutation in this study indicate that

  3. Pattern of seizure cases in tertiary care hospitals in Karnataka state of India

    Directory of Open Access Journals (Sweden)

    Nitin Joseph

    2013-01-01

    Full Text Available Background: The prevalence and incidence of epilepsy is higher in developing countries than in developed countries. Understanding pattern and risk factors of seizure cases will help in suggesting appropriate preventive measures. Objectives: This study was carried out to assess the pattern of seizure, its management and compliance with treatment. Materials and Methods: Data from medical records of seizure cases in three tertiary care hospitals of Mangalore city in south India admitted from January 2006 to December 2011 were collected and analyzed. Results: Nearly half (44.4% of the 196 cases belonged to productive age group (15-45 years and 2/3 rd (60.7% were males. Majority (>80% cases were unskilled workers and of low socio-economic status groups. Family history of seizures was present in 8.4% cases. Mean age of onset of seizure was found to be 19.9 years. Proportion of generalized tonic clonic seizure cases was 78.1%. Secondary seizures were seen in 66 (33.7% cases with the most common cause being trauma to the head (24.2%. Refractory seizures were present in 2.7% cases. Monotherapy was the most commonly followed treatment regimen and phenytoin was the most popular anti-epileptic drug (AED used. Non-compliance with AEDs was seen in 18.1% cases and was more among patients on polytherapy (P = 0.032. Conclusion: Seizure manifestations and treatment compliance vary widely in the studied population. In depth analysis of each seizure type will give more information about the factors associated with it.

  4. Nutritional status and nosocomial infections among adult elective surgery patients in a Mexican tertiary care hospital.

    Directory of Open Access Journals (Sweden)

    Judith Rodríguez-García

    Full Text Available Controversy exists as to whether obesity constitutes a risk-factor or a protective-factor for the development of nosocomial Infection (NI. According to the obesity-paradox, there is evidence that moderate obesity is a protective-factor. In Mexico few studies have focused on the nutritional status (NS distribution in the hospital setting.The aim of this study was to estimate the distribution of NS and the prevalence of nosocomial infection NI among adult elective surgery (ES patients and to compare the clinical and anthropometric characteristics and length of stays (LOS between obese and non-obese patients and between patients with and without NI.We conducted a cross-sectional study with a sample (n = 82 adult ES patients (21-59 years old who were recruited from a tertiary-care hospital. The prevalences of each NS category and NI were estimated, the assessments were compared between groups (Mann-Whitney, Chi-squared or the Fisher's-exact-test, and the association between preoperative risk-factors and NI was evaluated using odds ratios.The distribution of subjects by NS category was: underweight (3.66%, normal-weight (28.05%, overweight (35.36%, and obese (32.93%. The prevalence of NI was 14.63%. The LOS was longer (p<0.001 for the patients who developed NI. The percentages of NI were: 33.3% in underweight, 18.52% in obese, 17.39% in normal-weight, and 6.90% in overweight patients.The prevalence of overweight and obesity in adult ES patients is high. The highest prevalence of NI occurred in the underweight and obese patients. The presence of NI considerably increased the LOS, resulting in higher medical care costs.

  5. Pattern of obstetrics complication among pregnant females admitted in a tertiary care centre in central India

    Directory of Open Access Journals (Sweden)

    Manik S. Shirpurkar

    2015-04-01

    Background: About half a million women die every year of causes related to pregnancy and child birth. Complication can arise at any time during pregnancy; child birth and post natal period and in absence of intervention, there is a high feto - maternal morbidity and mortality. Aim:- To study the pattern of obstetrics complication among antenatal patients coming to a tertiary care centre. Material and Methods:- A cross sectional study was conducted among 102 antenatal women admitted in intensive care unit of our institute during July 2014 to November 2014. Data regarding maternal socio-demographic profile and antenatal profile was collected. Result:- Out of total 102 women included in the study. 95(93% were registered and 7 were unregistered women. 88(86.4% women had 3 or more antenatal visit, of which 3(2.9% were unregistered women. 82(80.3% women had blood Hb% <11; of which 7 (6.8% were unregistered women. Out of total 102 women, 64(62.7% women were having complications related to abnormal labour; 34(33.3% obstetrical disorder, 21(20.5% Hypertensive disorder. Because of multi-disciplinary team approach at our institute, no maternal mortality was reported among the antenatal women admitted during this period in our institute. Conclusion:- All women need access to antenatal care; institutional delivery and post partum care. Complication arises at any time in absence of intervention. Multidisciplinary team approach along with intensive care specialist and anaesthesiologists can bring optimum care and thereby help in reducing maternal mortality. [Int J Reprod Contracept Obstet Gynecol 2015; 4(2.000: 338-343

  6. A Qualitative Evaluation of Program Budgeting and Marginal Analysis in a Canadian Pediatric Tertiary Care Institution.

    Science.gov (United States)

    Smith, Neale; Mitton, Craig; Hiltz, Mary-Ann; Campbell, Matthew; Dowling, Laura; Magee, J Fergall; Gujar, Shashi Ashok

    2016-10-01

    Hospitals in Canada are being asked by governments to improve efficiency and do more with fewer resources. Healthcare decision makers are thus driven to find better ways to manage budgets and deliver on their mission. Formal processes of priority setting and resource allocation (PSRA) are one means to this end. This paper reports an evaluation of one such approach, Program Budgeting and Marginal Analysis (PBMA), as applied at a children and women's tertiary care facility in Nova Scotia, Canada. A brief evaluation conducted immediately after the conclusion of the PBMA process was supplemented with a larger retrospective evaluation. The retrospective evaluation included 26 face-to-face individual interviews with senior and middle managers who took part in PBMA. Interview transcripts were analyzed against a template consisting of 19 elements of structure, process, attitudes, and outcomes associated with high performance in PSRA. Respondents had a good experience with the implementation of PBMA, and considered it an improvement over past practice. Success was attributed to effective leadership, and substantial efforts to engage staff members. Understanding of economic and ethical principles of decision making was reportedly increased. Areas for improvement included ensuring that everyone participated in good faith, better communication of final results, and stronger follow-through to determine if anticipated changes and benefits in fact occurred. The evaluation framework employed here proved useful in assessing the quality of this resource allocation exercise. The results are directly useful to local decision makers, and the identified strengths and weaknesses are broadly consistent with those reported in studies of other organizations.

  7. VESICOVAGINAL FISTULA: OUR EXPERIENCE OF 47 CASES IN A TERTIARY CARE HOSPITAL OF WEST BENGAL

    Directory of Open Access Journals (Sweden)

    Biswajit

    2016-06-01

    Full Text Available Vesicovaginal Fistula (VVF, an abnormal communication between the urinary bladder and vagina, is one of the most distressing and embarrassing health problem for the ladies. The present observational study was planned to inquire into the demographic and aetiologic pattern of vesicovaginal fistula and the long-term success rate of its surgical management following different techniques of repair in a tertiary care centre of West Bengal, India. MATERIAL AND METHODS A total of 47 patients with vesicovaginal fistula presented at our hospital over a span of nine years, were observed during their course of treatment. The patients were evaluated with clinical history, physical examination, routine laboratory investigations, intravenous urogram and cystoscopy. Then the patients had undergone operation by vaginal or abdominal route. Patients were discharged from the hospital with per urethral catheter. On 21st post-operative day, routine cystogram was done in every patient before catheter removal to exclude the failure of the operation. RESULT Of the observed 47 patients, 66% were tracked back to their obstetric causes and 34% patients could be linked up to gynaecological aetiology like a complication of hysterectomy or after brachytherapy for carcinoma of cervix. In 23.4% of patients, the repair of fistula was done by vaginal route, whereas in 76.6% cases by abdominal approach. Overall success rate of surgical repair was 87.3%, which is comparable to the success rate mentioned in literature. CONCLUSION In spite of a decline in the incidence of vesicovaginal fistula in the western world, it is still highly prevalent in the developing countries. Prolonged obstructive labour was found as the most common aetiology of this devastating condition in our region. Timely intervention with meticulous surgical technique is essential for an acceptable success rate in fistula repair surgery. However, improved obstetric care, institutional delivery, high literacy rate

  8. Robot-assisted Surgery for Benign Ureteral Strictures: Experience and Outcomes from Four Tertiary Care Institutions.

    Science.gov (United States)

    Buffi, Nicolò Maria; Lughezzani, Giovanni; Hurle, Rodolfo; Lazzeri, Massimo; Taverna, Gianluigi; Bozzini, Giorgio; Bertolo, Riccardo; Checcucci, Enrico; Porpiglia, Francesco; Fossati, Nicola; Gandaglia, Giorgio; Larcher, Alessandro; Suardi, Nazareno; Montorsi, Francesco; Lista, Giuliana; Guazzoni, Giorgio; Mottrie, Alexandre

    2017-06-01

    Minimally invasive treatment of benign ureteral strictures is still challenging because of its technical complexity. In this context, robot-assisted surgery may overcome the limits of the laparoscopic approach. To evaluate outcomes for robotic ureteral repair in a multi-institutional cohort of patients treated for ureteropelvic junction obstruction and ureteral stricture (US) at four tertiary referral centres. This retrospective study reports data for 183 patients treated with standard robot-assisted pyeloplasty (PYP) and robotic uretero-ureterostomy (UUY) at four high-volume centres from January 2006 to September 2014. Robotic PYP and robot-assisted UUY were performed according to previously reported surgical techniques. Preoperative, intraoperative, and postoperative variables and outcomes were assessed. A descriptive statistical analysis was performed. No robot-assisted UUY cases required surgical conversion, while 2.8% of PYP cases were not completed robotically. The median operative time was 120 and 150min for robot-assisted PYP and robot-assisted UUY, respectively. No intraoperative complications were reported. The overall complication rate for all procedures was 11% (n=20) and complications were mostly of low grade. The high-grade complication rate was 2.2% (n=4). At median follow-up of 24 mo, the overall success rate was >90% for both procedures. The study limitations include its retrospective nature and the heterogeneity of the study population. Robotic surgery for benign US is safe and effective, with limited risk of high-grade complications and good intermediate-term results. In this study we review the use of robotic surgery at four different tertiary care centres in the treatment of patients affected by benign ureteral strictures. Our results demonstrate that robotic surgery is a safe alternative to the standard open approach in the treatment of ureteral strictures. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All

  9. Antibiotic susceptibility patterns of Pseudomonas aeruginosa at a tertiary care hospital in Gujarat, India

    Directory of Open Access Journals (Sweden)

    Javiya Viren

    2008-01-01

    Full Text Available Objectives: The present study was undertaken to assess the antibiotic susceptibility patterns of Pseudomonas aeruginosa at a tertiary care hospital in Gujarat, India. Due to significant changes in microbial genetic ecology, as a result of indiscriminate use of anti-microbials, the spread of anti-microbial resistance is now a global problem. Materials and Methods: Out of 276 culture positive samples, 56 samples of Pseudomonas aeruginosa were examined and 10 different types of specimen were collected. Microbial sensitivity testing was done using disk diffusion test with Pseudomonas species NCTC 10662, as per CLSI guidelines. Results: The highest number of Pseudomonas infections was found in urine, followed by pus and sputum. Pseudomonas species demonstrated marked resistance against monotherapy of penicillins, cephalosporins, fluoroquinolones, tetracyclines and macrolides. Only combination drugs like Ticarcillin + Clavulanic acid, Piperacillin + Tazobactum, Cefoperazone + Sulbactum, Cefotaxime + Sulbactum, Ceftriaxome + Sulbactum and monotherapy of amikacin showed higher sensitivity to Pseudomonas infections; however, the maximum sensitivity was shown by the Carbapenems. Conclusion: From the present study, we conclude that urinary tract infection was the most common hospital acquired infection. Also, co-administration of β -lactamase inhibitors markedly expanded the anti-microbial sensitivity of semi-synthetic penicillins and cephalosporins. The aminoglycoside group of antibiotics - amikacin - demonstrated maximum sensitivity against pseudomonas species. Therefore, use of amikacin should be restricted to severe nosocomial infections, in order to avoid rapid emergence of resistant strains. Periodic susceptibility testing should be carried out over a period of two to three years, to detect the resistance trends. Also, a rational strategy on the limited and prudent use of anti-Pseudomonal agents is urgently required.

  10. STUDY OF THE PREVALENCE OF MICROALBUMINURIA AND RETINOPATHY IN PREDIABETES IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Purushottam Rao

    2015-02-01

    Full Text Available BACKGROUND AND OBJECTIVE: Diabetes is a chronic disease that has a prolonged prediabetic phase. Indians develop diabetes 10 years earlier tha n other ethnic groups (mean age 42.5 years . 1 Diet, environment, genetics play a major role in development of diabetes. Complications of diabetes are directly proportional to the duration of diabetes and dysglycemia. Prediabetes is a condition is which glucose levels are high to be considered as normal, eventhough they do not meet the criteria for diabetes. 10% - 50% of prediabetics may develop diabetes in 3 - 10 year period. Components of prediabetes include either an isolated impai red fasting glucose or impaired glucose tolerance or both. Microvascular complications can begin is the prediabetic stage itself. Present study has been done to know the prevalence of microalbuminuria and retinopathy is prediabetic stage and correlation of both in prediabetics. MATERIALS AND METHODS: This study was conducted in a tertiary care Hospital from June 2013 to May 2014. Screening was done and patients recruited into the study after fulfilling the inclusion and exclusion criteria. American Diabetes Association Criteria 2 was used for screening and results were correlated using various parameters to know the prevalence of microalbuminuria and retinopathy in prediabetes. Data was analyzed using statistical package for social sciences(spss version 20.0 . RESULTS: In this study, 500 patients were screened for diabetes. 100 patients were included in the study. Prevalence of prediabetes was seen in 20% of patients screened. 19% of prediabetics had microalbuminuria and 8% had retinopathy. Association of both conditions was seen is 7% of patients. CONCLUSION: Diabetic Microvascular complications like retinopathy and nephropathy in the form of microalbuminuria starts even in the prediabetic stage in a significant number of patients. Screening high risk individu als for diabetes and screening of prediabetics for microvascular

  11. Acceptability and feasibility of immediate postpartum IUCD insertion in a tertiary care centre in Central India

    Directory of Open Access Journals (Sweden)

    Anjali Vivek Kanhere

    2015-02-01

    Full Text Available Background: This study was conducted to assess the acceptability and feasibility of immediate postpartum intrauterine contraception device insertion after vaginal deliveries in a tertiary care centre in Central India. Aims: To study acceptability, feasibility and complications of immediate PPIUCD. Methods: This is a prospective analytical study conducted at Department of Obstetrics and Gynecology, PCMS and RC Bhopal. 200 eligible postpartum women were counselled for IUCD insertion. After consent, Cu-T 380 A insertion was done. These women were also interviewed for their reasons for accepting and rejecting PPIUCD and their preference for other forms of contraception. Follow-up was done at 6 week or when they reported with any complaint. Results: Out of 200 eligible postpartum patient counselled, 72 (36% women underwent PPIUCD insertion which was significantly low as compared to preference to use of other methods of contraception at a later date (66%. Acceptance of PPIUCD was higher in the age group of 21-29 years (35%, para-1 (48%, and educated (60% clients. Expulsion rate was 22%. There was no case of perforation or any other major complication. 52 cases (72% reported for follow up. 43% of cases were comfortable with PPIUCD at 6 weeks. There was no case of perforation, PID reported in our study. Only one patient reported with intrauterine pregnancy at 6months with IUCD in place. Conclusions: PPIUCD was not very acceptable in our set up but it is a safe, highly effective, long acting, cost effective method of contraception with very few side effects and no major complication and contraindication. The feasibility of accepting PPIUCD insertion can increase with antenatal counselling and institutional deliveries. [Int J Reprod Contracept Obstet Gynecol 2015; 4(1.000: 179-184

  12. Profile of angle closure in a tertiary care center in north India

    Directory of Open Access Journals (Sweden)

    Ichhpujani Parul

    2010-01-01

    Full Text Available Purpose: To study the demographic and clinical profile of the types of primary angle closure patients presenting at a tertiary care center in North India. Materials and Methods: Clinic records of patients diagnosed as primary angle closure were reviewed. International Society of Geographical and Epidemiological Ophthalmology (ISGEO classification scheme was used to categorize patients. Demographic and clinical data including prior management was collected and analyzed. Main Outcome measures were age, sex, symptomatology, best corrected visual acuity (BCVA, intraocular pressure (IOP, gonioscopy, optic disc assessment and visual field defects. Logistic regression model and receiver operating curve (ROC were calculated for predictors of type of glaucoma. Results: Eight hundred and fourteen patients (1603 eyes; males: 380, females: 434 were diagnosed to have various subtypes of angle closure. Mean (±SD age at presentation was significantly higher for males (57.57 ± 11.62 years as compared to females (53.64 ± 10.67 years ( P < 0001. Primary angle closure glaucoma (PACG was most frequently diagnosed subtype (49.38% followed by Primary angle closure (PAC (39.68% and Primary angle closure suspect (PACS (10.93% respectively. The three subtypes differed significantly among their mean IOP (on ANOVA, F = 14.04; P < 0001 using Greenhouse-Geisser correction. Univariate analysis was done to find significant predictors for the outcome of PACG. Logistic regression model and ROC containing the significant predictors yielded a very high AUC of 0.93 with strong discriminatory ability for PACG. Conclusion: In our hospital-based study, the significant predictors for the outcome of PACG included male gender, diminution of vision, the presence of pain and worsening grades of BCVA. Nearly half of PACG presented with advanced disease. In spite of one-third of the patients being diagnosed as angle closure prior to referral, only 8.34% had iridotomy (laser or surgical

  13. Genotyping of methicillin resistant staphylococcus aureus from tertiary care hospitals in Coimbatore, South India

    Directory of Open Access Journals (Sweden)

    Toms John Peedikayil Neetu

    2016-01-01

    Full Text Available Background: Globally, methicillin resistant Staphylococcus aureus (MRSA is one of the most common pathogens that causes hospital- and community-acquired infections. The use of molecular typing methods is essential for determining the origin of the isolates, their clonal relations, and also epidemiological investigations. Objective: The purpose of this study was to determine the prevalence of antibiotic-resistant MRSA investigate the accessory gene regulator (agr and staphylococcal cassette chromosome mec (SCCmec types and perform multilocus sequence typing (MLST. Furthermore, the minimum inhibitory concentration of MRSA isolates was determined for vancomycin and daptomycin. Materials and Methods: Two hundred and fifty-nine MRSA isolates were collected from Tertiary Care Hospitals in Coimbatore. Disk diffusion method was employed to assess the sensitivity of MRSA isolates to selected antibiotics and genetic analysis was performed using SCCmec, agr, and MLST typing by multiplex-polymerase chain reaction strategy. Minimal inhibitory concentration (MIC was determined using Ezy MIC (vancomycin and Biomerieux (daptomycin E-test strip. Results: Of 259 MRSA isolates, 209 (80.7% were confirmed as methicillin resistant. Antibiotic susceptibility pattern revealed that all the MRSA isolates were 100% sensitive to linezolid, rifampicin, teicoplanin, and vancomycin. MIC results showed that of 209 MRSA isolates, 10 were found to be vancomycin intermediate S. aureus and 100% of the MRSA isolates were daptomycin-susceptible. The agr group I and SCCmec Type III were the major type among MRSA isolates. In addition to these MLST typing revealed the prevalence of sequence type (ST 239 (SLV of ST8 among the MRSA isolates. Conclusion: This study confirms that ST239 (Brazilian clone of MRSA is predominant in this region which is responsible for the hospital-acquired MRSA infections. Thus, the study also suggests that vancomycin and daptomycin can still be used as an

  14. Indications for performing flexible bronchoscopy: Trends over 34 years at a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Ankit Amar Gupta

    2015-01-01

    Full Text Available Background and Aim: Due to its easy maneuverability, patient comfort and documented safety as an outpatient procedure, flexible bronchoscopy (FB has replaced rigid bronchoscopy for routine diagnostic use. Herein, we report our 34-year experience with outpatient performance of FB. Materials and Methods: This was a retrospective analysis of all FB procedures performed between September 1979 and November 2013 (period I: 1979-1990; period II: 1991-2000; period III: 2001-2013 in a tertiary care hospital. Demographic profile of patients, indications for performing FB, and annual and seasonal trends were noted from the records. Results: A total of 24,814 bronchoscopies were performed during the study period. The mean (SD age of patients (71.6% males was 48.4 (15.5 years. The number of procedures performed per decade showed an absolute increase by 322%. The most common indication for FB was suspected bronchogenic carcinoma (32.2% followed by pulmonary infections (18.6% and interstitial lung diseases (13%. The proportion of annual cases due to interstitial lung diseases (3.9% in period I to 16.2% in period III increased over the years, whereas disorders such as hemoptysis and pleural effusion showed a declining trend as an indication for FB. A seasonal trend was observed for diseases such as sarcoidosis, bronchogenic carcinoma and pulmonary infections. Six deaths were encountered during the study period in patients undergoing FB. Conclusion: FB is increasingly being performed in the diagnosis of respiratory disorders and is a safe outpatient procedure. Although bronchogenic carcinoma remains a common indication for performing FB, benign conditions such as pulmonary infections and sarcoidosis constitute important indications in the Indian scenario.

  15. Profile of Cancer Cases at a Tertiary Care Level Teaching Hospital in Rural Western Maharashtra, India

    Directory of Open Access Journals (Sweden)

    Jayant D Deshpande , Kailash K Singh , Deepak B Phalke

    2012-01-01

    Full Text Available Background: Cancer is one of the major public health problems worldwide. Prevalence and pattern of cancer is known to vary from region to region. Epidemiological information on cancer including the pattern is an important basis for determining the priorities for cancer control in any population group. Objective: Present work is an attempt to study magnitude, profile and some epidemiological aspects in relation to cancer cases at a tertiary care level teaching hospital in rural area. Method: All records were studied and analyzed. A total of 1106 patients were treated during the period studied. A proforma was used to collect data such as age, sex, place of residence, type of cancers and treatment given. The data collected were entered into MS-Excel sheets and analysis was carried out. The information obtained was tabulated analyzed using the software GraphPad Instat demo version. Results: A total of 1106 cancer patients were treated during the January 2010 to December 2010. Among these, 626(56.60 were females and 480(43.39 were females. In males, the common cancers were oral cavity cancers, lung cancers and GIT cancers. The most common cancers among females were the cervical carcinomas, which constituted 32.10% of the total number of cancers cases followed by cancers of breast. Almost 2/3rd of cases occurred in the age group of 41 to 70 years. Maximum frequency was observed in 51–60 year age group in both sexes. Maximum numbers (74.59% of the cases were from rural area. The main methods of cancer treatment were surgery, chemotherapy and radiotherapy, used alone or in combination. Conclusion: Tobacco and alcohol related cancers predominated in males. In females, cervical cancer predominated over breast cancer. Human behavior is a major determinant in the successful control of cancer. Understanding cancer magnitude, risk and trends will be of help in cancer control.

  16. Prepare and prevent rather than repair and repent: Study of maternal mortality in tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Anjali Mundkur

    2013-07-01

    Full Text Available Context: Maternal death signifies the quality of healthcare provided in the population. It is the young, relatively healthy women who die of various reasons. Audit of such mortality would prevent the recurrence by taking appropriate measures. Aims: To find the causes of maternal mortality. Settings and Design: Retrospective observational study. Materials and Methods : All maternal deaths in a tertiary care referral center from January 2007 to September 2012 were studied for their demographic profile and causes of death. Results: All 62 women were referred from other healthcare units. Twenty-nine patients died within 24 h of admission and 33 women died after 24 h of admission. Death of 34 patients was due to direct obstetric causes and of 26 patients due to indirect obstetric causes. There were 2 maternal deaths due to accidental causes. Conclusions: The corrective action to prevent the recurrence of such deaths should be taken. Sepsis was found to be the commonest cause for maternal mortality followed by hemorrhage. It important to note that, in the present study, all mothers received antenatal care, had hospital delivery (none had home delivery, no teenage pregnancy or grand multigravidas, and no obstructed labor or rupture uterus, and yet they died. There is a change in the trend of causes of maternal mortality. Strengthening of the first referral units with equipment, blood bank, and adequately competent staff should be of prime importance. Continued medical education of the medial personnel at the periphery is required. Maternal deaths occur in inspite of atenatal care and hospital delivery which is alarming. Contributing factors may be delay in referral or the travel which should be looked in to inorder to minimize such death of young women.

  17. Balloon laryngoplasty for subglottic stenosis caused by orotracheal intubation at a tertiary care pediatric hospital.

    Science.gov (United States)

    Avelino, Melissa Gomes Ameloti; Fernandes, Edson Junior de Melo

    2014-01-01

    Introduction In recent years, there has been a reduction in mortality rates in neonatal intensive care units (NICUs) due to the impact of modern technological advances in the perinatal field. As a consequence, prolonged orotracheal intubation is used more frequently, and there has been an increase in acquired subglottic stenosis (SGS) in children. Subglottic stenosis is a narrowing of the endolarynx and one of the most common causes of stridor and respiratory distress in children. The laryngoplasty balloon has proven effective in dealing with stenosis both as primary and secondary treatments, after open surgery, with the added advantage of being less invasive and not requiring external access. Materials and Methods This study involved children from pediatric intensive care units or NICUs suffering from respiratory distress and who presented an endoscopic diagnosis of Myer and Cotton grade I to III SGS. These patients underwent balloon laryngoplasty with different numbers of interventions depending on the response in each individual case. Results All the patients responded satisfactorily to the balloon laryngoplasty. None required tracheostomy after treatment and all remained asymptomatic even after 6-month follow-up. One patient required just 1 dilation, 4 required 2, 3 underwent the procedure 3 times, and another had 5 dilations. Conclusion The experience presented here is that of balloon laryngoplasty post-orotracheal intubation SGS with very satisfactory results at a tertiary care pediatric hospital. Although the number of patients is limited, our incidence corroborates other studies that demonstrate the efficacy and safety of balloon dilatation in the treatment of SGS.

  18. Balloon Laryngoplasty for Subglottic Stenosis Caused by Orotracheal Intubation at a Tertiary Care Pediatric Hospital

    Directory of Open Access Journals (Sweden)

    Avelino, Melissa Gomes Ameloti

    2014-01-01

    Full Text Available Introduction In recent years, there has been a reduction in mortality rates in neonatal intensive care units (NICUs due to the impact of modern technological advances in the perinatal field. As a consequence, prolonged orotracheal intubation is used more frequently, and there has been an increase in acquired subglottic stenosis (SGS in children. Subglottic stenosis is a narrowing of the endolarynx and one of the most common causes of stridor and respiratory distress in children. The laryngoplasty balloon has proven effective in dealing with stenosis both as primary and secondary treatments, after open surgery, with the added advantage of being less invasive and not requiring external access. Materials and Methods This study involved children from pediatric intensive care units or NICUs suffering from respiratory distress and who presented an endoscopic diagnosis of Myer and Cotton grade I to III SGS. These patients underwent balloon laryngoplasty with different numbers of interventions depending on the response in each individual case. Results All the patients responded satisfactorily to the balloon laryngoplasty. None required tracheostomy after treatment and all remained asymptomatic even after 6-month follow-up. One patient required just 1 dilation, 4 required 2, 3 underwent the procedure 3 times, and another had 5 dilations. Conclusion The experience presented here is that of balloon laryngoplasty post–orotracheal intubation SGS with very satisfactory results at a tertiary care pediatric hospital. Although the number of patients is limited, our incidence corroborates other studies that demonstrate the efficacy and safety of balloon dilatation in the treatment of SGS.

  19. Profile of catering staff at a tertiary care hospital in Mumbai

    Directory of Open Access Journals (Sweden)

    Prateek S Bobhate

    2011-03-01

    Full Text Available BackgroundFood borne illnesses, even today, continue to be a majorpublic health problem in both developing and developednations. Food handlers play an important role in ensuringfood safety throughout the chain of production, processing,storage and preparation.Health of food handlers is of greatimportance for maintaining hygienic quality of foodprepared and served by them. Thus, the present study wasconducted to study socio-demographic characteristics,morbidity pattern and immunization status of catering staffat a tertiary care hospital in MumbaiMethodA cross sectional study was conducted from August 2010 toNovember 2010. Out of the total of 162 food handlersworking in 11 food service establishments, 137 wereinterviewed face to face using a semi-structuredquestionnaire, while remaining 25 food handlers wereexcluded because of either their absence or not givingconsent. The food handlers were assessed clinically forpersonal hygiene and investigated for hemoglobin, stoolroutine and sputum AFB examination.Results82 (59.8% food handlers were from the age group 10 – 29years, 113 (82.5% male, 95 (69% married, 59 (43.1%educated up to primary level. Only 7 (5.1% had everreceived a dose of typhoid vaccine. 103 (75.2% had anaddiction, majority consuming gutkha 59 (57.3%. Dentalcaries 32 (23.4% was the most common morbidityidentified. Entamoeba histolytica was isolated in 13 (9.5%subjects.ConclusionThis study has confirmed an association betweeneducational status and personal hygiene suggesting theneed for greater personal hygiene in this group. Preemploymentand periodical medical examination should beencouraged.

  20. Association between resource utilization and patient satisfaction at a tertiary care medical center.

    Science.gov (United States)

    Biondi, Eric A; Hall, Matthew; Leonard, Michael S; Pirraglia, Paul A; Alverson, Brian K

    2016-11-01

    The Centers for Medicare and Medicaid Services has emphasized patient satisfaction as a means by which hospitals should be compared and as a component of financial reimbursement. We sought to identify whether resource utilization is associated with patient satisfaction ratings. This was a retrospective, cohort study over a 27-month period from January 2012 to April 2014 of adult respondents (n = 10,007) to the Hospital Consumer Assessment of Healthcare Providers and Systems survey at a tertiary care medical center. For each returned survey, we developed a resource intensity score related to the corresponding hospitalization. We calculated a raw satisfaction rating (RSR) for each returned survey. Multivariable logistic regression was used to determine the association between resource intensity and top decile RSRs, using those with the lowest resource intensity as the reference group. Adjusting for age, gender, insurance payer, severity of illness, and clinical service, patients in higher resource intensity groups were more likely to assign top decile RSRs than the lowest resource intensity group ("moderate" [adjusted odds ratio {aOR}: 1.42, 95% confidence interval {CI}: 1.11-1.83], "major" [aOR: 1.56, 95% CI: 1.22-2.01], and "extreme" [aOR: 2.29, 95% CI: 1.8-2.92]). Resource utilization may be positively associated with patient satisfaction. These data suggest that hospitals with higher per-patient expenditures may receive higher ratings, which could result in hospitals with higher per-patient resource utilization appearing more attractive to healthcare consumers. Journal of Hospital Medicine 2016;11:785-791. © 2016 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.

  1. Skin, a mirror reflecting diabetes mellitus: A longitudinal study in a tertiary care hospital in Gujarat

    Directory of Open Access Journals (Sweden)

    Roshni Vahora

    2013-01-01

    Full Text Available Context: Diabetes mellitus (DM is the most common of the endocrine disorders. Mucocutaneous manifestations of diabetes mellitus are many and vary from trivial to life-threatening. Sometimes, mucocutaneous disorders may herald the onset of diabetes. Aims: To study the pattern of mucocutaneous manifestations in diabetics and role of it in diagnosing diabetes mellitus and its complications. Settings and Design: It was a longitudinal observational study of patients having diabetes with skin complaints attending skin outdoor department or admitted in wards for any reason in a tertiary care hospital. Materials and Methods: Total 300 patients were included in the study. Detailed history, clinical examination, and relevant investigations were done to diagnose the mucocutaneous disorders, diabetes, and diabetic complications. Statistical Analysis Used: The data was analyzed by using Epi info software. Results: Demographic profile shown majority of cases (78.66% in more than 40 years of age with almost equal male and female preponderance. Mucocutaneous manifestations as presenting feature of diabetes were observed in 21.67% cases. Infections were most common in 119 (39.66% cases, followed by acanthosis nigricans in 46 (15.33% cases. Various associated complications like hypertension, retinopathy, hyperlipidemia, coronary artery disease, neuropathy, nephropathy, and diabetic ketoacidosis were observed in 160 (53.3%. Conclusions: Skin is the mirror, which reflects internal diseases; this aptly applies to skin and diabetes mellitus. Through awareness about cutaneous manifestations of DM, dermatologist can not only take credit for detecting DM but also facilitate early diagnosis of systemic complications of DM. This is immensely beneficial to patients in long run.

  2. PINEAL GLAND TUMOURS - OUR EXPERIENCE AT TERTIARY CARE CENTRE: A 3-YEAR STUDY

    Directory of Open Access Journals (Sweden)

    Parsa Mani Mekhala

    2016-09-01

    Full Text Available BACKGROUND Pineal gland tumours are slow growing tumours arising in the pineal gland that resemble normal pineal gland. In WHO classification, they are considered as WHO Grade 1 tumours. Incidence of these tumours is very low. The germ cell tumours in this region are much more common arising from the pluripotent germ cells mistakenly lodged in this region during embryogenesis. Tumours which arise from the stroma are Gliomas and Atypical Teratoid Rhabdoid Tumours (ATRT. Commonest clinical presentation is hydrocephalus due to compression of tectum and upward gaze due to compression of superior colliculi. Radiology aids in giving a provisional diagnosis on CT and MRI. Confirmation with histopathology is important for proper treatment and prognosis. MATERIALS AND METHODS We present a retrospective study done over 3 years at a tertiary care centre. Radiologically diagnosed cases as pineal gland tumours, which were well demarcated within the region of pineal gland were included in the study. The surgically resected specimen were examined by squash cytology and then processed routinely for histopathology and immunohistochemistry. RESULTS AND CONCLUSION A total of 18 cases were studied and analysed. The lesions encountered were germ cell tumours, pineal parenchymal tumours and gliomas. On intraoperative squash, one case, which was diagnosed as glioma was later reported as Pineocytoma on histopathology and immunohistochemistry. Histological subtypes of pineal gland tumours on comparison with SEER database was correlated with our study. CONCLUSION Though pineal gland is a very small organ also considered as vestigial organ in lower primates the tumours present aggressively and are proved to be fatal except pineocytomas, which have a good prognosis with 5 year survival rate of 60 to 75% and hence exact diagnosis is critical to choose correct therapy.

  3. Comorbidity of migraine in children presenting with epilepsy to a tertiary care center.

    Science.gov (United States)

    Kelley, Sarah A; Hartman, Adam L; Kossoff, Eric H

    2012-07-31

    Migraine and epilepsy are 2 of the most common neurologic disorders in children. In this cross-sectional study we investigated a population of children with epilepsy to determine if children with a greater seizure burden or certain epilepsy syndromes had a higher risk of migraines. We also examined how often migraine is addressed and treated in a pediatric epilepsy cohort. Between January 2010 and March 2011 we distributed questionnaires regarding headache symptoms and treatment to consecutive children with epilepsy seen in clinic at Johns Hopkins Hospital (400 children were studied). Records were subsequently reviewed for seizure type, age at onset, and treatment. The prevalence of migraine in our pediatric epilepsy population was 25%, which is greater than reported for children without epilepsy (3%-23%). Migraine was more prevalent in children ≥10 years (p = 0.0009), children with benign epilepsy with centrotemporal spikes (BECTS) (p = 0.003), and children with juvenile myoclonic epilepsy (JME) (p = 0.008). Migraine onset was more likely to have occurred after epilepsy was diagnosed (p = 0.0002), but was not more prevalent in those with intractable epilepsy. Only 50% of patients with weekly or greater migraines had documented discussions regarding headaches with their neurologist. Migraine was comorbid in one-quarter of children with epilepsy in a tertiary care center. Children who were older or who had BECTS or JME were more likely to have migraines. Migraines were infrequently addressed within the neurology clinic. It is imperative to address comorbid migraine in treating children with epilepsy.

  4. Cutaneous manifestations of mixed connective tissue disease: Study from a tertiary care hospital in Eastern India

    Directory of Open Access Journals (Sweden)

    Sumit Sen

    2014-01-01

    Full Text Available Context: Mixed connective tissue disorder is an uncommon disease. Some scientists are reluctant to recognize it as a separate entity. Some others have defined this ailment. Cutaneous features of this condition are unique. Researchers from India have described these features to relate to those described in the studies from other parts of the globe. Aims: This study aims to delineate the skin manifestations of clearly defined mixed connective tissue disease (MCTD patients, to compare them with those established as overlap syndrome, and to relate them with studies from other parts of the globe. Settings and Design: Successive patients who fulfilled the specific criteria for MCTD presenting in the skin outpatient department of a tertiary care hospital in eastern India were clinically examined from 2009 for 3 years. Materials and Methods: The number of participants was 23 and the dermatological features of these were compared with 22 patients with overlap syndrome. The antibody to uridine-rich U1 ribonucleoprotein was measured for all patients. Statistical Analysis Used: SPSS (Version 17 and MedCalc (Version 11.6. Results: The Male: Female ratio among the MCTD patients was 1:6.67 and that of the overlap syndrome was 1:10. Twenty patients of the MCTD group presented with synovitis as against only seven in the overlap group. Raynaud′s phenomenon was present in some of the subjects. Puffy fingers were rare in our study. Facial numbness was reported by four of those suffering from MCTD. Antinuclear antibody (ANA was essentially of a speckled pattern in this disease Conclusions: Cutaneous indicators of MCTD are distinct from overlap syndrome. Knowledge of these manifestations prevalent in a region may lead to early diagnosis of the disease.

  5. Causality assessment of adverse drug reaction in Pulmonology Department of a Tertiary Care Hospital

    Science.gov (United States)

    Khan, Amer; Adil, Mir S.; Nematullah, K.; Ihtisham, S.; Aamer, K.; Aamir, Syed

    2015-01-01

    Background: Adverse drug reaction (ADR) is considered to be the sixth leading cause of death. The incidence rate estimates approximately 2% of hospital admissions are due to ADRs. Objective: To monitor ADRs in Pulmonology department of a tertiary care hospital patient with pulmonary diseases in an inpatient department of pulmonology. Materials and Methods: A prospective, single centered, observational and open labeled study was carried out in Princess Esra Hospital. The patient population was broadly divided into four categories based on diagnosis - chronic obstructive pulmonary disease, Infections, Asthma and Others. Suspected ADRs were reported, analyzed, and causality assessment was carried out using Naranjo's algorithm scale. Results: A total of 302 patients were observed, of which 98 patients experienced ADRs, which accounted for 32.23% of the incidence and totally 160 ADEs were observed. Adult Patients were found to have higher incidence (32.09%) while the incidence rate was slightly greater in geriatric patients (32.39%). The highest incidence of ADEs were found in others group (78.57%). Majority of ADRs were suspected to be due to theophylline (19.39%). Gastrointestinal system (38.75%) was the most common organ system affected due to ADRs. Drug was withdrawn in 12 patients, and specific treatment was administered to 32 patients in view of clinical status. Specific treatment for the management of suspected reaction was administered in 32.65% of ADR reports. Conclusion: A relatively high incidence of adverse drug events (32.2%) have been recorded which shows that not only Geriatric patients, but also adults are more susceptible to adverse drug effects. A number of drugs in combination were used, and ADEs often get multiplied. Careful therapeutic monitoring and dose individualization is necessary. PMID:26229344

  6. Drug utilization study of gynecology OPD: In a tertiary care hospital.

    Directory of Open Access Journals (Sweden)

    Baig MS, Bagle TR,Gadappa SN, Deshpande Sonali, Doifode SM

    2013-04-01

    Full Text Available Background: The treatment of diseases by use of essential medicines, prescribed by generic names, has been emphasized by WHO and National Health Policy of India. Drugs used in gynaecology are one of the top selling drugs in India; however they are least studied with respect to drug utilization. Thus present study was undertaken to analyze drug utilization pattern of gynecology OPD in a tertiary care hospital. Materials and Methods: A retrospective, cross sectional, observational study of prescriptions in Gynecology OPD. Data was obtained from an electronic medical record database of patients that attended Gynecology OPD during the study period. Prescription records of patients were screened as per inclusion and exclusion criteria and 300 prescriptions were randomly selected by Openepi software. Patient related and drug related information was collected on a customized data collection sheet. Results: The mean age of patients was 30.19+9.83 years and common age of presentation was >18-30 years. In infective cases, vaginal discharge (10.33% was common, and in non-infective cases, menstrual disorders (24% were common. The average number of drugs per prescription was 3.47+1.53. In drug category, minerals (30.94% were most commonly prescribed, followed by antimicrobials (24.98%, and NSAIDs (13.37%. Polypharmacy was observed in 96.33% of the prescriptions. Conclusion: It is only by drug utilization studies that burden of diseases and corresponding utilization of drugs in gynecology can be measured. In our study majority of the drugs prescribed were generic which were from the essential medical list NLEM and WHO.

  7. A STUDY OF ENTHESITIS IN SPONDYLOARTHROPATHY IN PATIENTS FROM A TERTIARY CARE SERVICE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Surajit

    2014-07-01

    Full Text Available INTRODUCTION: The enthesis is defined as the site of insertion of a tendon, ligament, joint capsule, or fascia to bone. A variety of anatomical sites can be symptomatically affected in Spondyloarthropathy. The spectrum of Spondyloarthropathy consists of Primary Ankylosing spondylitis, Reiter's syndrome/ reactive arthritis, Psoriatic arthropathy and arthropathy associated with Inflammatory Bowel Disease. One of the pathologic hallmarks of the disease is entheseal involvement with insertional tendonitis at different locations. AIM: To study the distribution of involved enthesis in patients with spondyloarthropathy. MATERIAL AND METHODS: The study group included 54 patients from diverse age groups and from different geographic areas in India and was carried out in a tertiary care service hospital. All these patients had historical evidence of sacroiliitis in the form of Inflammatory Back Pain and were diagnosed as Spondyloarthropathy according to ESSG criteria. RESULT: The male to female ratio in this study is 8.2:1. The distribution of enthesitis in our study showed a maximum incidence of heel and costosternal joint. The other enthesis involved were greater trochanter, anterior superior iliac spine and ischial tuberosity. MRI was compared against Plain radiography of Sacroiliac joints for detecting sacroiliitis changes. CONCLUSION: The disease expression has been considered different in males and females. The males with Ankylosing spondylitis have more often had radiological spinal changes and hip involvement than their female counterparts. MRI was compared against Plain radiography of Sacroiliac joints for detecting sacroiliitis changes. MRI was found to be better as compared to Plain radiography in detecting early sacroiliitis with a P value <0.05.

  8. A descriptive study of hyponatremia in a tertiary care hospital of Eastern India

    Directory of Open Access Journals (Sweden)

    Nandini Chatterjee

    2012-01-01

    Full Text Available Background: Hyponatremia is one of the commonest electrolyte disturbances encountered in medical wards and contributes to substantial morbidity and mortality. However, early recognition and management drastically alters prognosis. Therefore, this observational study was taken up to explore the clinical profile of hyponatremia. Aim: To assess the incidence and clinical profile of hyponatremia in medically ill patients. Materials and Methods: This observational study was conducted in the medical ward of a tertiary care hospital from March 2010 to April 2011. All patients underwent routine hemogram, blood biochemistry, serum electrolytes, thyroid function tests, and morning serum cortisol estimation. This was followed by a plasma and urinary osmolality determination (osmometer 800 CL as well as urinary sodium estimation. Patients were diagnosed to have syndrome of inappropriate antidiuretic hormone secretion (SIADH if they satisfied the Bartter and Schwartz criteria. Results: 201 patients (16.4% had a serum Na < 135 meq/l. There were 126 (62.69% male patients and 75 (37.31% female patients. Severe hyponatremia (Na < 120 meq/l was detected in 30 patients (2.4%. The largest group of hyponatremic patients were euvolemic [102 (50.74%], followed by hypervolemic [54 (26.86%] and hypovolemic [45 (22.4%]. Sixty-six patients fulfilled the criteria for SIADH. The most common underlying predisposing factor for hyponatremia in our case series was fluid loss by vomiting/diarrhea. During the hospital stay, 13.5% (15/201 hyponatremic patients died, while the corresponding figure in normonatremic patients was 8.5% (87/1020. Conclusion: The incidence of hyponatremia in our series was higher than values mostly reported in western literature. Euvolemic hyponatremia was the most common type, a significant fraction of which is SIADH.

  9. MICROBIAL PROFILE AND ANTIBIOTIC RESISTANCE PATTERN OF THE BACTERIAL ISOLATES IN A TERTIARY CARE PSYCHIATRY HOSPITAL

    Directory of Open Access Journals (Sweden)

    Jyoti

    2015-11-01

    Full Text Available BACKGROUND: Antibiotic resistance is a challenge for effective management of infections as it increases the morbidity, mortality and costs of treating infectious diseases. AIMS: This study was aimed to obtain the profile of the bacterial isolates and their antibiotic resistance pattern. SETTINGS AND DESIGN: It is a cross sectional study carried out in a tertiary care psychiatry hospital in India. MATERIALS AND METHODS: Isolation and identification of the isolates were done by standard methods. Susceptibility patterns were checked by Kirby Bauer disc diffusion method. STATISTICAL ANALYSIS USED: Statistical analysis was done by using SPSS 16.0 version to calculate the frequencies as well as for cross tabulation. RESULTS: Significant bacterial growth observed in 43(25.6% samples, of which 39(90.7% showed resistant to at least one of the antibiotics used and 36(83.7% were multi-drug resistant. Gram negative organism accounted for the 25(58.14% of total significant isolates, Escherichia coli being the highest (76% in this group. Among multi-drug resistant (MDR isolates E.coli was the highest (44.4% and imipenem resistance was also observed in 1(5.3% of 19 E.coli isolates. Among the 43 isolates 18(41.86% were Gram positive with Streptococcus spp. showing incidence of 41.7% among the total MDR isolates. CONCLUSION: Increasing incidence of MDR strains seen in the population requires continuous monitoring and a restricted use of antibiotics to keep a check on resistance pattern, for effective treatment plan.

  10. A STUDY OF NEONATAL SEPTICEMIA IN A TERTIARY CARE HOSPITAL IN KALABURAGI

    Directory of Open Access Journals (Sweden)

    Preeti M

    2015-08-01

    Full Text Available BACKGROUND: Neonatal septicemia refers to generalized bacterial infections documented by a positive blood culture in the first 4 weeks of life. It remains a significant cause of morbidity and mortality in the newborns. Neonates are particularly vulnerable to infection because of weak immune barrier. OBJECTIVES: To study the distribution of cases of neonatal septicemia at a tertiary care hospital in Kalaburagi. MATERIALS AND METHODS: Blood samples were collected aseptically from 200 clinically suspected cases and inoculated into BHI broth and incubated at 37 0 C for 7 days. Repeated subcultures were made on 1st, 3rd and 5th days onto Blood agar & Mac Conkey agar. Any growth was identified by colony characteristics & appropriate biochemical tests. RESULTS: Of the 200 cases, 31.5% were found to be culture positive. Of these culture positive cases, 53.97% were males and 46.03% were females. A higher number of culture positivity was noted in low birth weight babies i.e. 68.25%. Majority, 90.48% belonged to first week of life. A higher percentage of culture positivity was seen in Pre - term neonates (61.9% as compared to term and Post term neonates. The proportion of culture positives was higher among neonates delivered by spontaneous vaginal route. (76.2%. Most common neonatal risk factor was Prematurity 58.5%, followed by low birth weight 53.5%. Early onset septicemia was seen in 90.47% cases as compared to 9.53% cases in late onset septicemia. CONCLUSION: It is therefore necessary to generate hospital data on distribution of cases according to risk factors involved, so that measures can be taken to prevent neonatal septicemia.

  11. Prospective observational study to evaluate the pattern of adverse drug events in cancer patients receiving anti-cancer agents in a tertiary care hospital

    OpenAIRE

    Pooja B. Joshi; Neha G. Kadhe

    2016-01-01

    Background: Adverse drug reactions (ADRs) associated with the use of anticancer drugs are a worldwide problem and cannot be overlooked. They range from nausea, vomiting or any other mild reaction to severe myelosuppression. The study was planned to evaluate the pattern of adverse drug events to anti-cancer agents in a tertiary care hospital. Methods: This observational prospective study was carried out in a tertiary care hospital from 1st January 2011 to 31st December 2011. A total of 213 ...

  12. PROFILE OF CONGENITAL HEART DISEASE AS DIAGNOSED BY FETAL ECHOCARDIOGRAPHY, A TERTIARY CARE EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Venkata Arunavalli

    2015-09-01

    Full Text Available BACKGROUND : The incidence of congenital heart disease is 0.8 in 1000 live births. Fetal echo cardiography offers a chance to detect most hemodynamically significant congenital heart disease in early pregnancy, so that their management prenatally, at birth and postnatally can be planned better. OBJECTIVES : To analyze the profile of congenital heart disease as diagnosed by fetal echocardiography, in pregnant women referred to a tertiary care centre. MATERIAL AND METHODS : The study design is retrospective, observational study. A total number of 583 fetal echo studies were performed at our C entre from January 1 st 2014 to June 30 th 2015. All studies were performed by a single operator. The main i ndications for the referral were: inability to visualize a clear four chamber view on obstetric scan, echogenic focus in LV cavity, maternal diabetes, family history of congenital heart disease, and maternal request. Statistical analysis was performed usin g statistical package for social sciences SPSS: CHICAGO, 3L VSA program. All the women with abnormal FE studies, except ones with complex CHDS were instructed to bring the new borns for 2D echo within 1 – 2 days after birth. RESULTS : Overall, significant C HD was found in 5.4% of FE studies (32 out of 583 cases . The most common indications for referral were: inability to visualize a clear four chamber view on obstetric scan, echogenic focus in LV cavity, maternal diabetes, family history of congenital heart disease, and maternal request. The risk factors with highest yield of CHD were poly hydroamnios and maternal diabetes. The commonest lesion found was ostium secundum ASD. There was a significant correlation between the presence of echogenic focus prenatal ly and small to moderate sized ostium secundum ASD after birth. CONCLUSION : Our data suggests that the risk factors with highest yield of CHD are polyhydromnios and meternal diabetes. Presence of echogenic focus in the LV in FE is associated

  13. CLINICAL AND ETIOLOGICAL PROFILE OF PATIENTS WITH LUNG ABSCESS AT A TERTIARY CARE CENTRE

    Directory of Open Access Journals (Sweden)

    Manoj Kumar

    2015-10-01

    Full Text Available BACKGROUND: Lung abscess is a type of liquefactive necrosis of the lung tissue and formation of cavities (more than 2 cm containing necrotic debris or fluid caused by microbial infection. This pus - filled cavity is often caused by aspiration, which may occur during altered consciousness. OBJECTIVE: To study the clinical and etiological profile of lung abscess in patients admitted at a tertiary care centre. MATERIAL AND METHODS : A prospective study was condu cted on 142 cases with age more than 15 years, who were the suspected cases of lung abscess and the cases with evidence of lung abscess on the X - ray, CT scan presented to the OPD/ IPD clinic, Department of Pulmonary Medicine, Rohilkhand Medical College and Hospital (RMCH, Bareilly from January 2013 to December 2014 were included in the study. RESULTS: out of 142 patients enrolled in the study, 47(33.09% belonged to age group of ›60 years followed by 42(29.57% belong to 41 - 60 years of age. 116(81.6% wer e male and 26(18.3% were female. The most frequent symptom was cough (92.95%, followed by expectoration (91.54%, fever (87.32% and hemoptysis (41.5%. CONCLUSION: In our study conducted, data collection shows that lung abscess was more seen in the elderly and male patients 116( 81.6% as compared to female patients 26(18.3%. Majority of the patients had a risk factor of smoking, dental diseases, altered sensorium, comatosed patients, alcohol, diabetes, on steroid therapy and immunocompromised immune status. The following were the major symptoms in our patients : - Cough (92.95%, expectoration (91.54% , Fever(87.32%, Foul smell (66.90% , Chest pain (58.45% , Hemoptysis (41.5%, Impaired consciousness (29.57%. In our study locus of lesion was more pro minently on right side i.e. 101 patients ( 71.12% as compared to 36 ( 25.35%,while lung abscess was seen bilateral in 5 patients ( 3.5%. Primary lung abscess is a common presentation amongst the patients with the periodontal diseases, seizure

  14. Training potential in minimally invasive surgery in a tertiary care, paediatric urology centre.

    Science.gov (United States)

    Schroeder, R P J; Chrzan, R J; Klijn, A J; Kuijper, C F; Dik, P; de Jong, T P V M

    2015-10-01

    Minimally invasive surgery (MIS) is being utilized more frequently as a surgical technique in general surgery and in paediatric urology. It is associated with a steep learning curve. Currently, the centre does not offer a MIS training programme. It is hypothesized that the number of MIS procedures performed in the low-volume specialty of paediatric urology will offer insufficient training potential for surgeons. To assess the MIS training potential of a highly specialized, tertiary care, paediatric urology training centre that has been accredited by the Joint Committee of Paediatric Urology (JCPU). The clinical activity of the department was retrospectively reviewed by extracting the annual number of admissions, outpatient consultations and operative procedures. The operations were divided into open procedures and MIS. Major ablative procedures (nephrectomy) and reconstructive procedures (pyeloplasty) were analysed with reference to the patients' ages. The centre policy is not to perform major MIS in children who are under 2 years old or who weigh less than 12 kg. Every year, this institution provides approximately 4300 out-patient consultations, 600 admissions, and 1300 procedures under general anaesthesia for children with urological problems. In 2012, 35 patients underwent major intricate MIS: 16 pyeloplasties, eight nephrectomies and 11 operations for incontinence (seven Burch, and four bladder neck procedures). In children ≥2 years of age, 16/21 of the pyeloplasties and 8/12 of the nephrectomies were performed laparoscopically. The remaining MIS procedures included 25 orchidopexies and one intravesical ureteral reimplantation. There is no consensus on how to assess laparoscopic training. It would be valuable to reach a consensus on a standardized laparoscopic training programme in paediatric urology. Often training potential is based on operation numbers only. In paediatric urology no minimum requirement has been specified. The number of procedures quoted

  15. Geriatric patients' expectations of their physicians: findings from a tertiary care hospital in Pakistan

    Directory of Open Access Journals (Sweden)

    Qidwai Waris

    2009-11-01

    Full Text Available Abstract Background Geriatric health is a neglected and under-explored area internationally and in Pakistan. We aimed to ascertain the expectations of the geriatric patients from their physicians and the factors associated with patient satisfaction in this particular age bracket. Methods A cross-sectional survey was carried out at a tertiary care teaching hospital in Karachi, Pakistan. Data collection was carried out via face-to-face interviews based on structured, pre-tested questionnaires. All consenting individuals aged 65 years or above were recruited into the study. Convenience sampling was used to draw the sample. The data was analyzed using SPSS version 16. Geriatric patient's expectations from physicians were elicited using a set of 11 questions that were graded on a scale of 1-3 where 1 = not important, 2 = important, 3 = very important. Results Three hundred and eighty geriatric patients were interviewed. The response rate of this study was 89.8%. The mean age of the respondents was 73.4 ± 6.8 years. Two hundred and forty eight respondents (65.3% were female. Diabetes mellitus (53.7%, hypertension (59.5%, arthritis (40.5% and renal disease (32.1% were common ailments among geriatric patients. More than 50% of the patients were visiting their physicians once every two to three months. Discussing treatment options and letting patients make the final decision (79.2%, prescribing minimum possible medications (84.5%, physician's holistic knowledge about the spectrum of care issues for geriatric patients (79.2%, being given a realistic but optimistic picture of future health by physicians (85.5% were ranked as very important expectations by patients from their physicians. Cumulative household income (p = 0.005, most important health complaint (p = 0.01 and frequency of experiencing health complaint (p Conclusion We have documented the expectations of the geriatric patients from their physicians in a developing country. Physicians belonging

  16. Prescription auditing and drug utilization pattern in a tertiary care teaching hospital of western UP

    Directory of Open Access Journals (Sweden)

    Afroz Abidi

    2012-06-01

    Full Text Available Background: In India, a proper reporting of medication errors in the hospital is not available. Drugs worth crores of rupee are consumed every year but a substantial part of these drugs are irrationally prescribed. In order to promote rational drug usage standard policies on use of drugs must be set, and this can be done only after the current prescription practices have been audited. The prescriptions were analyzed based on the objectives of the study in order to promote rational use of drugs in a population. Methods: The study was carried out prospectively over a period of two months and 15 days in general medicine OPD of our tertiary care hospital. A specially designed performa was used with pre-inserted carbons. Results: Two hundred and thirty seven prescriptions were analyzed. Total no. of drugs in 237 prescriptions were 1001. Therefore average number of drugs/prescription is 4.22. Drugs were prescribed by generic names in 3.79% of cases, drugs on EDL are only 53.25% and fixed dose combinations are 26.87% of total drugs. Dosage forms used were mostly oral -93.51%. Injectables were only 6.19% and topical forms were least 0.299%. Doctors profile indicates that maximum number i.e. 93.67% were general practitioners. Basic information of patient was written in 72.57% prescriptions. Complete diagnoses were written in 70.04% prescriptions. Only 88.61% prescriptions were legible and only 76.79% prescriptions were complete in terms of dose, route, strength, frequency and dosage forms. Disease pattern seen was variable. Diseases of respiratory system were maximum 44.72 % followed by infectious and parasitic diseases - 16.03 % and diseases of digestive system - 13.92 %. The most common drug groups prescribed were NSAIDs± serratiopeptidases, antibiotics, antihistaminics, multivitamins, minerals, enzymes and expectorants & bronchodilators. The incidence of polypharmacy was also common with maximum number of drugs which were prescribed per prescription

  17. MATERNAL AND PERINATAL OUTCOME OF HYPERTENSIVE DISORDERS IN A TERTIARY CARE CENTRE IN NORTH KERALA

    Directory of Open Access Journals (Sweden)

    Smitha Sreenivas

    2014-05-01

    Full Text Available BACKGROUND: Hypertensive disorder of pregnancy is a major challenge for obstetricians contributing to adverse maternal and perinatal outcome. AIM: To assess the maternal demographic characteristics and maternal and perinatal outcome of the different hypertensive disorders of pregnancy including preeclampsia, gestational hypertension and chronic hypertension in a tertiary care hospital so that we can evolve strategies to avoid adverse outcome in our population. SETTINGS AND DESIGN: Government Medical College, Kozhikode, Kerala. Descriptive study. MATERIALS AND METHODS: We studied 100 cases each of preeclampsia, gestational hypertension and chronic hypertension who were admitted at the Government Medical College, Kozhikode during the study period from January 1, 2013 to April 15 2014. Cases were analyzed for the demographic factors, obstetric outcome and maternal and perinatal outcome. Statistical analysis: Data was expressed in percentages. RESULTS: Majority of the cases in our study population belonged to the age group of 20 to 34 years. Primipara were more in preeclampsia and gestational hypertension whereas in chronic hypertension 72% were multipara. Only 34% of preeclampsia patients were term gestation. Labor was induced in 60% of Group1, 57% of Group2 and 38% of Group3 patients. 44% of Group 1, 37% of Group 2 and 49% of Group 3 underwent caesarean section.10% of preeclampsia, 4% of gestational hypertension and 6% of chronic hypertension resulted in still birth. Of the live born babies 43.3% of preeclampsia mothers had asphyxiated babies. In Group 1, only 20% babies had birth weight above 2.5 Kg. 42.2% of Group 1 babies were admitted in neonatal ICU in contrast to only 9.4% of Group 2 and 9.6% of Group 3. In Group1, 14.4% of live born babies died in neonatal period compared to only 1% of Group1 and 3.2% of Group 3. Maternal complications were found more in Group1 with one case of maternal death in Group 3. CONCLUSIONS: Women with hypertensive

  18. Study of congenital malformation in tertiary care centre, Mumbai, Maharashtra, India

    Directory of Open Access Journals (Sweden)

    Prasannajeet Kokate

    2016-12-01

    the pregnancy with compatible congenital anamolies in baby then pregnancy may be continued. But if the congenital anamoly is imcompatible with life then pregnancy should be terminated. This study was conducted to study the incidence of various congenital anamolies in babies and their possible etiological factors in the population visiting to tertiary care hospital at Mumbai.

  19. Diagnostic indicators for peptic ulcer perforation at a tertiary care hospital in Thailand

    Directory of Open Access Journals (Sweden)

    Suriya C

    2011-12-01

    Full Text Available Chutikarn Suriya1, Nongyao Kasatpibal2, Wipada Kunaviktikul2, Toranee Kayee31Clinical Epidemiology, Faculty of Medicine, Chiang Mai University, 2Faculty of Nursing, Chiang Mai University, 3Department of Surgery, Nakornping Hospital, Chiang Mai, ThailandIntroduction: Limited data currently exists regarding the diagnostic indicators of peptic ulcer perforation for early detection among patients in Thailand. Delayed diagnosis and treatment for an ulcer can be life-threatening, resulting in shock or death.Objective: To determine the diagnostic indicators of peptic ulcer perforation.Material and methods: A cohort study was conducted in a tertiary care hospital in Thailand from 2005 to 2009. Peptic ulcer patients aged 15 years and over admitted to the surgical department were included. The diagnostic indicators used criteria of the patients' final diagnoses and operations, coded according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, which included patient profiles, gender, age, coexisting illnesses, personal habits, signs and symptoms, laboratory investigations, radiological finding, and treatment role. Exponential risk regression analyses to obtain relative risk (RR estimates for diagnostic indicators were analyzed using Stata® statistical software package, version 11 (StataCorp LP, College Station, TX.Results: The study included 1290 patients. Of these, 57% reported perforated peptic ulcer. Multivariate analysis showed five diagnostic indicators: signs and symptoms including intense abdominal pain (RR = 1.53, 95% confidence interval [CI] 1.14–2.06, tenderness (RR = 1.94, 95% CI 1.17–3.21, and guarding (RR = 1.52, 95% CI 1.05–2.20; X-ray with free air (RR = 2.80, 95% CI 2.08–3.77; and referral from other hospitals (RR = 1.37, 95% CI 1.03–1.82.Conclusion: Five diagnostic indicators for peptic ulcer perforation monitoring were suggested from this study. Improving diagnostic

  20. Medical tourism in india: perceptions of physicians in tertiary care hospitals

    Science.gov (United States)

    2013-01-01

    Senior physicians of modern medicine in India play a key role in shaping policies and public opinion and institutional management. This paper explores their perceptions of medical tourism (MT) within India which is a complex process involving international demands and policy shifts from service to commercialisation of health care for trade, gross domestic profit, and foreign exchange. Through interviews of 91 physicians in tertiary care hospitals in three cities of India, this paper explores four areas of concern: their understanding of MT, their views of the hospitals they work in, perceptions of the value and place of MT in their hospital and their views on the implications of MT for medical care in the country. An overwhelming majority (90%) of physicians in the private tertiary sector and 74.3 percent in the public tertiary sector see huge scope for MT in the private tertiary sector in India. The private tertiary sector physicians were concerned about their patients alone and felt that health of the poor was the responsibility of the state. The public tertiary sector physicians’ however, were sensitive to the problems of the common man and felt responsible. Even though the glamour of hi-tech associated with MT dazzled them, only 35.8 percent wanted MT in their hospitals and a total of 56 percent of them said MT cannot be a public sector priority. 10 percent in the private sector expressed reservations towards MT while the rest demanded state subsidies for MT. The disconnect between their concern for the common man and professionals views on MT was due to the lack of appreciation of the continuum between commercialisation, the denial of resources to public hospitals and shift of subsidies to the private sector. The paper highlights the differences and similarities in the perceptions and context of the two sets of physicians, presents evidence, that questions the support for MT and finally analyzes some key implications of MT on Indian health services, ethical

  1. POST STERILISATION ECTOPIC PREGNANCY IN A TERTIARY CARE CENTRE IN NORTH KERALA

    Directory of Open Access Journals (Sweden)

    Kusumam Vilangot Nhalil

    2017-03-01

    Full Text Available BACKGROUND To study the proportion of ectopic pregnancies with a history of female sterilisation and to assess the risk factors associated with post sterilisation ectopic pregnancy. MATERIALS AND METHODS This is a descriptive cross-sectional study. Cases of ectopic pregnancy that were admitted in Department of Obstetrics and Gynaecology, Kozhikode, from February 2014 to July 2015 are included in the study. Details of patient were collected and they were examined in person. Investigations were recorded and clinical findings were noted. Later outcome of cases was also recorded. Data from the study was coded and entered in MS Excel and analysed with SPSS software. RESULTS There were 372 cases of ectopic pregnancies, of which 51 had history of female sterilisation. Ectopic tubal pregnancies after tubal sterilisation accounted for 13.7% of all the ectopic pregnancies in this study. 45% cases occurred in patients less than 30 years. More than 75% cases of ectopic pregnancy in the study presented at less than 7 weeks. Abdominal pain was the main symptom with which they presented. Out of the 51 cases, more than 80% patients had undergone sterilisation by modified Pomeroy’s technique while 17.6% cases had undergone laparoscopic sterilisation. 98% of the patients had their sterilisation done before 30 years of age. 64.7% cases had undergone sterilisation from a secondary care centre while 35.5% had it from a tertiary care centre. In the present study, more than half of the cases presented (as ectopic pregnancy within 5 years after sterilisation. 15% cases had history of pelvic inflammatory disease. Bilateral near total salpingectomy was done in all cases. CONCLUSION In the present study, it is observed that ectopic pregnancies following female sterilisation are not rare. It constituted 13.7% cases of ectopic pregnancies. There may be a delay in diagnosis as there is a history of sterilisation. Absence of amenorrhoea does not rule out ectopic. Most of

  2. Medical tourism in India: perceptions of physicians in tertiary care hospitals.

    Science.gov (United States)

    Qadeer, Imrana; Reddy, Sunita

    2013-12-17

    Senior physicians of modern medicine in India play a key role in shaping policies and public opinion and institutional management. This paper explores their perceptions of medical tourism (MT) within India which is a complex process involving international demands and policy shifts from service to commercialisation of health care for trade, gross domestic profit, and foreign exchange. Through interviews of 91 physicians in tertiary care hospitals in three cities of India, this paper explores four areas of concern: their understanding of MT, their views of the hospitals they work in, perceptions of the value and place of MT in their hospital and their views on the implications of MT for medical care in the country. An overwhelming majority (90%) of physicians in the private tertiary sector and 74.3 percent in the public tertiary sector see huge scope for MT in the private tertiary sector in India. The private tertiary sector physicians were concerned about their patients alone and felt that health of the poor was the responsibility of the state. The public tertiary sector physicians' however, were sensitive to the problems of the common man and felt responsible. Even though the glamour of hi-tech associated with MT dazzled them, only 35.8 percent wanted MT in their hospitals and a total of 56 percent of them said MT cannot be a public sector priority. 10 percent in the private sector expressed reservations towards MT while the rest demanded state subsidies for MT. The disconnect between their concern for the common man and professionals views on MT was due to the lack of appreciation of the continuum between commercialisation, the denial of resources to public hospitals and shift of subsidies to the private sector. The paper highlights the differences and similarities in the perceptions and context of the two sets of physicians, presents evidence, that questions the support for MT and finally analyzes some key implications of MT on Indian health services, ethical

  3. BELIEFS AND PRACTICES AMONG MOTHERS REGARDING DIET DURING CHILDHOOD ILLNESS IN A TERTIARY CARE HOSPITAL, VISAKHAPATNAM

    Directory of Open Access Journals (Sweden)

    Madhavi

    2015-10-01

    Full Text Available INTRODUCTION : Malnutrition is the most widespread condition affecting the health of the children. Scarcity of suitable foods, lack of purchasing power of the family as well as traditional beliefs and taboos about what the baby should eat, often lead to an insufficient balanced diet, resulting in malnutrition. Culturally related food restriction and reduction in feeding frequency during common childhood illnesses further contributes to the burden of malnutrition and thus to childhood morbidity and mortality. METHODOLOGY : A hospital based, cross sectional descriptive study was conducted among 100 ill children less than 5 years age attending outpatient department of pediatrics in a tertiary care hospital, Visakhapatnam. A semi structured, pretested interview schedule was ad ministered after taking prior consent from mothers. Results were analyzed by using MS Excel. Data was represented as frequencies, percentages and p<0.05 was taken as statistically significant. RESULTS : Among 100 study subjects, 62% were boys and 38% were g irls. Thirty percent of children in the study had Grade IV malnutrition (IAP classification. 38% of the mothers had education up to high school. Most of them were Hindu by religion (70%, and housewives by occupation (71%. Most of them belonged to grade III socio - economic status according to modified B G Prasad classification. During illness, one fourth of mothers in group A (children < 6 months and group B (7 – 24 months decreased breast feeding and in group C (2 - 5 years, 35% mothers made the consiste ncy of food thinner than usual. Belief on hot and cold foods concept was among 34% mothers. Level of education of mothers didn’t show any significant difference in keeping beliefs regarding hot and cold properties of foods. CONCLUSION : False beliefs and pr actices like food restriction during child’s ill health was observed in our study. Appropriate nutritional education to care givers, during common childhood

  4. Medication reconciliation errors in a tertiary care hospital in Saudi Arabia: admission discrepancies and risk factors.

    Science.gov (United States)

    Mazhar, Faizan; Akram, Shahzad; Al-Osaimi, Yousif A; Haider, Nafis

    2017-01-01

    Medication reconciliation is a major component of safe patient care. One of the main problems in the implementation of a medication reconciliation process is the lack of human resources. With limited resources, it is better to target medication reconciliation resources to patients who will derive the most benefit from it. The primary objective of this study was to determine the frequency and types of medication reconciliation errors identified by pharmacists performing medication reconciliation at admission. Each medication error was rated for its potential to cause patient harm during hospitalization. A secondary objective was to determine risk factors associated with medication reconciliation errors. This was a prospective, single-center pilot study conducted in the internal medicine and surgical wards of a tertiary care teaching hospital in the Eastern province of Saudi Arabia. A clinical pharmacist took the best possible medication history of patients admitted to medical and surgical services and compared with the medication orders at hospital admission; any identified discrepancies were noted and analyzed for reconciliation errors. Multivariate logistic regression was performed to determine the risk factors related to reconciliation errors. A total of 328 patients (138 in surgical and 198 in medical) were included in the study. For the 1419 medications recorded, 1091 discrepancies were discovered out of which 491 (41.6%) were reconciliation errors. The errors affected 177 patients (54%). The incidence of reconciliation errors in the medical patient group was 25.1% and 32.0% in the surgical group (perror was the omission (43.5% and 51.2%). Lipid-lowering (12.4%) and antihypertensive agents were most commonly involved. If undetected, 43.6% of order errors were rated as potentially requiring increased monitoring or intervention to preclude harm; 17.7% were rated as potentially harmful. A multivariate logistic regression model showed that patients aged ≥65 years

  5. Bio-Medical Waste Managment in a Tertiary Care Hospital: An Overview.

    Science.gov (United States)

    Pandey, Anita; Ahuja, Sanjiv; Madan, Molly; Asthana, Ajay Kumar

    2016-11-01

    Bio-Medical Waste (BMW) management is of utmost importance as its improper management poses serious threat to health care workers, waste handlers, patients, care givers, community and finally the environment. Simultaneously, the health care providers should know the quantity of waste generated in their facility and try to reduce the waste generation in day-to-day work because lesser amount of BMW means a lesser burden on waste disposal work and cost saving. To have an overview of management of BMW in a tertiary care teaching hospital so that effective interventions and implementations can be carried out for better outcome. The observational study was carried out over a period of five months from January 2016 to May 2016 in Chhatrapati Shivaji Subharti Hospital, Meerut by the Infection Control Team (ICT). Assessment of knowledge was carried out by asking set of questions individually and practice regarding awareness of BMW Management among the Health Care Personnel (HCP) was carried out by direct observation in the workplace. Further, the total BMW generated from the present setup in kilogram per bed per day was calculated by dividing the mean waste generated per day by the number of occupied beds. Segregation of BMW was being done at the site of generation in almost all the areas of the hospital in color coded polythene bags as per the hospital protocol. The different types of waste being collected were infectious solid waste in red bag, soiled infectious waste in yellow bag and sharp waste in puncture proof container and blue bag. Though awareness (knowledge) about segregation of BMW was seen in 90% of the HCP, 30%-35% did not practice. Out of the total waste generated (57912 kg.), 8686.8 kg. (15%) was infectious waste. Average infectious waste generated was 0.341 Kg per bed per day. The transport, treatment and disposal of each collected waste were outsourced and carried out by 'Synergy' waste management Pvt. Ltd. The practice of BMW Management was lacking in 30

  6. Medication reconciliation errors in a tertiary care hospital in Saudi Arabia: admission discrepancies and risk factors

    Directory of Open Access Journals (Sweden)

    Mazhar F

    2017-03-01

    Full Text Available Background: Medication reconciliation is a major component of safe patient care. One of the main problems in the implementation of a medication reconciliation process is the lack of human resources. With limited resources, it is better to target medication reconciliation resources to patients who will derive the most benefit from it. Objective: The primary objective of this study was to determine the frequency and types of medication reconciliation errors identified by pharmacists performing medication reconciliation at admission. Each medication error was rated for its potential to cause patient harm during hospitalization. A secondary objective was to determine risk factors associated with medication reconciliation errors. Methods: This was a prospective, single-center pilot study conducted in the internal medicine and surgical wards of a tertiary care teaching hospital in the Eastern province of Saudi Arabia. A clinical pharmacist took the best possible medication history of patients admitted to medical and surgical services and compared with the medication orders at hospital admission; any identified discrepancies were noted and analyzed for reconciliation errors. Multivariate logistic regression was performed to determine the risk factors related to reconciliation errors. Results: A total of 328 patients (138 in surgical and 198 in medical were included in the study. For the 1419 medications recorded, 1091 discrepancies were discovered out of which 491 (41.6% were reconciliation errors. The errors affected 177 patients (54%. The incidence of reconciliation errors in the medical patient group was 25.1% and 32.0% in the surgical group (p<0.001. In both groups, the most frequent reconciliation error was the omission (43.5% and 51.2%. Lipid-lowering (12.4% and antihypertensive agents were most commonly involved. If undetected, 43.6% of order errors were rated as potentially requiring increased monitoring or intervention to preclude harm; 17

  7. Prevalence and Factors Associated with Needle Stick Injuries among Registered Nurses in Public Sector Tertiary Care Hospitals of Pakistan '

    Directory of Open Access Journals (Sweden)

    Haris Habib

    2011-02-01

    Full Text Available Background: Needle stick injuries remain the main cause of Hep B, Hep C and HIV which lead to mortality and morbidity in health care providers especially in nurses all over the world. Although needle stick injuries have been well studied in developed countries, data from developing countries is limited.Aim & Objectives: To estimate the prevalence of needle stick injuries among nurses and its associated factors in public sector tertiary care hospitals of Pakistan. Methods: This cross sectional survey was conducted in 3 major tertiary care hospitals of Rawalpindi, Pakistan. Study duration was from March 2010 to May 2010 (3 months. Two Hundred and Sixteen (216 nurses were selected by simple random sampling with proportionate sampling. All those registered nurses who were working in allied hospitals of Rawalpindi and involved in clinical work were included, while all those who were on administrative positions, students, retired or on maternity leave were excluded from the study. Pre structured questionnaire was used and data was collected by questionnaire having optional choices and few open ended questions. The questionnaire was piloted among thirty nurses in a tertiary care hospital and their comments were incorporated accordingly to redesign the final questionnaire. The data was analysed using SPSS 16.Results: Sixty Seven (67% of nurses got needle stick injury during job. Almost all (99% nurses said that they didn’t report their injury because of no reporting system in their hospital (p value < 0.05. Injection and needles (72% are the most injury causing instrument and needle stick injuries mostly occurred (81% at bedside and ward (p value < 0.05. Sixty six percent (66% of nurses said that they didn’t attended any educational session, seminar or workshop related to needle stick injuries during their job. Conclusion: The frequency of needle stick injuries among nurses is quite high in public sector hospitals of Rawalpindi Pakistan. Non

  8. Frequency and risk factors associated with dry eye in patients attending a tertiary care ophthalmology center in Mexico City

    Science.gov (United States)

    Martinez, Jaime D; Galor, Anat; Ramos-Betancourt, Nallely; Lisker-Cervantes, Andrés; Beltrán, Francisco; Ozorno-Zárate, Jorge; Sánchez-Huerta, Valeria; Torres-Vera, Marco-Antonio; Hernández-Quintela, Everardo

    2016-01-01

    Purpose The purpose of this study was to ascertain the frequency and risk factors of dry eye (DE) among patients attending a tertiary care ophthalmology center in Mexico. Methods Approximately 338 consecutive new patients attending a tertiary care ophthalmology center in Mexico City underwent an ocular surface examination, which included tear film break-up time, fluorescein corneal staining, Schirmer’s test, and evaluation of meibum quality. Symptoms of DE were evaluated by the Ocular Surface Disease Index and Dry Eye Questionnaire-5. Information on demographics, exposures, past medical and ocular history, and medications was also collected. Results The frequency of severe DE symptoms was found to be 43% based on the Ocular Surface Disease Index and 30% based on Dry Eye Questionnaire-5. Risk factors significantly associated with increased DE symptoms included dry mouth and gastrointestinal ulcer medications. With regard to signs, aqueous tear deficiency was a less-frequent finding (22%) in our population than evaporative deficiency (94%). Risk factors associated with aqueous tear deficiency were dry mouth and diuretic use. No risk factors were associated with evaporative deficiency. Risk factors associated with meibomian gland dysfunction included old age, male sex, arthritis, and use of an antihypertensive. The only risk factor associated with corneal staining was dry mouth. Conclusion This is the first study to demonstrate the frequency of symptomatic and clinical DE in a tertiary care ophthalmology center in Mexico. The frequency of DE ranged from 30% using a symptomatic definition to 94% using objective measures. Different risk factors were found for different aspects of DE, suggesting differing underlying pathophysiologies behind different DE subtypes. PMID:27499613

  9. Evaluation of Methods for AmpC Beta-Lactamase in Gram Negative Clinical Isolates from Tertiary Care Hospitals

    OpenAIRE

    Singhal S; Mathur T; Khan S; Upadhyay D; Chugh S; Gaind R; Rattan A

    2005-01-01

    The purpose of this study was to simultaneously screen for Extended-spectrum b-lactamases (ESBL) and AmpC b-lactamases in gram negative clinical isolates from four tertiary care hospitals and further to compare two detection methods three-dimensional extraction method and AmpC disk test for AmpC b-lactamases. A total of 272 isolates were screened for ESBL and AmpC β-lactamase by modified double disk approximation method (MDDM). Synergy observed between disks of ceftazidime/cefotaxime a...

  10. Safe emergency evacuation of a Tertiary Care Hospital during the “once in a century” floods in Chennai, India

    OpenAIRE

    Ilankumaran Kaliamoorthy; Mettu Srinivas Reddy; Akila Rajakumar; Joy Varghese; Sanjay Pandey; Balaji Pillai; Jothi Clara J Micheal; Ravindranath Kancherla; Mohamed Rela

    2016-01-01

    The coastal city of Chennai, India, was inundated by unprecedented heavy rains during the last week of November 2015, in what was billed as a “once in a century” floods. Over 350 people lost their lives in the floods. Global Hospital, a 250-bedded tertiary care hospital in Chennai, was heavily flooded leaving more than 100 patients and their relatives stranded inside with access totally cutoff from the rest of the world. This article describes how these patients, many in the Intensive Care Un...

  11. Development and evaluation of a computerised clinical decision support system for switching drugs at the interface between primary and tertiary care

    Directory of Open Access Journals (Sweden)

    Pruszydlo Markus G

    2012-11-01

    Full Text Available Abstract Background Upon admission to a hospital patients’ medications are frequently switched to alternative drugs compiled in so called hospital drug formularies. This substitution process is a laborious and error-prone task which should be supported by sophisticated electronic tools. We developed a computerised decision support system and evaluated benefit and potential harm associated with its use. Methods Based on a multi-step algorithm we identified drug classes suitable for exchange, defined conversion factors for therapeutic interchange, built a web-based decision support system, and implemented it into the computerised physician order entry of a large university hospital. For evaluation we compared medications manually switched by clinical pharmacists with the results of automated switching by the newly developed computer system and optimised the system in an iterative process. Thereafter the final system was tested in an independent set of prescriptions. Results After iterative optimisation of the logical framework the tool was able to switch drugs to pharmaceutical equivalents and alternatives; in addition, it contained 21 different drug classes for therapeutic substitution. In this final version it switched 91.6% of 202 documented medication consultations (containing 1,333 drugs automatically, leaving 8.4% for manual processing by clinical professionals. No incorrect drug switches were found. Conclusion A large majority (>90% of drug switches performed at the interface between primary and tertiary care can be handled automatically using electronic decision support systems, indicating that medication errors and workload of healthcare professionals can be considerably reduced.

  12. Clinico-radiological profile and outcome of dengue patients with central nervous system manifestations: A case series in an Eastern India tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Souren Pal

    2016-01-01

    Full Text Available Background and Objective: Dengue, an acute viral disease, transmitted by Aedes mosquitoes, has a variable clinical spectrum ranging from asymptomatic infection to life-threatening dengue hemorrhagic fever and dengue shock syndrome. However, neurological complications, in general, are unusual but have been observed more frequently in the recent past, and some studies highlighted varied neurological complications during the course of illness. Although dengue is classically considered a nonneurotropic virus, there is increasing evidence for dengue viral neurotropism. In this study, we have evaluated clinico-radiological profile and outcome of nine serologically confirmed dengue patients having varied manifestations of central nervous system (CNS involvement. Materials and Methods: All the consecutive patients presented with neurological complications with positive serology for dengue infection (IgM positivity in Department of Medicine, in a tertiary care hospital in Eastern India from August 2013 to October 2014 were included in the study. These patients were subjected to a detailed clinical evaluation, laboratory assessment including complete hemogram, coagulation profile, liver function test, serum electrolytes, and routine CSF (Cerebrospinal Fluid study with the exclusion of other common neuroinvasive pathogens. Results: Out of 9 patients with neurological complications associated with confirmed dengue infection, 2 (22% patients had dengue encephalopathy, 5 (56% patients have dengue encephalitis, 1 (11% patient had dengue meningitis, and 1 (11% patient had postdengue immune-mediated CNS involvement. Conclusion: This case series reaffirms the occurrence of varied CNS manifestations in dengue virus infection and underlines the importance of inclusion of dengue in the differential diagnosis of acute encephalitis syndrome.

  13. A Study of Workplace Violence Experienced by Doctors and Associated Risk Factors in a Tertiary Care Hospital of South Delhi, India

    Science.gov (United States)

    Kumar, Mukesh; Das, Timiresh; Pardeshi, Geeta; Kishore, Jugal; Padmanandan, Arun

    2016-01-01

    Introduction The increasing incidences of violence against doctors in their workplaces are an important reason for stress among these healthcare workers. Many incidences of workplace violence against doctors have been reported in the past and are also being continuously reported from different parts of the country as well as the world. Aim To determine the prevalence of workplace violence among doctors and to study the associated risk factors in a tertiary care hospital of Delhi, India. Material and Methods A cross-sectional study was conducted using a self-administered semi-structured questionnaire. The contents were: data related to the workplace, incidences at work, violence prevention policy of the institution, reporting of incidences and follow-up, education and training for violence management. A total of 151 doctors participated in the study. Results Total participants in the study were 151. The mean age of study participants was 26.73±4.24 years. Almost half (47.02%; 44.56% of males and 50.84% of females) of the doctors reported having an experience of violence during work hours in past 12 months. Among the cases, 39.4% were reported from Department of Obstetrics and Gynaecology while Surgery, Medicine and other departments reported 29.6%, 26.8% and 4.2% respectively. Patients or their relatives were perpetrators in most of the cases. Maximum (87.3%) of the reported cases were of verbal violence while 8.6% of the cases were of physical violence. Younger doctors with less work experience were more prone to physical violence. Regarding the time of violence, 35.1% of such cases occurred during afternoon while 30.1% of them took place at night. Conclusion A large number of doctors had experienced violence in past 12 months in a tertiary care hospital of South Delhi, India. Verbal violence came out to be most common form of violence experienced by the doctors. Afternoon or night hours were the timings when majority of such cases were reported. PMID:28050406

  14. Study of risk factors and prevalence of invasive candidiasis in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Chowta Mukta

    2007-01-01

    Full Text Available Introduction: The frequency of invasive mycoses has increased dramatically during the past two decades owing to medical advances such as intensive cancer chemotherapy, broad-spectrum antimicrobial therapy, invasive medical devices, organ transplantation, human immunodeficiency virus (HIV disease epidemic and an expanding aging population. There were few Indian studies regarding the incidence and risk factors for candidemia. Hence the aim of this work was to evaluate the changes in the prevalence of candidemia and invasive candidiasis in a tertiary care hospital and also to assess the risk factors and predictors of mortality Materials and Methods: Nonsystematic review of patients with candidemia/invasive candidiasis was done during the period 1999 to 2004. All in-patients who had shown signs and symptoms of nosocomial blood stream infection were screened for candidial infection. Among these, 29 patients had candidemia/invasive candidiasis. Demographic and clinical data of these patients were recorded on a standardized form, which included age, sex, site of isolation, infectious diagnosis, underlying conditions, predisposing factors, catheter status and clinical outcome. The data were collected during the years of 1999 to 2004, which is divided into two time periods (1999-2001 and 2002-2004. Data collected during these different time spans are compared with each other. Results: A total of 255 patients were screened during the study period. Among these, 100 patients were screened during the period 1999-2001 and 155 patients were screened during the year 2002-2004. Out of these patients, 29 showed positive cultures in blood or other sterile site (ascitic fluid, bronchial aspirate and urine from suprapubic puncture. Out of these, 24 were males and five were females. The most common risk factor was use of intravenous canulae (62.1%, followed by prolonged use of antibiotics (34.5% and HIV infection (24.1%. There were no statistically significant

  15. Prevalence of antibodies against Treponema pallidum among HIV-positive patients in a tertiary care hospital in Mexico.

    Science.gov (United States)

    Mata-Marín, José Antonio; Sandoval-Sánchez, Juan Joel; Huerta-García, Gloria; Arroyo-Anduiza, Carla Ileana; Alcalá-Martínez, Enrique; Mata-Marín, Luis Alberto; Sandoval-Ramirez, Jorge Luis; Gaytán-Martínez, Jesús

    2015-02-01

    Our objective was to determine the seroprevalence of syphilis among HIV-infected patients in a tertiary care hospital in Mexico City. A cross-sectional study was developed, and 318 HIV-positive patients were evaluated from January to February 2013 at Hospital de Infectología, National Medical Center 'La Raza' (a tertiary care hospital specialising in infectious diseases in Mexico City). Laboratory data were screened for the detection of antibodies against Treponema pallidum. Patients completed a questionnaire relating to socio-demographic data and factors associated with syphilis. Of the 318 patients, 83% were men. The mean age ± SD was 36 ± 11 years; 52% were men who have sex with men and 47% had undertaken higher education. The overall seroprevalence of syphilis among these patients was 25% (95% confidence interval 21%, 30%). Men who have sex with men had a significantly higher seroprevalence (30% vs. 15%, p = 0.009). We conclude that, in Mexico, there is a high seroprevalence of syphilis antibodies in HIV-infected patients and that men who have sex with men are the group most affected.

  16. Sexual dysfunction with the use of antidepressants in a tertiary care mental health setting - a retrospective case series

    Directory of Open Access Journals (Sweden)

    Kingshuk Lahon

    2011-01-01

    Full Text Available Sexual dysfunction affects patients′ quality of life. It can occur secondary to physical or mental disorders, substance abuse and treatment with prescription drugs like antidepressants. We wanted to study the prevalence of sexual dysfunction associated with antidepressant use in the psychiatric unit of a tertiary care hospital and assess for causality, severity and preventability. We did a retrospective data collection from case records of patients on antidepressants from the Psychiatry outpatient clinic of a tertiary care teaching hospital during the period 1 st January 2006 to 31 st December 2006, excluding those with complaints of sexual dysfunction prior to treatment. Data are presented as a case series. Documented adverse events were subjected to analysis for causality, severity and preventability using Naranjo′s, modified Hartwig and Siegel and modified Schumock and Thornton′s Preventability scales respectively. Out of 169 patients, four patients developed sexual dysfunction (2.36% associated with duloxetine, mirtazapine, trazodone and sertraline. We observed a possible causal relationship of mild to moderately severe ADR (sexual dysfunction which was not preventable. Prevalence of antidepressant associated sexual dysfunction was lower than quoted in Western literature probably due to the retrospective nature of our study design. Active monitoring and intervention can greatly improve the quality of life and compliance to treatment.

  17. ATTAINMENT OF TREATMENT TARGETS AMONG TYPE 2 DIABETIC PATIENTS FIRST ATTENDING A TERTIARY CARE SETTING IN SUBURBAN KERALA

    Directory of Open Access Journals (Sweden)

    Sajeeth Kumar

    2016-03-01

    Full Text Available BACKGROUND Type 2 diabetes is growing in epidemic proportions worldwide, particularly in Asian subcontinent and especially in India. The disease takes a toll on the health system of a country, especially the developing nations. AIMS AND OBJECTIVES To study the attainment of metabolic and anthropometric goals of individuals with type 2 diabetes attending a tertiary care centre. MATERIALS AND METHODS i Informed consents were obtained. ii The study subjects were subjected to a detailed clinical, anthropometrical and biochemical evaluation at baseline by a dedicated diabetologist. iii These data were collected using a structured questionnaire and were analysed using EPI INFO (Ver 3.4.1. RESULTS A total of 350 cases were studied. Overall, 76.3% of patients could not achieve ADA A1c goal and 36.3% had very poor glycaemic control as evidenced by A1c >9%. CONCLUSIONS Despite the increasing awareness of type 2 diabetes both among attending physicians and patients, attainment of treatment targets still is a challenge even at a tertiary care setting. The lifestyle and dietary habits may be a main contributing factor for this situation. More focus needs to be given to nutritional aspects and physical exercise in not only in patients with type 2 diabetes mellitus, but also in apparently healthy individuals of the productive age group so that the disease can be delayed if not prevented.

  18. Prevalence of Enterotoxin Genes and spa Genotypes of Methicillin-resistant Staphylococcus aureus from a Tertiary Care Hospital in China.

    Science.gov (United States)

    Li, Yanmeng; Zhao, Ruike; Zhang, Xianfeng; Han, Qingzhen; Qian, Xuefeng; Gu, Guohao; Shi, Jinfang; Xu, Jie

    2015-05-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen that causes a variety of infections. MRSA has evolved resistance to multiple antibiotics. Genetic background and virulence differs in different geographic regions. The present study was aimed to investigate the prevalence of enterotoxin genes and spa genotypes of hospital-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) isolated from a tertiary care hospital of Jiangsu province, China. HA-MRSA isolates from August 2013 to April 2014 at a tertiary care hospital of China were collected. We investigated antimicrobial pattern, spa types, SCCmec types and the presence of 14 virulence genes. Eighty HA-MRSA isolates were collected. Results from SCCmec typing revealed that 73.8% were type II; 13.8% were type III; 12.5% were type V. There were 19 different spa types. Spa type t2460 was the most common (35.0%), followed by t002 (11.3%). CC5 was the predominant MLST CCs type (50%). The most frequent toxin genes were sea, seb, sed, sel, sen and seo (100.0%). None of the investigated isolates carried the sec or tst. Genotypic and virulence evaluation of the isolated HA-MRSA revealed that the isolates with CC5 and SCCmec II were the predominant type and highly homological. The virulence profiles mainly existed in the genes of sea, seb, sed, sel, sen, seo and ser. The prevalence of t2460 was an outbreak and the predominant spa type.

  19. Awareness of cervical cancer and Pap smear among nursing staff at a rural tertiary care hospital in Central India

    Directory of Open Access Journals (Sweden)

    S M Jain

    2016-01-01

    Full Text Available Background: Cancer cervix is the leading cause of cancer deaths in females in developing countries and one in five women suffering from cervical cancer lives in India. Aims: The aim of this study is to determine the awareness about cervical cancer and Pap smear among nurses working in a tertiary care institute. Study Setting and Design: Cross-sectional survey in a tertiary care institute. Materials and Methods: Nurses working at our institute excluding those who have worked or working in the Obstetrics and Gynecology department were provided with a pre-designed questionnaire testing their knowledge about cervical cancer. Results: Approximately, 86% were aware about cancer cervix and 69% were aware of a pre-cancerous stage. 42.3% were not aware of any risk factor and 27.6% were not aware of any symptom of cancer cervix. 86.2% were aware about Pap smear, but only 58.6% were aware that facilities of Pap smear were available at our hospital. Conclusions: Knowledge about cervical cancer and awareness of Pap smear as screening test was inadequate in nursing staff. Awareness programs about cervical cancer and screening are needed to increase awareness for this preventable condition. Recommendation: There is a need to arrange reorientation programs to sensitize nurses and establish cytology clinics to offer facilities for easily accessible and affordable screening.

  20. Pathways to Care of Alcohol -Dependent Patients: An Exploratory Study From a Tertiary Care Substance Use Disorder Treatment Center

    Directory of Open Access Journals (Sweden)

    Pal Singh Balhara

    2016-02-01

    Full Text Available Background No study from India has examined pathways to care in alcohol using population systematically. Objectives The present study aimed to understand the pathways to care among alcohol-dependent individuals seeking help at a tertiary care center. Patients and Methods It was a cross-sectional, observational study. A total of 58 subjects diagnosed with alcohol- dependence syndrome as per DSM-IV-TR were included in the study. Pathways to care were assessed using the world health organization encounter form. Results For 56.9% of the subjects, first point of contact was with a tertiary care addiction psychiatrist. Traditional healers were consulted by about 5.2% of the patients seeking help for the first time. The mean duration of main problems due to alcohol use was 5.82 ± 4.95 years. The first contact tended to be at place nearer to the patient’s residence while further contacts tended to be farther away. Family, friends and neighbours together constituted the single largest group suggesting patients to seek care. Conclusions There is a long time lag between the onset of alcohol use related problems and the first help seeking attempt. Of those who do decide to seek help, the proportion of those obtaining specialist help is higher than commonly believed.

  1. A study of HIV-concordant and -discordant couples attending voluntary counselling and testing services at a tertiary care center in North India.

    Science.gov (United States)

    Mehra, Bhanu; Bhalla, Preena; Rawat, Deepti; Kishore, Jugal

    2015-01-01

    A large number of Indian couples are exposed to the risk of heterosexual human immunodeficiency virus (HIV) transmission. The present records-based study was undertaken at the voluntary counselling and testing facility of a tertiary care hospital in New Delhi, India to determine HIV prevalence among Indian couples; to assess the magnitude of seroconcordance and discordance among HIV-affected couples; and to compare the concordant and discordant partnerships for sociodemographic determinants and cluster of differentiation 4 (CD4) counts. Of the 1309 couples included in the study, 249 (19%) were HIV-affected, and of them 113 (45.4%) were concordantly and 136 (54.6%) discordantly affected by HIV. Males were the HIV-infected partners in 72% of the serodiscordant partnerships analyzed. Seroconcordance was significantly associated with the occupation status of being a housewife (P = 0.009). The contribution of discordant partnerships to the burden of HIV/acquired immune deficiency syndrome (AIDS) is significant, warranting novel couple-targeted counselling strategies and preventive measures, including safe sexual behavior and possibly preexposure HIV prophylaxis of the uninfected partner.

  2. A study of HIV-concordant and -discordant couples attending voluntary counselling and testing services at a tertiary care center in North India

    Directory of Open Access Journals (Sweden)

    Bhanu Mehra

    2015-01-01

    Full Text Available A large number of Indian couples are exposed to the risk of heterosexual human immunodeficiency virus (HIV transmission. The present records-based study was undertaken at the voluntary counselling and testing facility of a tertiary care hospital in New Delhi, India to determine HIV prevalence among Indian couples; to assess the magnitude of seroconcordance and discordance among HIV-affected couples; and to compare the concordant and discordant partnerships for sociodemographic determinants and cluster of differentiation 4 (CD4 counts. Of the 1309 couples included in the study, 249 (19% were HIV-affected, and of them 113 (45.4% were concordantly and 136 (54.6% discordantly affected by HIV. Males were the HIV-infected partners in 72% of the serodiscordant partnerships analyzed. Seroconcordance was significantly associated with the occupation status of being a housewife (P = 0.009. The contribution of discordant partnerships to the burden of HIV/acquired immune deficiency syndrome (AIDS is significant, warranting novel couple-targeted counselling strategies and preventive measures, including safe sexual behavior and possibly preexposure HIV prophylaxis of the uninfected partner.

  3. Outcomes of endoscopic dacryocystorhinostomy: Experience of a fellowship trainee at a tertiary care center

    Directory of Open Access Journals (Sweden)

    Saurabh Kamal

    2016-01-01

    Full Text Available Aim: The study aims to report a single trainee's experience of learning and performing endoscopic endonasal dacryocystorhinostomy (En-DCR. Settings and Design: This study was a retrospective, interventional case series. Subjects and Methods: Fifty-four eyes of fifty patients presenting at a tertiary eye care center over 1 year were included in the study. All cases underwent endoscopic DCR with mitomycin-C and silicone intubation. The parameters studied included demographics, clinical features, intraoperative details, and postoperative ostium evaluation. Stent removal and nasal endoscopy were performed at 6 weeks and a further ostium evaluation at 3 and 6 months following surgery. Anatomical success rate was defined as patent irrigation, and functional success rate was defined as positive functional endoscopic dye test and absence of epiphora. Results: Fifty-four eyes of fifty patients were operated, and three cases were lost to follow-up after surgery. The mean age at presentation was 34 (4–75 years. Clinical diagnosis included primary acquired nasolacrimal duct (NLD obstruction in 72% (39/54, acute dacryocystitis in 15% (8/54, failed DCR in 7% (4/54, and persistent congenital NLD obstruction in 5% (3/54. The first five cases needed intervention by the mentor for superior osteotomy. Common variations in anatomical landmarks were posterior location of sac, large ethmoidal bulla, high internal common opening, and thick maxillary bone. Surgical time taken in the last 27 eyes was significantly lesser compared to the surgical duration taken in the initial 27 cases (P < 0.05. Anatomical and functional success rate was 94% (48/51 at 6 months follow-up period. Conclusions: Endoscopic En-DCR has a good success rate when performed by oculoplastic surgery trainees. Nasal anatomical variations, instrument handling, and adaptation to monocular view of endoscope are few of the challenges for beginners. Structured skill transfer can help trainees to learn

  4. Clinicopathologic features of adult T-cell leukemias/lymphomas at a North American tertiary care medical center: infrequent involvement of the central nervous system.

    Science.gov (United States)

    Hsi, Andy C; Kreisel, Friederike H; Frater, John L; Nguyen, TuDung T

    2014-02-01

    Human T-cell lymphotropic virus type 1 is associated with adult T-cell leukemia/lymphoma (ATLL). Published series of ATLLs seen at a United States medical institution are rare. We present the features of 4 ATLLs diagnosed at our North American tertiary care medical center from 1990 to 2012. Despite the absence of a history of origin from an endemic region, all our ATLLs demonstrated evidence of human T-cell lymphotropic virus type 1 infection. Central nervous system (CNS) involvement by ATLL was uncommon in our series, and represented only 1.6% (1/64) of all CNS B-cell or T-cell lymphomas diagnosed over a 20+ year period at our institution. Review of the medical literature reveals that the majority of CNS-involved ATLLs present with the lymphoma or acute subtype, and complete remission is difficult to achieve in these cases. CNS involvement frequently occurs with a systemic disease, which carries an aggressive clinical course with poor prognosis. In addition, CNS involvement by ATLL can be the initial presentation or seen with relapsed disease, can be the only site or be associated with other tissue sites of involvement, and may manifest with variable clinical signs/symptoms. Our retrospective study reveals that ATLLs are rare mature T-cell lymphomas in a native North American population, but the clinical and histopathologic features of ATLLs from this nonendemic region are similar to those seen from other endemic regions. Early recognition of these rare ATLLs involving uncommon sites, such as the CNS, will help optimize treatment for these infrequent mature T-cell lymphomas.

  5. PRESCRIBING PRACTICES OF NON TEACHING GENERAL PRACTITIONERS OF PRIVATE CLINICS AND PHYSICIANS OF A TERTIARY CARE TEACHING HOSPITAL: A COMPARATIVE CROSS SECTIONAL STUDY

    Directory of Open Access Journals (Sweden)

    Sudar Codi R, Samiya Khan, Manimekalai K

    2015-01-01

    Full Text Available Background: Doctor’s prescription provides vivid information and instruction to the patient. In spite of the WHO programs, irrational prescribing is still a common practice. Aim: To evaluate and compare the prescribing pattern of private practitioners and physicians of a tertiary care teaching hospital in a semi urban area and detect their rationality. Materials & methods: 150 prescriptions, each prescribed by private practitioners and physicians of a tertiary care hospital were collected over a period of two months and evaluated. Information regarding the drugs used, drugs from the essential drug list, the use of injections, fixed dose combinations, drug prescribed by generic names were observed. Results: The average number of drugs per prescription prescribed by the private practitioners was 2.47 compared to 1.58 by the physicians of a tertiary care hospital. 82% of prescriptions of private practitioners had one injection prescribed in the prescription compared to 12% by physicians of a tertiary care hospital. 30 unnecessary drugs, 46 unnecessary injections and 8 irrational fixed dose combinations were prescribed by the private practitioners, whereas only 6 unnecessary drugs and 2 unnecessary injections were prescribed by the physicians of a tertiary care hospital respectively. There was no irrational fixed dose combination prescribed by them. The private practitioners prescribed 12 (3.2% drugs by generic names, whereas the physicians of a tertiary care hospital prescribed 72 (30.3% drugs by generic names. (P<0.000. 36 (9.7% drugs prescribed by the private practitioners were not included in the essential drug list and only 2 (0.8% drugs prescribed by the physicians of a tertiary care hospital were not included in the essential drug list. Conclusion: Private practitioners prescribe more irrational prescriptions on comparison with the physicians of a tertiary care teaching hospital. This may be due to the promotional pharmaceutical incentives

  6. Frequency and risk factors associated with dry eye in patients attending a tertiary care ophthalmology center in Mexico City

    Directory of Open Access Journals (Sweden)

    Martinez JD

    2016-07-01

    Full Text Available Jaime D Martinez,1 Anat Galor,2,3 Nallely Ramos-Betancourt,1 Andrés Lisker-Cervantes,1 Francisco Beltrán,1 Jorge Ozorno-Zárate,1 Valeria Sánchez-Huerta,1 Marco-Antonio Torres-Vera,1 Everardo Hernández-Quintela1 1Cornea and External Diseases Service, Asociación Para Evitar la Ceguera en Mexico (Association to prevent blindness in Mexico, Universidad Nacional Autónoma de México, Mexico City, Mexico; 2Department of Ophthalmology, Miami Veterans Affairs Medical Center, 3Cornea and External Diseases Division, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA Purpose: The purpose of this study was to ascertain the frequency and risk factors of dry eye (DE among patients attending a tertiary care ophthalmology center in Mexico.Methods: Approximately 338 consecutive new patients attending a tertiary care ophthalmology center in Mexico City underwent an ocular surface examination, which included tear film break-up time, fluorescein corneal staining, Schirmer’s test, and evaluation of meibum quality. Symptoms of DE were evaluated by the Ocular Surface Disease Index and Dry Eye Questionnaire-5. Information on demographics, exposures, past medical and ocular history, and medications was also collected.Results: The frequency of severe DE symptoms was found to be 43% based on the Ocular Surface Disease Index and 30% based on Dry Eye Questionnaire-5. Risk factors significantly associated with increased DE symptoms included dry mouth and gastrointestinal ulcer medications. With regard to signs, aqueous tear deficiency was a less-frequent finding (22% in our population than evaporative deficiency (94%. Risk factors associated with aqueous tear deficiency were dry mouth and diuretic use. No risk factors were associated with evaporative deficiency. Risk factors associated with meibomian gland dysfunction included old age, male sex, arthritis, and use of an antihypertensive. The only risk factor associated with corneal staining was dry

  7. Drug-prescribing patterns during pregnancy in the tertiary care hospitals of Pakistan: a cross sectional study

    Directory of Open Access Journals (Sweden)

    Shaikh Abdul M

    2008-07-01

    Full Text Available Abstract Background The rationale for use of drugs during pregnancy requires a careful assessment as in addition to the mother, the health and life of her unborn child is also at stake. Information on the use of drugs during pregnancy is not available in Pakistan. The aim of this study was to evaluate the patterns of drug prescriptions to pregnant women in tertiary care hospitals of Pakistan. Methods This was a cross-sectional study conducted at five tertiary care hospitals of Pakistan. Copies of outpatient medicinal prescriptions given to pregnant patients attending the antenatal clinics were collected. The drugs were classified according to the pharmacological class and their teratogenic potential. Results All the pregnant women attending the antenatal clinics received a prescription containing at least one drug. A total of 3769 distinct prescriptions given to different women were collected. Majority of the women who received the prescriptions belonged to third trimester (55.4% followed by second (33.6% and first trimester (11.0%. On an average, each prescription contained 1.66 ± 0.14 drugs. The obstetricians at Civil Hospital, Karachi and Chandka Medical College Hospital, Larkana showed a tendency of prescribing lesser number of drugs compared to those in other hospitals. Anti-anemic drugs including iron preparations and vitamin and mineral supplements (79.4% were the most frequently prescribed drugs followed by analgesics (6.2% and anti-bacterials (2.2%. 739 women (19.6% received prescriptions containing drugs other than vitamin or mineral supplements. Only 1275 (21.6% of all the prescribed drugs (n = 6100 were outside this vitamin/mineral supplement class. Out of these 1275 drugs, 29 (2.3% drugs were prescribed which are considered to be teratogenic. Misoprostol was the most frequently prescribed (n = 6 among the teratogenic drugs followed by carbimazole (n = 5 and methotrexate (n = 5. Twenty nine pregnant women (0.8% of all the women

  8. Intravascular catheter related infections and antimicrobial susceptibility pattern of isolated bacteria in a tertiary care hospital of Bangladesh

    Directory of Open Access Journals (Sweden)

    F J Mansur

    2014-01-01

    Full Text Available The aim of this study was to evaluate the rate of bacterial colonisation and catheter related blood stream infections (CRBSI together with the antibiotic susceptibility patterns in a tertiary care hospital. CRBSI was detected with semi-quantitative and quantitative methods. The antimicrobial susceptible patterns of the isolated organisms were performed by Kirby Bauer disk diffusion method. The rate of catheter colonisation and CRBSI were 42.1% and 14% (16.1/1000 catheter days respectively. The most common causative pathogens were Pseudomonas sp. (23.7%, Acinetobacter sp. (18.4%, Staphylococcus aureus (13.2% and Enterobacteriaceae (10.5%. The rate of isolation of methicillin resistance S. aureus, imipenem resistant Pseudomonas sp. and extended spectrum β lactamase producing Enterobacteriaceae were 60%, 44.0% and 100%. The result of this study would be useful for control and treatment of CRBSI.

  9. Control of an Outbreak of Acinetobacter baumannii in Burn Unit in a Tertiary Care Hospital of North India

    Directory of Open Access Journals (Sweden)

    Shweta Sharma

    2014-01-01

    Full Text Available Acinetobacter infection is increasing in hospitals and now it is considered as a global threat, as it can be easily transmitted and remain viable in the hospital environment for a long time due to its multidrug-resistant status, resistance to desiccation, and tendency to adhere to inanimate surfaces. Outbreaks caused by multidrug-resistant Acinetobacter baumannii (MDRAB are difficult to control and have substantial morbidity and mortality, especially in vulnerable host. Here we are describing an outbreak of multidrug-resistant Acinetobacter baumannii in burn unit of a tertiary care hospital in India followed by its investigation and infection control measures taken to curtail the outbreak. Outbreak investigation and environmental sampling are the key factors which help in deciding the infection control strategies for control of outbreak. Implementation of contact precautions, hand hygiene, personnel protective equipment, environmental disinfection, isolation of patients, and training of health care workers are effective measures to control the outbreak of MDRAB in burn unit.

  10. Burden of transfusion transmissible viral infections among blood donors at a tertiary care referral teaching hospital in South India

    Directory of Open Access Journals (Sweden)

    Suresh B

    2016-07-01

    Full Text Available Background: Blood serves as a vehicle for transmission of blood-borne pathogens including human immunodeficiency virus (HIV, hepatitis B virus (HBV and hepatitis C virus (HCV. The present study was conducted to estimate the prevalence of these transfusion transmitted infections (TTIs in blood donors. Methods: All blood donors presenting to the blood bank at our tertiary care teaching hospital were screened for HIV, HBV and HCV by using enzyme-linked immunosorbent assay (ELISA method. Results: During the period January to December 2014, 9958 blood donors were screened for viral markers. The prevalence of HIV, HBsAg and HCV was 0.36%, 1.67%, and 0.56% respectively. Conclusions: Although multiple critical steps are taken to minimize the risk of infection from transfusion of blood or blood products, this risk can never be entirely eliminated. Stringent donor selection, proper counseling and deferral/ self exclusion may reduce the seroreactivity in donated blood and wastage of resources.

  11. Knowledge, Attitude and Practices towards Pharmacovigilance and Adverse Drug Reactions in health care professional of Tertiary Care Hospital, Bhavnagar

    Directory of Open Access Journals (Sweden)

    Dr.Mukeshkumar B Vora

    2014-11-01

    Full Text Available Purpose: Adverse drug reactions (ADRs are adverse consequences of drug therapy. ADRs are representing a major concern of health systems in terms of early recognition, proper management and prevention. Under reporting of Adverse Drug Reactions (ADRs is a common problem in Pharmacovigilance programs. Poor perceptions of doctors about ADRs and risk management have contributed to high rate of ADR under-reporting in India. Underreporting has also been attributed to lack of time to doctor, misconceptions about spontaneous reporting and lack of information on how to report, where to report and a lack of availability of report forms, and also physicians' attitudes to ADRs. The objective of our study was to evaluate the knowledge, attitude and practices (KAP of health care professional towards Pharmacovigilance and adverse drug reactions in a tertiary care hospital, Bhavnagar, Gujarat, India. Methods: A cross-sectional questionnaires based study was carried out in Post graduate students and faculties of tertiary care hospital attached with Govt. Medical College, Bhavnagar, Gujarat. Post graduate students and faculties of different clinical subjects working in the tertiary care teaching hospital, Bhavnagar, Gujarat (India were enrolled and present throughout in study. 22 questionnaires about knowledge, attitude and practices towards ADRs and Pharmacovigilance were developed and peer viewed of all questionnaires by expert faculties from Pharmacology department. We were contacted directly to post graduate students and faculties of respective clinical department, questionnaires were distributed, 30 minutes time given to filled form. Any clarification and extra time was needed, provided to them. The filled KAP questionnaires were analyzed in question wise and their percentage value was calculated by using Microsoft excel spread sheet and online statistical software. Results: In study, postgraduate residents (n=81 and faculties (n=63 from different clinical

  12. Safe emergency evacuation of a Tertiary Care Hospital during the "once in a century" floods in Chennai, India.

    Science.gov (United States)

    Kaliamoorthy, Ilankumaran; Reddy, Mettu Srinivas; Rajakumar, Akila; Varghese, Joy; Pandey, Sanjay; Pillai, Balaji; Micheal, Jothi Clara J; Kancherla, Ravindranath; Rela, Mohamed

    2016-02-01

    The coastal city of Chennai, India, was inundated by unprecedented heavy rains during the last week of November 2015, in what was billed as a "once in a century" floods. Over 350 people lost their lives in the floods. Global Hospital, a 250-bedded tertiary care hospital in Chennai, was heavily flooded leaving more than 100 patients and their relatives stranded inside with access totally cutoff from the rest of the world. This article describes how these patients, many in the Intensive Care Unit on ventilators, were safely managed within the hospital for over 48 h on very limited power supply and resources and then safely evacuated by fishing boats to three other city hospitals. Careful planning, anticipating hazards, identifying critical areas, effective communication and team work contributed to the successful management of this situation.

  13. Safe emergency evacuation of a Tertiary Care Hospital during the “once in a century” floods in Chennai, India

    Directory of Open Access Journals (Sweden)

    Ilankumaran Kaliamoorthy

    2016-01-01

    Full Text Available The coastal city of Chennai, India, was inundated by unprecedented heavy rains during the last week of November 2015, in what was billed as a “once in a century” floods. Over 350 people lost their lives in the floods. Global Hospital, a 250-bedded tertiary care hospital in Chennai, was heavily flooded leaving more than 100 patients and their relatives stranded inside with access totally cutoff from the rest of the world. This article describes how these patients, many in the Intensive Care Unit on ventilators, were safely managed within the hospital for over 48 h on very limited power supply and resources and then safely evacuated by fishing boats to three other city hospitals. Careful planning, anticipating hazards, identifying critical areas, effective communication and team work contributed to the successful management of this situation.

  14. Superbugs causing ventilator associated pneumonia in a tertiary care hospital and the return of pre-antibiotic era!

    Science.gov (United States)

    Qureshi, S; Agrawal, C; Madan, M; Pandey, A; Chauhan, H

    2015-01-01

    The rise in super bugs causing Ventilator-Associated Pneumonia (VAP) is a major cause of mortality and morbidity despite recent advances in management owing to the looming 'antibiotic apocalypse'. The aetiology and susceptibility pattern of the VAP isolates varies with patient population, type of intensive care unit (ICU) and is an urgent diagnostic challenge. The present study carried out for a period of one year in a tertiary care hospital, enrolled patients on mechanical ventilation (MV) for ≥48 hrs. Endotracheal aspirates (ETA) from suspected VAP patients were processed by semi quantitative method. Staphylococus aureus, members of Enterobacteriaceae were more common in early onset VAP (EOVAP), while Nonfermenting Gram negative bacilli (NFGNB) were significantly associated with late onset VAP (LOVAP). Most of the isolates were multi drug resistant (MDR) super bugs. With limited treatment options left for this crisis situation like the pre-antibiotic era; it is an alarm for rational antibiotic therapy usage and intensive education programs.

  15. CHARACTERISTICS OF PATIENTS HOSPITALIZED WITH 2009 H1N1 INFLUENZA IN A TERTIARY CARE HOSPITAL IN SOUTHERN SAUDI ARABIA

    Directory of Open Access Journals (Sweden)

    Adnan Agha

    2012-01-01

    Full Text Available Background Pandemic influenza A (H1N1 virus emerged and spread globally in the spring of 2009.  We describe the clinical features of the patients who were hospitalized with 2009 H1N1 influenza July 2009 to June 2010 in a tertiary care hospital in Khamis Mushyt, Saudi Arabia.  We analyzed the clinical and laboratory variables in order to determine predictors of poor outcome Methods We performed a prospective study in all patients who were hospitalized for at least 48 hours  and with a positive test for 2009 H1N1 virus through RT-PCR(real time polymerase chain reaction.  Their epidemiological, clinical, biochemical characteristics were collected and the hospital course of the patients with eventual outcome (discharge or death was observed. We applied a logistic regression analysis to determine the best predictor of death.

  16. A STUDY OF MORPHOLOGICAL TYPES OF ANAEMIA IN A TERTIARY CARE HOSPITAL - A TWO-YEAR STUDY

    Directory of Open Access Journals (Sweden)

    Kiran Kumar Epari

    2016-08-01

    Full Text Available BACKGROUND In this tertiary care hospital, one of the common condition of all the patients attending the hospital is Anaemia, which is a decrease in haemoglobin content or decrease in haematocrit below the lower limit of the 95% reference range for the individual’s age and sex. The patient presents with varied symptoms of different grades, depending on the severity of anaemia, in different clinical settings. Common presenting symptoms of anaemia are generalised weakness, malaise, loss of appetite and muscular pains. METHODS All the patient samples received at the central laboratory for haemogram, complete blood counts and peripheral smear examination over the period of two years between June 2014 to May 2016 were included in the study. Anaemia cases were diagnosed depending on the criteria of the definition of anaemia, and morphological typing of anaemia was done based on the peripheral smear examination of all the cases with decreased haemoglobin level. Standard cell counter was used to estimate the Hb and other red cell indices, and corroborated with peripheral blood smear examination by standard Romanowsky stains. RESULTS A total of 810 cases of anaemia were diagnosed over the period of two years, of which morphological typing yielded 685 cases of Microcytic and hypochromic anaemia, 15 cases of Dimorphic anaemia, 22 cases of Macrocytic anaemia and 88 cases of Normocytic and normochromic anaemia. CONCLUSION Anaemia is one of the most common problems of patients attending this tertiary care hospital, and detection and morphological typing of anaemia is very helping in guiding the clinicians in diagnosis and further management of anaemias for better patient care.

  17. Job satisfaction and Job stress among various employees of tertiary care level hospital in central Uttar Pradesh, India

    Directory of Open Access Journals (Sweden)

    Ruchi Yadav

    2017-03-01

    Full Text Available Introduction: Job satisfaction defined as the end state of feeling, the feeling that is experienced after a task is accomplished. Job stress can be defined as the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or need of the worker. Objectives: To study the relationship between job satisfaction and job stress among various employees of tertiary care level hospital and to find the co-relates of job stress and job satisfaction. Materials & Methods: A cross sectional study carried out for a period of 2 month among various employees working in Uttar Pradesh University of Medical Sciences, Saifai, Etawah, Uttar Pradesh, a tertiary care level hospital. A total 225 Participants 75 from each medical, paramedical and office staff were selected by purposive sampling technique. The study was conducted using pretested structured questionnaire regarding socio-demographic profile, job satisfaction and job stress. Data was analyzed using chi square test. Result: A total of 225 participants,75 from each medical, paramedical and office staff were interviewed. On doing analysis of questionnaire regarding job satisfaction and job stress it was found that majority believe that their job was well recognized and working in a good institute and were not satisfied with the management and salary and were coping well with their job stress and were having average level of satisfaction. Conclusion: The present study conclude that majority of the participants felt they are well recognized with their job, working in a good institute but not satisfied with the management and salary.

  18. Assessment of Stress and Depression among Geriatric Inpatients at a Tertiary Care Teaching Hospital in Rural Area

    Directory of Open Access Journals (Sweden)

    Jayant D Deshpande

    2014-04-01

    Full Text Available AIM: Elderly people are at risk of mental health problems. Recognizing these problems is even a greater issue in a rural community where mental health resources may be lacking or inadequate. The purpose of this study was to assess stress and depression levels among patients above 60 years attending a tertiary care teaching hospital in in rural India. METHOD: A cross sectional study was conducted at a tertiary care hospital in rural India. Patients aged 60 years and above seeking help at the various in-patient departments of Medical College and those who agree with written inform consent were included in study. General health questionnaire (GHQ-12 used for assessment of stress. Geriatric Depression Scale (GDS-30 was used as screening instruments to detect depression among the elderly. RESULT: A total of 229 elderly participated in the study out of which 138 (60.26% were males and 91 (39.73% were females. The mean age of the subjects was 67.68 +/- 6.61 years. The prevalence of mild depression was 25.32% and severe depression was 8.7%. There was no significant difference in the prevalence of depression for different gender. Factors like lack of family support, chronic morbidity, lack of economic support, dependence on others for day to day activities and neoplastic conditions were significantly associated with depression. Depression according to marital status was found to be significantly higher in the elderly who were widowed. CONCLUSION: Physical morbidity, lack of family support, lack of economic support, dependence on others for day to day activities and neoplastic conditions seem to be associated with increased depressive symptoms in elderly population over 60 years of age [TAF Prev Med Bull 2014; 13(2.000: 125-132

  19. A study of changing trends of maternal mortality at the tertiary care centre, MMC AND RI Mysore, India

    Directory of Open Access Journals (Sweden)

    Ashraf Ali M

    2015-02-01

    Full Text Available Background: Maternal mortality is a reflection of the care given to women by the society. It is tragic that deaths occur during the natural process of child birth and most of them are preventable. Aims and objectives: To study the maternal mortality and the causes resulting in maternal death over 5 years in a tertiary care centre, Cheluvamba hospital, MMC and RI, Mysore. To find out avoidable factors and use information thus generated to reduce maternal mortality. Methods: A retrospective study of all maternal deaths from June 2008 to June 2013. All maternal deaths were reviewed and studied in detail including admission death interval and cause of death. Results: Maternal mortality ratio ranged between 262 to 109/100000 births. The causes of death were hypertensive disorders (30.4%, haemorrhage (24.8%, anaemia (14.8%, sepsis (6.8% and others (23.2%. Maximum deaths (70.6% occurred in women between 20-29 years of age, multigravida contributed to 54.96% of maternal mortality. 42 % were unbooked, 97% were referred cases. Conclusions: Overall maternal mortality was 215/100000 live births. Maternal deaths due to direct obstetric causes were 87% and indirect were 13 %. The causes of potentially preventable deaths include haemorrhage, anaemia, sepsis, disseminated intravascular coagulation and its complications. Hypertensive disorders were the leading cause of death, followed by haemorrhage. Anaemia was an important indirect cause of death. Most maternal deaths are preventable by optimum utilization of existing MCH facilities, identifying the bottlenecks in health delivery system, early identification of high risk pregnancies and their timely referral to tertiary care centre. [Int J Reprod Contracept Obstet Gynecol 2015; 4(1.000: 239-242

  20. Utilization Study of Antihypertensives in a South Indian Tertiary Care Teaching Hospital and Adherence to Standard Treatment Guidelines

    Science.gov (United States)

    Datta, Supratim

    2016-01-01

    Aim: Hypertension represents a major health problem primarily because of its role in contributing to the initiation and progression of major cardiovascular diseases. Concerns pertaining to hypertension and its sequelae can be substantially addressed and consequent burden of disease reduced by early detection and appropriate therapy of elevated blood pressure. This cross-sectional observational study aims at analyzing the utilization pattern of antihypertensives used for the treatment of hypertension at a tertiary care hospital in perspective of standard treatment guidelines. Materials and Methods: Prescriptions were screened for antihypertensives at the medicine outpatient department of a tertiary care teaching hospital. Medical records of the patients were scrutinized after which 286 prescriptions of patients suffering from hypertension were included. The collected data were sorted and analyzed on the basis of demographic characteristics and comorbidities. Results: The calcium channel blockers were the most frequently used antihypertensive class of drugs (72.3%). Amlodipine (55.6%) was the single most frequently prescribed antihypertensive agent. The utilization of thiazide diuretics was 9%. Adherence to the National List of Essential Medicines (NLEMs) was 65%. The combination therapy was used more frequently (51.5%) than monotherapy (48.8%). The use of angiotensin-converting enzyme inhibitors/angiotensin 2 receptor blockers (ACE-I/ARB) was 41.4% in diabetes. Conclusions: The treatment pattern, in general, conformed to standard treatment guidelines. Few areas, however, need to be addressed such as the underutilization of thiazide diuretics, need for more awareness of drugs from the NLEMs and enhanced use of ACE-I/ARB in diabetic hypertensives. PMID:28104972

  1. Surveillance of Candida spp bloodstream infections: epidemiological trends and risk factors of death in two Mexican tertiary care hospitals.

    Directory of Open Access Journals (Sweden)

    Dora E Corzo-Leon

    Full Text Available INTRODUCTION: Larger populations at risk, broader use of antibiotics and longer hospital stays have impacted on the incidence of Candida sp. bloodstream infections (CBSI. OBJECTIVE: To determine clinical and epidemiologic characteristics of patients with CBSI in two tertiary care reference medical institutions in Mexico City. DESIGN: Prospective and observational laboratory-based surveillance study conducted from 07/2008 to 06/2010. METHODS: All patients with CBSI were included. Identification and antifungal susceptibility were performed using CLSI M27-A3 standard procedures. Frequencies, Mann-Whitney U test or T test were used as needed. Risk factors were determined with multivariable analysis and binary logistic regression analysis. RESULTS: CBSI represented 3.8% of nosocomial bloodstream infections. Cumulative incidence was 2.8 per 1000 discharges (incidence rate: 0.38 per 1000 patient-days. C. albicans was the predominant species (46%, followed by C. tropicalis (26%. C. glabrata was isolated from patients with diabetes (50%, and elderly patients. Sixty-four patients (86% received antifungals. Amphotericin-B deoxycholate (AmBD was the most commonly used agent (66%. Overall mortality rate reached 46%, and risk factors for death were APACHE II score ≥ 16 (OR = 6.94, CI95% = 2.34-20.58, p<0.0001, and liver disease (OR = 186.11, CI95% = 7.61-4550.20, p = 0.001. Full susceptibility to fluconazole, AmBD and echinocandins among C. albicans, C. tropicalis, and C. parapsilosis was observed. CONCLUSIONS: The cumulative incidence rate in these centers was higher than other reports from tertiary care hospitals from Latin America. Knowledge of local epidemiologic patterns permits the design of more specific strategies for prevention and preemptive therapy of CBSI.

  2. Surveillance of Candida spp Bloodstream Infections: Epidemiological Trends and Risk Factors of Death in Two Mexican Tertiary Care Hospitals

    Science.gov (United States)

    Corzo-Leon, Dora E.; Alvarado-Matute, Tito; Colombo, Arnaldo L.; Cornejo-Juarez, Patricia; Cortes, Jorge; Echevarria, Juan I.; Guzman-Blanco, Manuel; Macias, Alejandro E.; Nucci, Marcio; Ostrosky-Zeichner, Luis; Ponce-de-Leon, Alfredo; Queiroz-Telles, Flavio; Santolaya, Maria E.; Thompson-Moya, Luis; Tiraboschi, Iris N.; Zurita, Jeannete; Sifuentes-Osornio, Jose

    2014-01-01

    Introduction Larger populations at risk, broader use of antibiotics and longer hospital stays have impacted on the incidence of Candida sp. bloodstream infections (CBSI). Objective To determine clinical and epidemiologic characteristics of patients with CBSI in two tertiary care reference medical institutions in Mexico City. Design Prospective and observational laboratory-based surveillance study conducted from 07/2008 to 06/2010. Methods All patients with CBSI were included. Identification and antifungal susceptibility were performed using CLSI M27-A3 standard procedures. Frequencies, Mann-Whitney U test or T test were used as needed. Risk factors were determined with multivariable analysis and binary logistic regression analysis. Results CBSI represented 3.8% of nosocomial bloodstream infections. Cumulative incidence was 2.8 per 1000 discharges (incidence rate: 0.38 per 1000 patient-days). C. albicans was the predominant species (46%), followed by C. tropicalis (26%). C. glabrata was isolated from patients with diabetes (50%), and elderly patients. Sixty-four patients (86%) received antifungals. Amphotericin-B deoxycholate (AmBD) was the most commonly used agent (66%). Overall mortality rate reached 46%, and risk factors for death were APACHE II score ≥16 (OR = 6.94, CI95% = 2.34–20.58, p<0.0001), and liver disease (OR = 186.11, CI95% = 7.61–4550.20, p = 0.001). Full susceptibility to fluconazole, AmBD and echinocandins among C. albicans, C. tropicalis, and C. parapsilosis was observed. Conclusions The cumulative incidence rate in these centers was higher than other reports from tertiary care hospitals from Latin America. Knowledge of local epidemiologic patterns permits the design of more specific strategies for prevention and preemptive therapy of CBSI. PMID:24830654

  3. Correlates of subjective transportation deficiency among older adults attending outpatient clinics in a tertiary care hospital in Mexico City.

    Science.gov (United States)

    Navarrete-Reyes, Ana Patricia; Medina-Rimoldi, Carlos Tonatiuh; Avila-Funes, José Alberto

    2017-02-11

    Older adults frequently report problems of transportation. Little is known about the correlates of transportation deficiency in Latin America. Therefore, the aim of the present study was to determine the correlates of subjective transportation deficiency (STD) among community-dwelling older adults attending a tertiary care hospital in Mexico City. Cross-sectional study of 228 participants aged ≥70 years being followed in any of the outpatient clinics of a tertiary care hospital in Mexico City. Data were obtained through a structured questionnaire. Univariate and multivariate logistic regression analyses were carried out in order to identify the correlates of STD. The mean age of the participants was 79.8 years (SD 6.4) and 67.1% were women. STD was present in 46% of participants. The multivariate logistic regression model showed that female sex, illiteracy, mobility disability and the use of an assistive walking device had an independent and statistically significant association with STD. Female sex, illiteracy, mobility disability and the use of an assistive walking device were independent correlates of STD in the present study. Identifying the frequency and correlates of transportation deficiency in vulnerable populations will allow for the identification and implementation of useful public policies, as well as for the optimization of prevention and treatment strategies in an attempt to preserve mobility and autonomy, especially in low- and middle-income countries where previous work on transportation deficiency is lacking. Geriatr Gerontol Int 2016; ••: ••-••. © 2017 Japan Geriatrics Society.

  4. Clinical presentation and treatment outcome of molar pregnancy: Ten years experience at a Tertiary Care Hospital in Dammam, Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Ayman A Al-Talib

    2016-01-01

    Full Text Available Objectives: To study the clinical presentation and treatment outcome of molar pregnancy at a Tertiary Care Hospital in Dammam, Saudi Arabia. Materials and Methods: Reviewed medical records of all molar pregnancy cases among all the deliveries at a tertiary care hospital in Dammam from 2005 to 2014, after approval by institutional ethical review committee. Data abstracted included patient′s age, parity, presenting symptoms, gestational age at diagnosis, uterine size, ultrasonographic findings, BhCG level at the time of diagnosis and at follow-up after evacuation, and blood loss during evacuation. Data was entered and analyzed using Excel; frequency distribution for categorical variables and descriptive statistics for continuous variables were computed. Results: Of a total of 25,000 deliveries in ten years, 22 cases of complete molar pregnancy were encountered: 0.9 cases of molar pregnancy per 1000 pregnancies. Majority of patients (63.7% were older than 35 years, and were nulliparous (45.5%. The commonest symptom was vaginal bleeding (86.4% followed by hyperemesis gravidarum (41.0%; Hyperthyroidism was seen in 1 patient (4.5%. Ovarian enlargement by theca-lutin cyst was seen in 3 patients (13.6%. The majority of patients (63.6% had normal BhCG within 9 weeks (63 days after suction curettage. The majority of the cases followed a benign course. Conclusion: Aged older than 35 years seems a risk factor and vaginal bleeding is the commonest presenting symptom. Early booking of pregnant women to antenatal care clinics and routine first trimester ultrasound made diagnosis easier and earlier before complications appear.

  5. Antibiotic resistance pattern of Enterococci isolates from nosocomial infections in a tertiary care hospital in Eastern India.

    Science.gov (United States)

    Chakraborty, Atreyi; Pal, Nishith K; Sarkar, Soma; Gupta, Manideepa Sen

    2015-01-01

    Resistance to commonly used antibiotics by Enterococci causing nosocomial infections is of concern, which necessitates judicious, responsible and evidence-based use of antibiotics. The present study was conducted to review the prevalence and identify therapeutic options for nosocomial Enterococcal infections in our tertiary care hospital. Isolates identified by morphological and biochemical characteristics were tested for antibiotic susceptibility using Kirby-Bauer method. 153 of 2096 culture positive clinical samples comprised of 101 urine, 30 wound swab/pus, 13 blood and 09 high vaginal swab isolates were identified as Enterococcus faecalis (90.85%), Enterococcus faecium (8.50%) and Enterococcus gallinarum (0.65%). Enterococci accounted for 8.45%, 4.53%, 4.23%, 4.43% of urinary, wound swab or pus, blood, high vaginal swab isolates respectively, causing 7.3% of all nosocomial infections. Significant number of Enterococci isolated from nosocomial urinary tract infection (66.01%) and wound infections (19.6%) were multidrug resistant (MDR). Although all isolates were sensitive to vancomycin and linezolid, resistance to erythromycin (71.24%) and ciprofloxacin (49.67%) was frequently observed. High-level gentamicin resistance was observed in 43.88%, and 61.53% of E. faecalis and E. faecium isolates respectively. Minimal inhibitory concentration of vancomycin of all the isolates were ≤1 μg/ml. 7% of the Enterococcal isolates were MDR strains and vancomycin or linezolid were the only effective antibiotics. A combination of vancomycin and/or linezolid were effective against Enterococci causing nosocomial infections in our tertiary care facility, nevertheless continuous and frequent surveillance for resistance patterns are necessary for judicious and evidence based use of antibiotics.

  6. Clinical presentation and treatment outcome of molar pregnancy: Ten years experience at a Tertiary Care Hospital in Dammam, Saudi Arabia

    Science.gov (United States)

    Al-Talib, Ayman A.

    2016-01-01

    Objectives: To study the clinical presentation and treatment outcome of molar pregnancy at a Tertiary Care Hospital in Dammam, Saudi Arabia. Materials and Methods: Reviewed medical records of all molar pregnancy cases among all the deliveries at a tertiary care hospital in Dammam from 2005 to 2014, after approval by institutional ethical review committee. Data abstracted included patient's age, parity, presenting symptoms, gestational age at diagnosis, uterine size, ultrasonographic findings, BhCG level at the time of diagnosis and at follow-up after evacuation, and blood loss during evacuation. Data was entered and analyzed using Excel; frequency distribution for categorical variables and descriptive statistics for continuous variables were computed. Results: Of a total of 25,000 deliveries in ten years, 22 cases of complete molar pregnancy were encountered: 0.9 cases of molar pregnancy per 1000 pregnancies. Majority of patients (63.7%) were older than 35 years, and were nulliparous (45.5%). The commonest symptom was vaginal bleeding (86.4%) followed by hyperemesis gravidarum (41.0%); Hyperthyroidism was seen in 1 patient (4.5%). Ovarian enlargement by theca-lutin cyst was seen in 3 patients (13.6%). The majority of patients (63.6%) had normal BhCG within 9 weeks (63 days) after suction curettage. The majority of the cases followed a benign course. Conclusion: Aged older than 35 years seems a risk factor and vaginal bleeding is the commonest presenting symptom. Early booking of pregnant women to antenatal care clinics and routine first trimester ultrasound made diagnosis easier and earlier before complications appear. PMID:27625583

  7. A prospective study to assess the efficacy and safety of iron sucrose in pregnant women with iron deficiency anemia in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    R. Nanthini

    2015-12-01

    Conclusion: Parenteral iron therapy was effective in increasing Hb, serum ferritin, and other hematological parameters in pregnant women with moderate anemia. Intravenous iron sucrose complex can be used in tertiary care hospitals where it can replace conventional parenteral iron therapy due to injection-related side effects. [Int J Basic Clin Pharmacol 2015; 4(6.000: 1271-1275

  8. [207-POS]: Termination of pregnancy for hypertensive disorders prior to fetal viability in the Netherlands: A retrospective cohort study in 10 Dutch tertiary care centers

    NARCIS (Netherlands)

    Eerden, L. van; Zeeman, G.G.; Christiaens, G.C.; Vandenbussche, F.P.; Oei, S.G.; Scheepers, H.C.J.; Eyck, J. van; Middledorp, J.M.; Pajkrt, E.; Duvekot, J.J.; Groot, C.J. de; Bolte, A.C.

    2015-01-01

    OBJECTIVES: To ascertain the incidence and demographic data of TOP for hypertensive disorders at the limits of fetal viability. METHODS: We conducted a retrospective cohort study. All terminations for hypertensive disorders between 2000 and 2009 in the ten Dutch tertiary care centers with a gestatio

  9. Incidence of Hospital Acquired Thrombosis (HAT) in a Tertiary Care Hospital.

    LENUS (Irish Health Repository)

    Khan, MI

    2017-04-01

    Venous thromboembolism (VTE) is a major cause of preventable morbidity and mortality in hospitalized patients. In spite of guidelines, VTE prophylaxis continues to be underutilised, and hospital acquired thrombosis (HAT) continues to be a problem. This study was conducted to estimate the incidence of HAT in a tertiary referral centre and to examine whether VTE risk assessment and thromboprophylaxis (TP) were implemented. Patients 18 years and above, with a radiologically-confirmed acute VTE during the study period of 15 weeks were included. Acute VTE was diagnosed in 100 patients and HAT was diagnosed in 48. There were 12,024 admissions over the study period, therefore the incidence of HAT was 0.4%. TP was prescribed in only 35% of patients, and 65% did not receive any or appropriate TP. Hospitals without active implementation of a formal risk assessment tool and TP policy are likely to continue to have increased incidence of HAT.

  10. Spontaneous diabetic myonecrosis: report of four cases from a tertiary care institute

    OpenAIRE

    Mukherjee, Soham; Aggarwal, Anuradha; Rastogi, Ashu; Bhansali, Anil; Prakash, Mahesh; Vaiphei, Kim; Dutta, Pinaki

    2015-01-01

    Summary Spontaneous diabetic muscle infarction (DMI) is a rare and under diagnosed complication of diabetes mellitus. Clinically it presents with acute to subacute onset swelling, pain and tenderness of muscle(s) without systemic manifestations. MRI is helpful in diagnosis, exclusion of other causes and for localization of affected muscle for biopsy in atypical cases. Muscles of the thighs are commonly affected in diabetic myonecrosis (DMN). Here we present the summary of four cases seen in t...

  11. Post-operative analgesia for major abdominal surgery and its effectiveness in a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Aliya Ahmed

    2013-01-01

    Conclusion: Epidural, PCIA and opioid infusions are used for pain relief after major abdominal surgeries at our hospital. Although there is limited drug availability, regular assessments and appropriate dose adjustments by acute pain management service (APMS and use of multimodal analgesia led to a high level of patient satisfaction. We recommend that feedback to the primary anesthesiologists by APMS is of utmost importance to enable improvement in practice.

  12. A prospective, non-interventional study of assessment and treatment adequacy of pain in the emergency department of a tertiary care cancer hospital

    Directory of Open Access Journals (Sweden)

    P N Jain

    2013-01-01

    Full Text Available Introduction: Pain is the most common reason for emergency department (ED visits by the cancer patients. Treatment inconsistency and inadequacy are reported worldwide in the management of ED pain. We conducted a non-interventional observational study of 100 patients visiting ED with moderate to severe pain in a tertiary care cancer center. Aims: The goal of this study was to describe the characteristics of pain and its treatment by oncologists in ED. Materials and Methods: Management of 100 adult patients with complaints of moderate to severe pain was observed by the investigator in ED. Treatment was provided by the doctors of respective oncological services. Later, patients were interviewed by the investigator to collect data about the details of their pain and treatment adequacy. Results: On arrival to ED, about 65% patients reported severe pain, however no formal pain assessment was performed and no patient received strong opioids. Poor compliance for prescribed analgesic medications was noted in a large number of patients (31%, primarily due to suboptimal pain relief and lack of awareness. Protocol based analgesic treatment was non-existent in ED. Majority of patients remained in significant pain after 30 min of analgesic administration and 24% patients could never achieve more than 50% pain relief at the time of discharge. Conclusion: Due to lack of formal pain assessment and laid down protocols, suboptimal pain management is commonly prevalent in ED. Use of strong opioids continues to be scarce in management of severe pain. There is a need to formulate pain management protocols for ED pain.

  13. Study of knowledge, attitude and practices regarding dengue in the urban and rural field practice area of a tertiary care teaching hospital in Pune, India

    Directory of Open Access Journals (Sweden)

    Samir Singru

    2013-01-01

    Full Text Available Context: Dengue is the most common disease among all the arthropod-borne viral diseases. There is no specific treatment or vaccine available for dengue. The sole method of prevention and control is the knowledge attitude and practices (KAP for the same. Although, dengue is considered an urban- and semi-urban disease, in recent years, due to water storage practices and large-scale development activities in rural areas, dengue has become endemic in rural areas of India as well. Aims: To assess the KAP regarding dengue. Settings and Design: Urban and rural field practice area of a Tertiary Care Teaching Hospital in Pune, India. Materials and Methods: A pre-tested, semi-structured questionnaire was used to study the knowledge, attitude, and practices regarding dengue. Stratified random sampling technique was used. A modified B. G. Prasad criterion was used for socio-economic classification. Statistical Analysis Used: KAP represented as proportion (%. Chi-square test was used as a test of significance. P value < 0.05 was considered as statistically significant. Results: 68.4% in urban areas and 40.4% in rural area knew that dengue is transmitted by mosquito. 62.6% in urban areas and 48% in rural areas respectively stated fever as a symptom of dengue. The use of anti-adult mosquito measures was 48.05% and 51.42% in urban and rural area respectively Conclusions: There is a definite need to increase the information education communication activities for dengue in the study area.

  14. Pattern of antidiabetic drugs use in type-2 diabetic patients in a medicine outpatient clinic of a tertiary care teaching hospital

    Directory of Open Access Journals (Sweden)

    Bela Patel

    2013-08-01

    Full Text Available Background: Diabetes mellitus (DM is an important public health problem in developing countries. Drug utilisation study of antidiabetic agents is of paramount importance to promote rational drug use in diabetics and make available valuable information for the healthcare team. The aim of study was to investigate the drug utilization pattern in type-2 diabetic patients. Methods: A prospective, cross-sectional study was carried out in medicine outpatient clinic of tertiary care hospital, Ahmedabad for eight weeks. Patients with type-2 diabetes and on drug therapy for at least one month were included. Patients’ socio-demographic and clinical data were noted in a pre-designed proforma. Data was analysed by using SPSS version 20 and Excel 2007. Results: Total 114 patients were enrolled with mean (± standard deviation age and duration of diabetes of 56.8 ± 10.5 and 8.3 ± 9.4 years respectively. Male: Female ratio was 0.72:1. Mean fasting and postprandial blood glucose levels were 147.5 ± 73.1 and 215.6 ± 97.3 mg/dl respectively. Most common symptom was weakness/fatigue (77.2%. Hypertension (70.2% was most common co-morbid illness. Mean number of drugs prescribed were 7.8 ± 2.5. Total numbers of patients receiving more than five drugs were 89.5%. Most commonly used drug group was biguanides (87.7% followed by sulphonylureas (68.4%. Conclusion: Metformin (biguanide was the most utilized (87.7% antidiabetic drug for type-2 diabetes. This study revealed that the pattern of antidiabetic prescription was rational and largely compliant with NICE (National Institute for Health and Clinical Excellence guidelines. [Int J Basic Clin Pharmacol 2013; 2(4.000: 485-491

  15. Estrogen, progesterone and HER2 receptor expression in breast tumors of patients, and their usage of HER2-targeted therapy, in a tertiary care centre in India

    Directory of Open Access Journals (Sweden)

    J Ghosh

    2011-01-01

    Full Text Available Background: This study was undertaken to document the pattern of expression of estrogen (ER, progesterone (PR and human epidermal growth factor receptor-2 (HER2 and the usage of HER2-targeted therapy in a large tertiary care hospital in India in the year 2008. Materials and Methods: The histopathology reports of all breast cancer patients registered in the hospital in 2008 were extracted from the electronic medical record system. All the cases were immunohistochemically evaluated for estrogen and progesterone receptor status (ER and PR, and c-erbB-2 protein (HER2 expression using standard immunoperoxidase method. The use of HER2-targeted therapies was evaluated by extracting relevant information from the database of the hospital pharmacy and case charts of patients enrolled in ongoing approved trials. Results: A total of 2001 new patients of invasive breast cancers with available pathology reports were registered in the hospital in the year 2008. ER and/or PR expression was positive in tumors of 1025 (51.2% patients. HER2 3+ expression by immunohistochemistry (IHC was found in 335 (16.7% and HER2 2+ in 163 (8.1%. The triple negative phenotype was found in 596 (29.8% patients. An estimated 441 patients were eligible to receive HER2-targeted therapy based on their HER2 status. Of these 38 (8.6% patients received some form of HER2-targeted therapy; 20 patients (4.5% as part of ongoing clinical trials and 18 (4.1% as part of routine care. Conclusions: The overwhelming majority of patients eligible for HER2-targeted therapy in our institution are unable to receive it because of financial constraints and limited access to health insurance. There is a higher fraction of patients with the triple negative phenotype compared to the Western population.

  16. Cobalamin and Folic Acid Status in Relation to the Etiopathogenesis of Pancytopenia in Adults at a Tertiary Care Centre in North India

    Science.gov (United States)

    Premkumar, M.; Gupta, N.; Singh, T.; Velpandian, T.

    2012-01-01

    Background. Pancytopenia has multiple etiologies like megaloblastic anemia, aplastic anemia, leukemia, and various infections. We investigated the clinical, etiological and hematological profile including bone marrow morphology of patients with pancytopenia in relation to their vitamin B12 and folic acid status at a tertiary care referral hospital in north India. Methods. A total of 140 consecutive patients with pancytopenia were selected from June 2007 to December 2008. Bone marrow examination and other tests were carried out as warranted, including serum cobalamin and folate assays using liquid chromatography mass spectroscopy (LC MS/MS). Results. The study population consisted of 92 males and 48 females with a mean age of 32.8 years. Megaloblastic anemia 60.7%, aplastic anemia (7.8%), and leukemia (9.2%) were common causes. Infectious causes (16.4% of all cases) included leishmaniasis, HIV–AIDS, malaria and tuberculosis. Severe cobalamin deficiency (B12 < 100 pg/mL) was seen in 81% of all patients including 91.6% of patients with MA. In contrast, only 7.14% of all pancytopenic patients were folate deficient. Folate deficiency (<5 ng/mL) was seen in just 5% MA patients. Combined cobalamin and folate deficiency was seen in 5 patients (3.51%). Conclusion. Cobalamin deficiency was found to be more common in our setting and is largely underdiagnosed in the age of folate supplementation. Infectious diseases like tuberculosis, leishmaniasis, and increasingly HIV are important and treatable causes of pancytopenia. This is in contrast with the developed nations where the bulk of disease is due to malignancy or marrow aplasia. PMID:22545211

  17. Cobalamin and Folic Acid Status in Relation to the Etiopathogenesis of Pancytopenia in Adults at a Tertiary Care Centre in North India

    Directory of Open Access Journals (Sweden)

    M. Premkumar

    2012-01-01

    Full Text Available Background. Pancytopenia has multiple etiologies like megaloblastic anemia, aplastic anemia, leukemia, and various infections. We investigated the clinical, etiological and hematological profile including bone marrow morphology of patients with pancytopenia in relation to their vitamin B12 and folic acid status at a tertiary care referral hospital in north India. Methods. A total of 140 consecutive patients with pancytopenia were selected from June 2007 to December 2008. Bone marrow examination and other tests were carried out as warranted, including serum cobalamin and folate assays using liquid chromatography mass spectroscopy (LC MS/MS. Results. The study population consisted of 92 males and 48 females with a mean age of 32.8 years. Megaloblastic anemia 60.7%, aplastic anemia (7.8%, and leukemia (9.2% were common causes. Infectious causes (16.4% of all cases included leishmaniasis, HIV–AIDS, malaria and tuberculosis. Severe cobalamin deficiency (B12 < 100 pg/mL was seen in 81% of all patients including 91.6% of patients with MA. In contrast, only 7.14% of all pancytopenic patients were folate deficient. Folate deficiency (<5 ng/mL was seen in just 5% MA patients. Combined cobalamin and folate deficiency was seen in 5 patients (3.51%. Conclusion. Cobalamin deficiency was found to be more common in our setting and is largely underdiagnosed in the age of folate supplementation. Infectious diseases like tuberculosis, leishmaniasis, and increasingly HIV are important and treatable causes of pancytopenia. This is in contrast with the developed nations where the bulk of disease is due to malignancy or marrow aplasia.

  18. Prevalence of macrolide-non-susceptible isolates among β-lactamase-negative ampicillin-resistant Haemophilus influenzae in a tertiary care hospital in Japan.

    Science.gov (United States)

    Wajima, Takeaki; Seyama, Shoji; Nakamura, Yuka; Kashima, Chihiro; Nakaminami, Hidemasa; Ushio, Masanobu; Fujii, Takeshi; Noguchi, Norihisa

    2016-09-01

    β-Lactamase-negative ampicillin-resistant (BLNAR) Haemophilus influenzae account for a large portion of H. influenzae clinical isolates in Japan. The aim of this study was to clarify the antimicrobial susceptibility of BLNAR H. influenzae clinical isolates as well as the annual changes in susceptibility. BLNAR H. influenzae isolates were collected from a tertiary care hospital from 2007 to 2012. Antimicrobial susceptibility testing was performed and resistance mechanisms were analysed. All of the isolates (n=304) had amino acid substitutions in penicillin-binding protein 3 (PBP3) and isolates were classified by these amino acid substitutions: R517H or N526K (class I); S385T and R517H (class II); and S385T and N526K (class III). Classes I, II and III represented 8.2% (n=25), 9.5% (n=29) and 81.6% (n=248) of the isolates, respectively; 2 isolates could not be classified because they had a PBP3 with a substantially mutated FtsI transpeptidase domain. All of the isolates were highly susceptible to fluoroquinolones and carbapenems. The number of clarithromycin (CAM)-non-susceptible [minimum inhibitory concentration (MIC) ≥16μg/mL] H. influenzae isolates increased significantly between 2010 and 2012. Moreover, CAM-non-susceptible H. influenzae isolates were prevalent among class II and class III BLNAR H. influenzae. Multilocus sequence typing (MLST) of the CAM-resistant (MIC ≥32μg/mL) H. influenzae isolates showed that they were not specific sequence types, suggesting that CAM resistance may occur in any isolates. These results raise concern regarding the occurrence of multidrug-resistant BLNAR H. influenzae.

  19. Drug Utilization Study on Acute Poisoning Cases Treated at a Tertiary Care Hospital in Western Part of India

    Directory of Open Access Journals (Sweden)

    Pratik D. Asari

    2016-03-01

    Conclusion: Use of antimicrobial medicines for poisoned patients was too high and irrational.  Due to high incidence of snakebites, hospital stockpiles should be regularly checked for availability of antivenom. Educational programs with emphasis on preventive measures for toxic exposures are necessary to create awareness among the general public.

  20. Pre-hospital and hospital delay in patients with non-ST elevation acute coronary syndromes in tertiary care

    Directory of Open Access Journals (Sweden)

    G.S. Youssef

    2017-09-01

    Conclusion: Pre-hospital delay was mainly patient-related. Hospital delay was mainly related to healthcare resources. Governmental measures to promote ambulance emergency services may reduce the pre-hospital delay, while improving the utilization of healthcare resources may reduce hospital delay.

  1. Evaluation of antivenom therapy for Vipera palaestinae bites in children: experience of two large, tertiary care pediatric hospitals.

    Science.gov (United States)

    Pivko-Levy, Dikla; Munchnak, Itamar; Rimon, Ayelet; Balla, Uri; Scolnik, Dennis; Hoyte, Christopher; Voliovitch, Yair; Glatstein, Miguel

    2017-04-01

    Antivenom has been successfully used to treat systemic and progressive, local manifestations of envenomation inflicted by Vipera (V.) palaestinae, the most common venomous snake in Israel. The objective of this study was to evaluate the fixed dose V. palaestinae monovalent (equine) immunoglobulin G antivenom used in two pediatric emergency departments. In particular, we wanted to assess the need for repeated antivenom administration and the rate of adverse antivenom effects in children. A retrospective chart review was performed for all children admitted with definite or probable signs of V. palaestinae envenomation to Chaim Sheba Medical Center and Kaplan Medical Center between 1 March 2008 and 1 March 2014. Extracted data included: age, location of bite, time to hospital arrival, time to antivenom administration if indicated, outcomes, and complications of the envenomation and adverse effects to the antivenom. 57 patients met inclusion criteria; they ranged from 1 to 17 years in age and median age was 9.5 years. Clinical manifestations were evident in 55 (96.4%) of victims: 18 presented with minimal local signs and 37 showed marked progressive, local features (rapidly progressing edema) and signs of systemic envenomation: tachycardia (20), vomiting (17), abdominal pain (11) and hypotension (6). Two patients developed compartment syndrome and underwent surgical decompression (both received only a loading dose of antivenom with no subsequent maintenance dose). One patient developed thrombocytopenia and three patients presented with mild coagulopathy. Antivenom was administered to 25 (42%) children. Indications for antivenom administration included moderate to severe local signs (19 patients) and systemic signs (6 patients). None of these patients developed adverse reactions, serum sickness, or other side effects to the antivenom. One patient received a single additional 30mL dose of antivenom, due to hypotension and syncope, with good response. In children, 50 ml dosing of V. palaestinae antivenom is efficacious and safe for the treatment of systemic and progressive local manifestations of envenomation by V. palaestinae.

  2. Clinical significance of Staphylococcus saprophyticus identified on blood culture in a tertiary care hospital.

    Science.gov (United States)

    Choi, Sang-Ho; Woo, Jun Hee; Jeong, Jin-Yong; Kim, Nam Joong; Kim, Mi-Na; Kim, Yang Soo; Ryu, Jiso

    2006-11-01

    Staphylococcus saprophyticus is a well-known cause of acute uncomplicated urinary tract infection in young women. However, the clinical significance of this organism isolated from blood culture has not been determined. We assessed the clinical significance and characteristics of S. saprophyticus identified on blood culture. A total of 24 patients were identified, and 7 patients (29.2%) were considered to have clinically significant bacteremia. Of the 7 patients with clinically significant bacteremia, hematologic malignancy was the most common underlying illness (5 patients), and tunneled-central venous catheter was the most common portal of entry (4 patients). In no case did S. saprophyticus bacteremia originate from the urinary tract. One patient died during hospitalization. However, the death was not directly related to bacteremia. In conclusion, our data suggest that bacteremia caused by S. saprophyticus is most commonly associated with tunneled-central venous catheter in patients with hematologic malignancies and may be associated with a lower risk of mortality.

  3. Clinico-microbiological study of diabetic limb amputations in a tertiary care hospital in North India

    Directory of Open Access Journals (Sweden)

    Rajpal Singh Punia

    2015-04-01

    Full Text Available The diabetic population faces 80% increased risk of cellulitis, 4-fold increased risk of osteomyelitis and 2-fold risk of both sepsis and death caused by infections.Study objectives.The present study was carried out to assess the clinical aspects and microbiological profile of organisms isolated from 25 patients undergoing diabetic limb amputations.Materials and Methods. In 25 diabetes persons who underwent limb amputation, grading of ulcers was done according to Wagner system. Material was stained with Gram stain. Potassium hydroxide wet mounts were also studied. Culture was done in blood agar, MacConkey agar, Sabouraud dextrose agar tube slants and brain heart infusion broth and examined for growth. The histopathology sections were also studied and special stains were done.Results. Of 25 cases, 16 were males and 9 were females. The age ranged from 30 to 90 years (mean: 58±10.91. Majority of ulcers were grade 3. Osteomyelitis was seen in 13 (52% cases; acute in 2 (8%, chronic in 3 (12% and acute exacerbation of chronic osteomyelitis in 8 (32% cases. On culture Proteus mirabilis was isolated in majority of cases followed by Escherichia coli. In 20 cases more than one bacterium were isolated. Candida was cultured in 8 cases followed by Trichosporon in 2 and Fusarium in one case. On histopathology Candida was seen in 3 cases, while one case showed spores of Trichosporon. 80% cases with osteomyelitis had polymicrobial infection.Conclusions. The isolation of etiologic agent helps in administering appropriate antibiotic regimens, thus reducing the problem of multidrug resistance, morbidity and surgical limb amputations in patients suffering from diabetes mellitus.

  4. Clinical manifestations and outcome of patients with human immunodeficiency virus infection at tertiary care teaching hospital

    Directory of Open Access Journals (Sweden)

    Virendra Chandrashekhar Patil

    2016-01-01

    Full Text Available Background: AIDS has become chronic illness which is well treated with antiretroviral therapy and management of opportunistic infections (OIs. Aims and Objectives: The study clinical profile and outcome of human immunodeficiency virus (HIV seropositive patients. Materials and Methods: This was retrospective observational study carried out over a period of 1 year (January 2011–December 2011. All HIV patients admitted in medicine ward, and ICU were enrolled. Statistical analysis was performed using SSPE statistical software trial version 11. The P< 0.05 was considered as statistically significant. Results: Of total 111 patients with a diagnosis of HIV/AIDS, 75 (67.56% were male and 36 (32.43% were female patients. A total 52 (46.84% patients presented with respiratory manifestations, of them 23 (44.23% had pulmonary tuberculosis (TB, 6 (11.53% had tubercular effusion, and 3 (5.76% had Pneumocystis jirovecii pneumonia. Respiratory manifestations including pulmonary TB were the most common presentation (P< 0.001. Total 27 (24.32% patients were presented with the neurological manifestation of them 8 (29.62% had a cerebro-vascular accident, 5 (18.51% had cryptococcal meningitis, 4 (14.81% had tubercular meningitis, and 1 (3.70% had progressive multifocal leukoencephalopathy. Total 12 (38.70% had acute gastroenteritis 6 (19.35% had oral candidiasis, 8 (25% had general tonic clonic seizure and 7 (21.87% had pyrexia of unknown origin, 6 (18.75% had septicemia, 6 (18.75% had acute renal failure, and 6 (94.11% had anemia. A total 11 (9.90% patients succumbed. Conclusions: Overall respiratory manifestations were the common presentation in a present cohort of HIV seropositive patients and TB was the most common OI and the cerebrovascular accident was the most common neurological manifestation.

  5. Hypertensive crisis in children: an experience in a single tertiary care center in Korea.

    Science.gov (United States)

    Lee, Geum Hwa; Lee, I Re; Park, Se Jin; Kim, Ji Hong; Oh, Ji Young; Shin, Jae Il

    2015-01-01

    Hypertensive crisis is a medical emergency that can cause acute damage to multiple end-organs. However, relatively little is known on the etiology, treatment, and outcomes of hypertensive crisis in Korean children. The aim of this study was to determine the etiologies and efficacy of drugs for hypertensive crisis in children during the past 5 years at a single center in Korea. We analyzed data from 51 children with hypertensive crisis during the period between January 1, 2010 and April 1, 2014. The patients were divided into two groups: those diagnosed with a hypertensive emergency (hypertension with organ injury, n = 31) and those diagnosed with a hypertensive urgency (hypertension without organ injury, n = 20). Baseline etiologies and risk factors were compared between the two groups. In addition, systolic and diastolic blood pressures were evaluated at 1, 2, 4, and 5 hours after the administration of intravenous antihypertensive drugs. Kidney injury and cancer were the common causes in patients with hypertensive crisis. Cardiovascular complications (cardiac hypertrophy) (p = 0.002), central nervous system complications (p = 0.004), and retinopathy (p = 0.034) were more frequently observed in children with hypertensive emergency than those with hypertensive urgency. However, the proportion of renal complications was similar in both groups. Hydralazine was most commonly used in both groups to control acute increasing blood pressure at first. However, it was often ineffective for controlling abrupt elevated blood pressure. Therefore, intravenous antihypertensive drugs were changed from hydralazine to nicardipine, labetalol, or nitroprusside to control the high blood pressure in 45.1 % of the patients. Particularly, in patients with hypertensive crisis, there was no significant difference in reduction of systolic and diastolic blood pressure and in improvement of clinical outcomes between nicardipine and labetalol administration. Close blood

  6. Genotype 3b of human parvovirus B19 detected from hospitalized children with solid malignancies in a North Indian tertiary care hospital.

    Science.gov (United States)

    Jain, Amita; Jain, Parul; Prakash, Shantanu; Kumar, Archana; Khan, Danish N; Seth, Akansha; Gupta, Shikha; Kant, Ravi

    2016-11-01

    Human parvovirus B19 (B19V) infection is known to cause serious consequences in immuno-compromized individuals. The present cross sectional study was designed to estimate the prevalence and genotype distribution of B19V in children receiving chemotherapy for solid malignancies at a tertiary care hospital in North India during October 2013 to May 2015. Serum samples from all the patients were tested for anti-B19V IgM and IgG antibodies and for B19V-DNA as soon as received. Samples testing positive for B19V-DNA were subjected to viral load estimation and to genotype determination by sequencing. Total 96 children were enrolled of which 9 (9.3%), 32 (33.3%), and 25 (26%) tested positive for anti-B19V IgM, anti-B19V IgG, and B19V-DNA, respectively. The viral load of B19V-DNA positive children ranged from 5.5 × 10(2) to 3.5 × 10(12) copies/ml. Accordingly children were divided into three groups: group I, with acute infection (n = 25); group II, previously exposed (n = 27), and group III, negative for B19V infection or with inappropriate antibody response (n = 44). B19V positivity was significantly associated (P-value < 0.0001) with a history of blood transfusion in the past 6 months, severe anemia (hemoglobin levels <6 gm%) and thrombocytopenia (platelets <150,000/cu.mm.). Sequence analysis of 21 of 25 DNA positive samples showed that all of them were Genotype 3b that clustered into three groups. All the sequences within each cluster were identical. The nucleotide identity of the sequences suggests a nosocomial outbreak of B19V during the study period. Children on chemotherapy for solid tumors should be routinely screened for B19V infection by both serology and PCR. J. Med. Virol. 88:1922-1929, 2016. © 2016 Wiley Periodicals, Inc.

  7. Prescription patterns and appropriateness of antibiotics in the management of cough/cold and diarrhea in a rural tertiary care teaching hospital

    Directory of Open Access Journals (Sweden)

    Akram Ahmad

    2016-01-01

    Full Text Available Background: Acute gastroenteritis and respiratory illnesses are the major causes of morbidity and mortality in children under 5 years of age. The objective of this study was to evaluate the prescription pattern of antibiotic utilization during the treatment of cough/cold and/or diarrhea in pediatric patients. Methods: A descriptive, cross-sectional study was conducted for 6 months in pediatric units of a tertiary care hospital in South India. Children under 5 years of age presenting with illness related to diarrhea and/or cough/cold were included in this study. Data were collected by reviewing patient files and then assessed for its appropriateness against the criteria developed in view of the Medication Appropriateness Index and Guidelines of the Indian Academy of Pediatrics. The results were expressed in frequencies and percentages. Chi-square test was used to analyze the data. A P < 0.05 was considered statistically significant. Results: A total of 303 patients were studied during the study period. The mean age of the patients was 3.5 ± 0.6 years. The majority of children were admitted mainly due to chief complaint of fever (63% and cough and cold (56.4%. The appropriateness of antibiotic prescriptions was higher in bloody and watery diarrhea (83.3% and 82.6%; P< 0.05. Cephalosporins (46.2% and penicillins (39.9% were the most commonly prescribed antibiotics, though the generic prescriptions of these drugs were the lowest (13.5% and 10%, respectively. The seniority of prescriber was significantly associated with the appropriateness of prescriptions (P < 0.05. Antibiotics prescription was higher in cold/cough and diarrhea (93.5% in comparison to cough/cold (85% or diarrhea (75% alone. Conclusions: The study observed high rates of antibiotic utilization in Chidambaram during the treatment of cough/cold and/or diarrhea in pediatric patients. The findings highlight the need for combined interventions using education and expert counseling

  8. HOSPITALIZATIONS DUE TO RESPIRATORY PROBLEMS DURING DIWALI FESTIVAL IN A TERTIARY CARE HOSPITAL IN SOUTH INDIA

    Directory of Open Access Journals (Sweden)

    Raghu

    2016-02-01

    Full Text Available BACKGROUND The burning of firecrackers during Diwali festival produces an adverse respiratory outcome. However, there are no published articles on the impact of fireworks on hospital admission due to acute respiratory issues, hospital stay, and respiratory mortality during Diwali in India. MATERIALS AND METHODS This was a prospective, open label, observational study. It was conducted in patients admitted to the pulmonary emergency unit with respiratory symptoms 15 days before and after Diwali. It was conducted after the approval of ethics committee and written informed consent. RESULTS The number of admissions post-Diwali were significantly more compared to pre-Diwali from both rural and urban locations (p<0.001. The mean duration of hospital stay was significantly less pre-Diwali (7.59±0.74 days compared to post-Diwali (9.46±0.44 days. Also, significantly increased number of patients required ventilator support post Diwali. CONCLUSION The findings from the present study validate the deterioration of respiratory health during Diwali festival in India. There should be more awareness campaigns about the harmful effects of fire-crackers. Patients suffering from respiratory problems should be advised to avoid heavy exposure to fireworks

  9. Kerosene-a toddler's sin: A five years study at tertiary care hospital in western India.

    Science.gov (United States)

    Parekh, Utsav; Gupta, Sanjay

    2017-04-01

    Acute kerosene poisoning is a preventable health problem in children perceived mainly in developing countries. It influences socioeconomic and cultural status of country due to its contribution in morbidity and mortality. As kerosene is widely used as household energy source in India at rural areas as well as urban, it accounts for significant number of poisoning cases mainly accidental in manner. As there are only handful studies from India on kerosene poisoning in children, we planned this study to evaluate incidence of kerosene poisoning in Western Indian population and its clinico-epidemiotoxicological profile. In this retrospective cross-sectional study, we collected data of all the cases of kerosene poisoning diagnosed during five years from 2009 to 2013 at Shri Krishna hospital situated at Karamsad, Gujarat state of Western India. We observed among total 42 cases, all victims were under 3 years of age. Evening in summer months, rural areas, storage of kerosene in household containers, inadequate parental supervision and door-to-hospitalization period emerged as most serious associated factors. Fever, cough, vomiting, tachypnoea and leucocytosis were commonest manifestations while pneumonia was the most common complication. Signs of central nervous system involvement, leucocytosis and vomiting were significantly correlated with pneumonia. Deaths occurred due to pneumonia. Early diagnosis and treatment of pneumonia may reduce mortality and recommendations are made to reduce the incidence of kerosene poisoning. Copyright © 2017 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  10. Dengue fever in Czech travellers: A 10-year retrospective study in a tertiary care centre.

    Science.gov (United States)

    Trojánek, Milan; Maixner, Jan; Sojková, Naděžda; Kynčl, Jan; Roháčová, Hana; Marešová, Vilma; Stejskal, František

    2016-01-01

    Dengue fever is a frequent cause of morbidity in travellers. The objective was to describe the epidemiological and clinical characteristics of dengue fever in Czech travellers. This descriptive study includes patients with acute dengue fever diagnosed at Hospital Na Bulovce during 2004-2013. Data were collected and analysed retrospectively. A total of 132 patients (83 males and 49 females) of median age 33 years (IQR 29-40) were included. Diagnosis was established by NS1 antigen detection in 87/107 cases (81.3%) and/or RT-PCR in 50/72 (69.4%) and by serology in 25 cases (18.9%). Dengue was acquired in South-East Asia in 69 cases (52.3%), followed by South Asia (48 cases; 36.3%), Latin America (14; 10.6%) and Sub-Saharan Africa (1; 0.8%). The most frequent symptoms included fever, rash and headache. Initial leukocyte and lymphocyte counts were lower in patients who presented in the early phase (0-4 days), however, platelet count was lower and AST, ALT and LDH activity higher in patients with a longer symptoms duration (≥5 days). The clinical course was mostly uncomplicated. Dengue fever is becoming a frequent cause of fever in Czech travellers. Clinicians should be familiar with the typical clinical findings and novel diagnostic methods. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Bacteriological profile and antibiotic susceptibility patterns of clinical isolates in a tertiary care cancer center

    Directory of Open Access Journals (Sweden)

    Vivek Bhat

    2016-01-01

    Full Text Available Introduction: This increased risk of bacterial infections in the cancer patient is further compounded by the rising trends of antibiotic resistance in commonly implicated organisms. In the Indian setting this is particularly true in case of Gram negative bacilli such as Escherichia coli, Klebsiella pneumoniae and Acinetobacter spp. Increasing resistance among Gram positive organisms is also a matter of concern. The aim of this study was to document the common organisms isolated from bacterial infections in cancer patients and describe their antibiotic susceptibilities. Methods: We conducted a 6 month study of all isolates from blood, urine, skin/soft tissue and respiratory samples of patients received from medical and surgical oncology units in our hospital. All samples were processed as per standard microbiology laboratory operating procedures. Isolates were identified to species level and susceptibility tests were performed as per Clinical Laboratory Standards Institute (CLSI guidelines -2012. Results: A total of 285 specimens from medical oncology (114 and surgical oncology services (171 were cultured. Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus and Acinetobacter spp. were most commonly encountered. More than half of the Acinetobacter strains were resistant to carbapenems. Resistance in Klebsiella pneumoniae to cephalosporins, fluoroquinolones and carbapenems was >50%. Of the Staphylococcus aureus isolates 41.67% were methicillin resistant. Conclusion: There is, in general, a high level of antibiotic resistance among gram negative bacilli, particularly E. coli, Klebsiella pneumoniae and Acinetobacter spp. Resistance among Gram positives is not as acute, although the MRSA incidence is increasing.

  12. Profile of children admitted with seizures in a tertiary care hospital of Western Nepal

    Science.gov (United States)

    2013-01-01

    Background Seizure is one of the common causes of childhood hospitalization with significant mortality and morbidity. There is limited data regarding acute seizures episodes form the developing countries. Current study aims to find the common etiology of seizure and classify seizure types in various age groups presenting to tertiary center in Western Nepal. Methods This was a hospital based retrospective study carried out in the data retrieved from the records maintained in the Department of Pediatrics, Manipal Teaching Hospital, Pokhara from 1st July 2007 to 31st July 2011.Variables collected were demographics, clinical presentations, laboratory tests, brain imaging studies, electroencephalography, diagnosis and hospital course. Results A total of 551 patients were admitted for seizures with 338 (61.3%) males and 213 (38.7%) females. Among these patients, 295 (53.5%) presented with fever and 317 (57.5%) of children were less than 5 years of age. Generalized tonic-clonic seizures were the most common seizure type (69.9%). Seizure disorder (33.4%), febrile seizures (30.7%), CNS infections and neurocysticercosis were common etiologies. Abnormal brain images were noted in 111 (45.9%) of 242 patients and most common abnormality was neurocysticercosis 66 (59.5%). Conclusion CNS infections and febrile convulsions were common causes of seizures in febrile children. Neuroimaging should be advised in all afebrile children for the diagnosis of neurocysticercosis. Children diagnosed as seizure disorder require long term follow up studies including neurophysiologic studies. PMID:23536998

  13. A terrorist bomb blast, a real challenge for any tertiary care health provider.

    Science.gov (United States)

    Singh, Shiv Kumar; Kumar, Amit; Katyal, Surabhi

    2014-01-01

    Multiple casualties and the complex set of injuries in survivors of a terrorist bomb blast poses a real challenge to health care providers. We are presenting three such cases, first case suffered a fracture of both bone lower limb bilaterally along with head injury (foreign bodies were impacted in the scalp and brain parenchyma). Following primary resuscitation, patient shifted to operation theatre after a quick computerized tomography scan and external fixator applied in general anesthesia using the rapid sequence induction. No active neurosurgical intervention was done. As this patient had acute post-traumatic stress response, he was subjected to low pressure hyperbaric oxygen therapy (pressure of 1.5 ATA for 60 min a day for 10 days) and group counseling. He had good recovery except one lost a limb because of extensive neurovascular damage due to blast. Second case had much more extensive damage involving multiple organ systems. He had blast lung, big cerebrovascular hemorrhage along with gut perforation. Despite best possible surgical and intensive care interventions, patent developed multiple organ failure and unfortunately we lost our patient. Third case was of a right sided globe rupture resulted from blast induced flying foreign bodies. After primary survey and initial resuscitation evisceration done for the damaged eye and patient later on discharged with necessary instruction (including warning signs) for follow-up.

  14. Epidemiology of Norovirus Infection Among Immunocompromised Patients at a Tertiary Care Research Hospital, 2010–2013

    Science.gov (United States)

    Bok, Karin; Prevots, D. Rebecca; Binder, Alison M.; Parra, Gabriel I.; Strollo, Sara; Fahle, Gary A.; Behrle-Yardley, Allison; Johnson, Jordan A.; Levenson, Eric A.; Sosnovtsev, Stanislav V.; Holland, Steven M.; Palmore, Tara N.; Green, Kim Y.

    2016-01-01

    Background. Noroviruses are a major cause of infectious gastroenteritis worldwide, and viruses can establish persistent infection in immunocompromised individuals. Risk factors and transmission in this population are not fully understood. Methods. From 2010 through 2013, we conducted a retrospective review among immunocompromised patients (n = 268) enrolled in research studies at the National Institutes of Health Clinical Center and identified a subset of norovirus-positive patients (n = 18) who provided stool specimens for norovirus genotyping analysis. Results. Norovirus genome was identified by reverse-transcription quantitative polymerase chain reaction in stools of 35 (13%) of the 268 immunocompromised patients tested, and infection prevalence was 21% (11 of 53) in persons with primary immune deficiencies and 12% (20 of 166) among persons with solid tumors or hematologic malignancies. Among 18 patients with norovirus genotyping information, norovirus GII.4 was the most prevalent genotype (14 of 18, 78%). Persistent norovirus infection (≥6 months) was documented in 8 of 18 (44%) individuals. Phylogenetic analysis of the GII.4 capsid protein sequences identified at least 5 now-displaced GII.4 variant lineages, with no evidence of their nosocomial transmission in the Clinical Center. Conclusions. Norovirus was a leading enteric pathogen identified in this immunocompromised population. Both acute and chronic norovirus infections were observed, and these were likely community-acquired. Continued investigation will further define the role of noroviruses in these patients and inform efforts toward prevention and treatment. PMID:27800529

  15. A terrorist bomb blast, a real challenge for any tertiary care health provider

    Science.gov (United States)

    Singh, Shiv Kumar; Kumar, Amit; Katyal, Surabhi

    2014-01-01

    Multiple casualties and the complex set of injuries in survivors of a terrorist bomb blast poses a real challenge to health care providers. We are presenting three such cases, first case suffered a fracture of both bone lower limb bilaterally along with head injury (foreign bodies were impacted in the scalp and brain parenchyma). Following primary resuscitation, patient shifted to operation theatre after a quick computerized tomography scan and external fixator applied in general anesthesia using the rapid sequence induction. No active neurosurgical intervention was done. As this patient had acute post-traumatic stress response, he was subjected to low pressure hyperbaric oxygen therapy (pressure of 1.5 ATA for 60 min a day for 10 days) and group counseling. He had good recovery except one lost a limb because of extensive neurovascular damage due to blast. Second case had much more extensive damage involving multiple organ systems. He had blast lung, big cerebrovascular hemorrhage along with gut perforation. Despite best possible surgical and intensive care interventions, patent developed multiple organ failure and unfortunately we lost our patient. Third case was of a right sided globe rupture resulted from blast induced flying foreign bodies. After primary survey and initial resuscitation evisceration done for the damaged eye and patient later on discharged with necessary instruction (including warning signs) for follow-up. PMID:25886231

  16. “Near Miss” Obstetric Events and Maternal Deaths in a Tertiary Care Hospital: An Audit

    Directory of Open Access Journals (Sweden)

    Roopa PS

    2013-01-01

    Full Text Available Objectives. (1 To determine the frequency of maternal near miss, maternal near miss incidence ratio (MNMR, maternal near miss to mortality ratio and mortality index. (2 To compare the nature of near miss events with that of maternal mortality. (3 To see the trend of near miss events. Design. Audit. Setting. Kasturba Hospital, Manipal University, Manipal, India. Population. Near miss cases & maternal deaths. Methods. Cases were defined based on WHO criteria 2009. Main Outcome Measures. Severe acute maternal morbidity and maternal deaths. Results. There were 7390 deliveries and 131 “near miss” cases during the study period. The Maternal near miss incidence ratio was 17.8/1000 live births, maternal near miss to mortality ratio was 5.6 : 1, and mortality index was 14.9%. A total of 126 cases were referred, while 5 cases were booked at our hospital. Hemorrhage was the leading cause (44.2%, followed by hypertensive disorders (23.6% and sepsis (16.3%. Maternal mortality ratio (MMR was 313/100000 live births. Conclusion. Hemorrhage and hypertensive disorders are the leading causes of near miss events. New-onset viral infections have emerged as the leading cause of maternal mortality. As near miss analysis indicates the quality of health care, it is worth presenting in national indices.

  17. Urinary tract infections in the era of newer immunosuppressant agents : A tertiary care center study

    Directory of Open Access Journals (Sweden)

    Khanna Pallavi

    2010-01-01

    Full Text Available We studied the incidence and the risk factors predisposing to post transplantation urinary tract infection (UTI and the association with use of different immunosuppressive regimens. We performed a retrospective analysis of 152 recipients of renal transplantation over a period of two years. Seventy one (46.71% patients had culture positive UTI, Escherichia coli (45.1% being the commonest. Thirty four (22.39% patients had acute rejection and 14.4% of those had suffered UTI in the early post transplant period. Immunosuppression included induction with various anti-bodies and maintenance on antirejection medications. Trimethoprim-sulphamethoxazole was given as prophylaxis throughout the period. The UTI was treated according to microbiological sensitivity. 2.8% died due to urosepsis. In our retrospective analysis renal transplant recipients under the age of 45, female gender and diabetics suffered more UTI. Combination therapy with micro-emulsion form of cyclosporine A, prednisolone and azathioprine developed more UTI (P= 0.0418.

  18. Neurodevelopment of very low birth weight infants in the first two years of life in a Havana tertiary care hospital.

    Science.gov (United States)

    Cejas, Gianny; Gómez, Yahima; Roca, María del Carmen; Domínguez, Fernando

    2015-01-01

    Improved survival rates of neonates with very low birth weight (Havana tertiary care hospital. A case-series study was conducted to assess neurodevelopment outcomes of very low birth weight infants over their first two years of life. The study population comprised 116 surviving neonates with very low birth weight (Havana, Cuba, 2006-2010. A longitudinal, multidisciplinary and interdisciplinary follow up of all infants' neurodevelopment was performed, from hospital discharge to age two years, corrected for gestational age at birth. Data on each infant's perinatal variables were collected: birth weight in grams, gestational age at birth, and 1-minute and 5-minute Apgar scores. Patients were classified as having normal neurodevelopment, mild abnormalities and moderate-to-severe abnormalities. Pearson's chi-square test was used to determine possible relationships between perinatal variables studied and neurodevelopment, with exact sampling distribution and 95% confidence level. Normal neurodevelopment was observed in 69% of very low birth weight infants, 25.9% had mild abnormalities, and 5.2% displayed moderate-to-severe abnormalities. The results demonstrate a statistically significant relationship between gestational age and neurodevelopmental outcomes; more neurodevelopmental abnormalities were found in infants born at earlier gestational age (<30 weeks). Surviving very low birth weight neonates with lower gestational age at birth face a higher risk of neurodevelopmental abnormalities.

  19. Ecology of blood stream infection and antibiotic resistance in intensive care unit at a tertiary care hospital in North India

    Directory of Open Access Journals (Sweden)

    Chand Wattal

    2014-06-01

    Full Text Available OBJECTIVE: To analyse the prevalent microorganisms and their antimicrobial resistance among intensive care unit patients in a tertiary care centre in New Delhi. METHODS: A retrospective study of all consecutive blood cultures from various intensive care unit patients in the hospital during four years (January 2008 to December 2011. Antibiotic consumption data in the intensive care units were also analysed during the same period. RESULTS: Out of the total 22,491 blood cultures processed, 2846 samples were positive and 3771 microorganisms were isolated. The blood culture positivity was estimated as 12.7% of which 67.5% were monomicrobial and 32.5% polymicrobial infections. Gram negative bacilli, Gram positive cocci, and fungi were isolated in 49%, 33%, and 18% cases, respectively. Coagulase negative staphylococcus was the commonest single isolate followed by Candida spp. A drastic shift in the distribution of Candida spp. towards nonalbicans along with high resistance to azole group of antifungals suggest echinocandins for the empiric therapy of candidemia. High penicillin resistance in Gram positive isolates suggest vancomycin, linezolid and tigecycline as the options for empiric therapy, whereas tigecycline and colistin are the only options remaining for highly resistant Gram negative isolates. Aminoglycosides were observed to have better sensitivity and reduced usage when compared with cephalosporins and ß-lactam + ß-lactam inhibitor combinations. CONCLUSIONS: High frequencies of multidrug resistant organisms were observed in intensive care units which is a warning as to use the only few effective antimicrobials wisely to reduce selective pressure on sensitive strains.

  20. A PROSPECTIVE OBSERVATIONAL STUDY OF SHORT TERM MORBIDITY PATTERN IN PRETERM NEWBORNS DELIVERED IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Harsha

    2015-08-01

    Full Text Available OBJECTIVE: To study the short term morbidity pattern in preterm new born babies delivered in a tertiary care hospital with level III neonatal intensive care unit (NICU. MATERIAL AND METHODS: A prospective observational study was conducted in a level III NICU betwee n November 2009 to July 2010 at Grant medical college and JJ Group of hospitals, Mumbai. All the in born preterm babies were assessed for morbidity pattern from the time of admission till discharge or death. RESULT: 156 preterm babies were included in the study. 83(54.21% were male and 73(46.79% were female. The major morbidities observed in the preterm neonates were hyperbilirubinemia in 50.54%, Respiratory distress syndrome (RDS in25.64% and severe birth asphyxia in13.46%. Other common morbidities seen were retinopathy of prematurity in 12.17%, apnoea in 11.54% and anaemia in 10.9%. Preterm neonates also had in 9.62% culture proven sepsis, in 8.33% hypoglycaemia, in 7.05% Intraventricular haemorrhage (IVH and in 6.41% various congenital anomalies. CONCL USION: Hyperbilirubinemia, respiratory distress syndrome and severe birth asphyxia are major preterm morbidity

  1. Progressive multifocal leucoencephalopathy in HIV/AIDS: Observational study from a tertiary care centre in northern India

    Directory of Open Access Journals (Sweden)

    S K Sharma

    2013-01-01

    Full Text Available Background & objectives: Progressive multifocal leucoencephalopathy (PML is seen mostly in advanced human immunodeficiency virus (HIV infection. Little is known about the epidemiology and disease course of these patients from India. This study was aimed to determine the frequency of PML in patients with HIV/AIDS, and the clinical features and survival of these patients. Methods: The charts of HIV/AIDS patients with PML seen over a period of five years (2006-2011 at the Antiretroviral treatment (ART centre at a tertiary care centre in New Delhi, India, were retrospectively reviewed. Results: Of 1465 patients with HIV/AIDS, 18 (1.2% were diagnosed with PML; four were laboratory confirmed and 14 had consistent clinical and radiological features. PML was the initial presentation of HIV infection in 10 (56% patients, and 16 (89% patients had CD4 count less than 200/μl. Insidious onset focal limb weakness (78% and visual disturbance (28% were common symptoms. Magnetic resonance imaging (MRI of the brain revealed characteristic white matter lesions in all the patients. The estimated median survival was 7.6 months (95% CI, 0-20 months. Interpretation & conclusions: Our results show that the patients present late to access treatment with advanced immunosuppression at presentation. PML is associated with high morbidity and mortality despite institution of highly active antiretroviral therapy (HAART. There is a need to address the lacuna in diagnostic and management services for these patients in India.

  2. A STUDY OF DISTRIBUTION OF ABO AND RH BLOOD GROUPS SYSTEM AMONG BLOOD DONORS AT A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Rajesh Kumar

    2015-02-01

    Full Text Available Up till now about 400red cells antigen have been identified. The majority are inherited by Mendelian fashion. The ABO and Rh blood group system was first to be identified and is most important for blood transfusion purposes. OBJECTIVE: This study was conducted to determine the frequency of ABO and Rhesus (Rh blood groups in a tertiary care teaching hospital in India. MATERIALS AND METHODS: A retrospective data based study was conducted at blood bank , Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh, India over a period of four years. RESULTS: Study includes a record of 3188 (28.54% voluntary and 7982 (71.46% replacement donors attending blood bank from February 2011 to January 2015. Out of 11170, 10723(95.998% were male and 447(4.002% female donors. The most common blood group was found to be B in 4013 (35.927% donors followed by O in 3462 (30.994% donors , an in 2516 (22.524% donors and AB in 1179 (10.555% donors. Out of these, 10659(95.425% donors were Rh - positive while 511 ( 4.575 % were Rh - negative.

  3. A prospective audit of transfusion requests in a tertiary care hospital for the use of fresh frozen plasma

    Directory of Open Access Journals (Sweden)

    Makroo R

    2007-01-01

    Full Text Available Aims and Background: Like any other drug, therapeutic use of fresh frozen plasma (FFP has its own side effects, adverse reactions and risks involved. Overall use of FFP has been on the increase in most tertiary care hospitals. Since the guidelines for FFP use in a clinical setting are not well defined, the present study aims at defining the appropriateness of use of FFP in the light of its risks and benefits as a drug. Materials and Methods: We carried out a prospective survey of 821 transfusion orders for 2,915 units of fresh frozen plasma components in our hospital over a 4-month period and recorded indication for transfusion and the number of components requested. Results: Five hundred seventy-three (69.8% of transfusion requests affecting 2,202 (75.54% units of FFP were appropriately indicated, while 248 (30.2% of FFP requests were inappropriately indicated. The majority of fresh frozen plasma requests used were for surgical bleeding (22.77% because of the deranged coagulation profile before surgery in most of the patients. It was followed by liver disease and transplantation (12.54%. Out of 821 patients, 586 were male and 235 were female. Conclusion: Inappropriate requests accounted for 30.2% of the total FFP requests in patients who had normal coagulation parameters. Regular audits, appropriate training of medical staff, conducting regular CMEs are the measures being incorporated in our hospital to rationalize the use of blood components.

  4. Hopelessness and Suicidal Ideation among Patients with Depression and Neurotic Disorders Attending a Tertiary Care Centre at Eastern Nepal.

    Science.gov (United States)

    Pokharel, R; Lama, S; Adhikari, B R

    2016-09-01

    Hopelessness is thought to result from a negative appraisal system and interacts with, and worsens, appraisals of defeat and trap which in turn interact with suicide schema and lead to suicidal behaviour. This study was intended to assess hopelessness and suicidal ideation among patients with depression and neurotic disorders at tertiary care centre of eastern Nepal. A cross sectional design included 70 respondents by purposive sampling technique. Beck Hopelessness Scale and Scale of Suicidal Ideation were used to measure hopelessness and suicidal ideation, respectively. Data were analyzed using SPSS statistical software. Pearson chi-square, binary logistic regression and Spearmans' rho, test were applied at 95% confidence interval. Mean ± SD age was 32.8 ± 13.5 years. Most (62.8%) of the patients were female and with the diagnosis of depression. Majority (66%) of the patients had hopelessness. There was no significant difference in hopelessness among patients with depression and neurotic disorders. About 17% respondents had suicidal ideation, among them 82.4% were female. There was no significant difference of suicidal ideation among patients with depression and neurotic disorders (p=0.013). Significant positive correlation between hopelessness and suicidal ideation was found (p=0.001). Binary logistic regression revealed hopelessness was independently related to income and family history of mental illness. Similarly, suicidal ideation was independently related to depression and family history of mental illness. Female respondents, people living under poverty and positive family history of mental illness had more hopelessness and suicidal ideation.

  5. High rate of complicated idiopathic gallstone disease in pediatric patients of a North American tertiary care center

    Institute of Scientific and Technical Information of China (English)

    Denise Herzog; Guylaine Bouchard

    2008-01-01

    AIM:To assess spectrum and etiology of gallstones and biliary sludge in the pediatric population of a North American tertiary care centre.METHODS:Retrospective review of abdominal ultrasounds recorded at Saint Justine Hospital over a period of 24 mo(8/2003 to 8/2005)in patients<19 years of age.Patients<2 years of age were analyzed separately.RESULTS:The presence of gallstones was noted in 127 patients.In 107 it was a new diagnosis,in 48/105 (45.7%)patients>2 years of age idiopathic gallstone disease was found.These 48 patients represent 2.1% of the population who required ultrasound for abdominal pain.Complicated gallstone disease occurred in 28/48 with idiopathic disease,mainly adolescent girls.Patients with hemolytic disorders,cystic fibrosis,oncologic diseases or kidney transplantation and gallstones were asymptomatic and stones were detected during routine abdominal ultrasound.Twenty two patients<2 years of age not consulting for abdominal pain had gallstone disease of diverse etiology.Biliary sludge was seen in 84 patients,78.5% on total parenteral nutrition.In 4 patients,sludge progressed to gallstones.CONCLUSION:Idiopathic gallstone disease and its rate of complication are more frequent in our cohort than expected from previous studies.Adolescent girls with abdominal pain and idiopathic gallstones require special attention for complicated disease course.

  6. Prescribing practices of topical corticosteroids in the outpatient dermatology department of a rural tertiary care teaching hospital.

    Science.gov (United States)

    Rathod, Suvarna S; Motghare, Vijay M; Deshmukh, Vinod S; Deshpande, Rushikesh P; Bhamare, Chetanraj G; Patil, Jyoti R

    2013-09-01

    Inappropriate or excessive use of topical corticosteroids can lead to cutaneous and systemic adverse effects which occur more commonly with the use of very potent steroids. Monitoring and analysis of the prescription practices of topical steroids can help to achieve rational prescription of these drugs. The present study was carried out to study and analyze the pattern of prescribing topical corticosteroids among outpatients attending the dermatology clinic in a rural tertiary care and teaching hospital, Ambajogai, Maharashtra. A cross-sectional descriptive study was conducted for a duration of two months from August 2011 to September 2011, and 500 prescriptions were randomly collected from the dermatology pharmacy and analyzed. About 66% of the prescriptions contained four to five drugs per prescription. Topical steroids were given in 28.4% of all the prescriptions. In almost all the prescriptions, strength, quantity of the steroid to be used, frequency, site, and duration of application was not mentioned. The chief complaints and diagnoses were not mentioned in about 85% of the prescriptions for topical corticosteroids. About 94.36% of the prescriptions contained very potent steroids. Inadequate prescribing information is a clear characteristic of the dermatological prescriptions containing topical corticosteroids. Doctors should be educated about the importance of giving patients sufficient information regarding the use of steroids. There is a need to revise hospital formulary where low-potency steroids can also be included along with potent ones so that the latter can be avoided in conditions where they are unnecessary.

  7. Cost analysis of an outbreak of Clostridium difficile infection ribotype 027 in a Dutch tertiary care centre.

    Science.gov (United States)

    van Beurden, Y H; Bomers, M K; van der Werff, S D; Pompe, E A P M; Spiering, S; Vandenbroucke-Grauls, C M J E; Mulder, C J J

    2017-04-01

    The economic impact of Clostridium difficile infection (CDI) on the healthcare system is significant. From May 2013 to May 2014, an outbreak of C. difficile ribotype 027 occurred in a Dutch tertiary care hospital, involving 72 patients. The primary aim of this study was to provide insight into the financial burden that this CDI outbreak brought upon this hospital. A retrospective analysis was performed to estimate the costs of a one-year-long C. difficile ribotype 027 outbreak. Medical charts were reviewed for patient data. In addition, all costs associated with the outbreak control measures were collected. The attributable costs of the whole outbreak were estimated to be €1,222,376. The main contributing factor was missed revenue due to increased length of stay of CDI patients and closure of beds to enable contact isolation of CDI patients (36%). A second important cost component was extra surveillance and activities of the Department of Medical Microbiology and Infection Control (25%). To the authors' knowledge, this is the first study to provide insight into the attributable costs of CDI in an outbreak setting, and to delineate the major cost items. It is clear that the economic consequences of CDI are significant. The high costs associated with a CDI outbreak should help to justify the use of additional resources for CDI prevention and control. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  8. Biofim formation and antimicrobial resistance in Klebsiella pneumoniae isolated from patients visiting a tertiary care center of Nepal

    Directory of Open Access Journals (Sweden)

    Hari Prasad Nepal

    2017-06-01

    Full Text Available Objective: To evaluate the biofilm forming ability of Klebsiella pneumoniae (K. pneumoniae isolates recovered from patients visiting a tertiary care center of Nepal and to determine their antimicrobial resistance with special reference to extended spectrum β-lactamase (ESBL production. Methods: A total 60 phenotypically identified clinical isolates were included in this study. The production of biofilm was detected by tissue culture plate method and their antimicrobial susceptibility was determined by standard microbiological methods. Results: Among the total isolates, 44 (73.3% isolates were found to be biofilm producers. The biofilm positive strains exhibited higher rate of antimicrobial resistance compared to the biofilm negative strains. Multi-drug resistance was seen in 39/60 (65% isolates of which 36 (92.3% were biofilm producers and 3 (7.7% were biofilm non-producers. Similarly, ESBL production was detected in 26/60 (43.3% isolates. Among ESBL producers, 24 (92.3% were biofilm producers and the rest 2 (7.7% were non-producers. Conclusions: Biofilm formation in clinical isolates of K. pneumoniae is very high with varying degrees of resistance to all commonly used antimicrobial agents. The biofilm positive strains are more resistant to antimicrobial agents than the biofilm negative strains. Therefore, it is recommended to identify biofilm producing K. pneumoniae for the effective use of antimicrobial agent.

  9. Superbugs causing ventilator associated pneumonia in a tertiary care hospital and the return of pre-antibiotic era!

    Directory of Open Access Journals (Sweden)

    S Qureshi

    2015-01-01

    Full Text Available The rise in super bugs causing Ventilator-Associated Pneumonia (VAP is a major cause of mortality and morbidity despite recent advances in management owing to the looming ′antibiotic apocalypse′. The aetiology and susceptibility pattern of the VAP isolates varies with patient population, type of intensive care unit (ICU and is an urgent diagnostic challenge. The present study carried out for a period of one year in a tertiary care hospital, enrolled patients on mechanical ventilation (MV for ≥48 hrs. Endotracheal aspirates (ETA from suspected VAP patients were processed by semi quantitative method. Staphylococus aureus, members of Enterobacteriaceae were more common in early onset VAP (EOVAP, while Nonfermenting Gram negative bacilli (NFGNB were significantly associated with late onset VAP (LOVAP. Most of the isolates were multi drug resistant (MDR super bugs. With limited treatment options left for this crisis situation like the pre-antibiotic era; it is an alarm for rational antibiotic therapy usage and intensive education programs.

  10. A study of occupational health and safety measures in the Laundry Department of a private tertiary care teaching hospital, Bengaluru

    Directory of Open Access Journals (Sweden)

    M. Shashi Kumar

    2014-01-01

    Full Text Available Introduction: The Laundry Department plays an important role in preventing the spread of infection and continuously supplying clean linen to various departments in any hospital. Objectives of the Study: To identify existing practices and occupational safety and health (OSH measures in the Laundry Department and to assess the use of personal protective equipments (PPEs among health care workers. Materials and Methods: A cross-sectional study was carried out in a private tertiary care teaching hospital. An observation checklist was developed, which was partially based on occupational hazard checklist of OSHA for Laundry Department. This was field tested and validated for applicability for this study. Results: The potential biological hazards are infections through exposure to aerosols, spills and splashes during various activities, fungal infection due to wet clothes and environment and infections through fomites. The potential physical hazards are injuries due to slips and falls, exposure to heat, humidity, dust, noise, and vibration. The potential chemical hazards are contact dermatitis and allergic asthma due to exposure to detergents, phenyl solution, bleaching powder, and soap oil solution. The potential ergonomic hazards are musculoskeletal diseases and repetitive stress injuries at the shoulder, elbow, and small joints of the hands. PPEs were not used consistently in most areas of the department.

  11. Prevalence of HIV-associated cryptococcal meningitis and utility of microbiological determinants for its diagnosis in a tertiary care center

    Directory of Open Access Journals (Sweden)

    Thakur Rajeev

    2008-04-01

    Full Text Available Context: Human immunodeficiency virus (HIV infection continues to be the most important risk factor for the development of central nervous system (CNS cryptococcosis, which in turn is an important contributor to morbidity and mortality in HIV-infected patients. Early diagnosis of such patients is the key to their therapeutic success. Aims: This study was undertaken to find out the prevalence of CNS cryptococcosis and to assess the role of microbiological parameters for its specific diagnosis in HIV-reactive hospitalized patients admitted with meningeal signs in a tertiary care setting. Materials and Methods: A total of 104 patients suspected to be suffering from meningitis/meningoencephalitis were subjected to cerebrospinal fluid (CSF analysis (including India ink preparation, culture by conventional methods and Bactec MGIT 960 system, antigen detection and tests for HIV antibodies by standard laboratory operating procedures. Results: The prevalence of HIV infection in our study group was 12.5% (13/104, while the prevalence of cryptococcal CNS infection in HIV-reactive cohort was 46% (6/13. Additionally, 15.3% (2/13 of the patients from this cohort were positive for Mycobacterium tuberculosis. Conclusions: High prevalence of cryptococcal CNS infections in HIV-infected patients underscores the importance of precise and early microbiological diagnosis for better management of such patients

  12. A STUDY ON THE INCID ENCE OF PLEUROPULMON ARY MANIFESTATIONS OF RH EUMATOID ARTHRITIS I N A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Purushottam Rao

    2015-03-01

    Full Text Available INTRODUCTION: Rheumatoid arthritis is a chronic systemic inflammatory disorder that affects many tissue organs such as skin, blood vessels, heart, lungs and muscles but principally affects joints producing synovitis that often progress to tissue destruction of articular cartilage and ankylosis of joints. Pulmonary manifestations in rheumatoid arthritis are varied as the pleura, lung, parenchyma, airways and pulmonary vasculature all can be involved. AIM AND OBJECTIVES : To study the incidence of pleuropulmonary manifestations of Rheumatoid Arthritis in patients who were confirmed to have rheumatoid arthritis by 2010 ACR criteria . 6 METHODOLOGY : This prospective study was carried out at King George Hospital, Visakhapatnam, Andhra Pradesh. It is a Tertiary Care Hospital. The study was conducted from January 2013 to December 2014. RESULTS: A total of sixty patients who were confirmed to have rheumatoid arthritis were included in this study. Of these, female patients were 34 (56.66% and males were 26 (43.33%. In this study, out of sixty patients of rheumatoid arthritis 24 patients (40% had pleuropulmonary manifestations. CONCLUSION : Rheumatoid Arthritis is prevalent in females but pleuropulmonary manifestations are common in males. Prevalence of pleuropulmonary manifestations is independent of duration of rheumatoid arthritis. But presence of pleuropulmonary manifestations indicate the severity of disease process

  13. Awareness and use of Benzodiazepines in healthy volunteers and ambulatory patients visiting a tertiary care hospital: a cross sectional survey.

    Directory of Open Access Journals (Sweden)

    Mustafa Raoof

    Full Text Available BACKGROUND: Indiscriminate prescription of Benzodiazepines in Pakistan and subsequent availability over-the-counter without prescription is a major public health problem, requiring systematic inquiry through research. Additionally, there is limited data on the awareness and use of Benzodiazepines from developing countries making it impossible to devise meaningful health policies. METHODOLOGY/PRINCIPAL FINDINGS: This was an Observational, Cross-Sectional study. conducted at Aga Khan University. A total of 475 (58.5% males, 41.5% females people visiting a tertiary care hospital were interviewed by means of a structured questionnaire. The results showed that majority of population was aware of one or more Benzodiazepines (80.4% and 30.4% had used them at some point in life. 42.4% of the users had been using it for more than a year. Commonest reason for use was sleep disturbance. Frequency of usage was higher for females, married individuals, educated (>Grade12, high socioeconomic status and housewives. More (59% were prescribed than not and of them most by GP (58.5%. Only 36.5% of them were particularly told about the long-term addiction potential by the use of these drugs. CONCLUSION: Easy availability, access to re-fills without prescription and self prescription compounded with the lack of understanding of abuse potential of benzodiazepines constitutes a significant problem demanding serious consideration from health policy makers.

  14. Stillbirth in a Tertiary Care Referral Hospital in North Bengal - A Review of Causes, Risk Factors and Prevention Strategies

    Directory of Open Access Journals (Sweden)

    Shritanu Bhattacharya,

    2011-01-01

    Full Text Available Background and Aims: Stillbirth is one of the most common adverse outcomes of pregnancy, accounting for half of all perinatal mortality. Each year approximately 4 million stillbirths are reported, with 97% occurring in developing countries. The objective of the present study was to evaluate the stillbirth rate, exploring the risk factors and causes of stillbirth and suggest policies to reduce it. Settings and Design: A retrospective study of stillbirth among all deliveries over 5 years at North Bengal Medical College, a referral tertiary care teaching hospital in a rural background. The stillbirth rate and its trend were defined and the probable causes and risk factors were identified. Results: Stillbirth rate is 59.76/1000 live births, and Perinatal Mortality 98.65/1000 births. Of the still births, 59.72% were fresh and 40.27% were macerated. Among the causes of stillbirths, poor antenatal attendance and low socioeconomic status were important; other risk factors included prematurity, PIH, birth asphyxia, poor intrapartum care including prolonged and obstructed labour. In 23% cases, the cause remained unexplained. Conclusion: In addition to poor antenatal care, low socioeconomic condition, poor referral service, suboptimal intrapartum care in health facilities including tertiary centre were mainly responsible for majority of still births which could have been prevented. We speculate that upgrading the existing health system performance, particularly high quality intrapartum care by skilled health personnel, will reduce stillbirths substantially in our institute.

  15. SEROPREVALENCE OF HEPATITIS B, HEPATITIS C, SYPHILIS AND HIV IN PREGNANT WOMEN IN A TERTIARY CARE HOSPITAL, GUJARAT, INDIA

    Directory of Open Access Journals (Sweden)

    Swati Dhirajlal Jethava

    2017-08-01

    Full Text Available BACKGROUND This study was conducted to assess the extent of seropositivity of hepatitis B, hepatitis C, syphilis and HIV in pregnant women at tertiary care hospitals in Gujarat from December 2015 to June 2016 and to re-evaluate the need for routine antenatal care screening for these infections among obstetric patients. MATERIALS AND METHODS Patients were enrolled for study after taking informed consent. All samples were tested to detect HbsAg by Enzyme-Linked Immunosorbent Assay (ELISA, anti-HCV by ELISA, samples were also tested for antibodies to Treponema pallidum by Rapid Plasma Regain (RPR, samples were tested for antibodies to HIV by three different methods as per strategy III of the National AIDS Control Organisation by using different systems of testing to establish a diagnosis of HIV. RESULTS Total 1000 samples were tested. Out of this, seropositivity of hepatitis B was (0.6%, hepatitis C was (0.2%, syphilis was (0.0% and HIV was 0.1%. Out of the 1000 samples, no coinfection was found between hepatitis B, hepatitis C, syphilis or HIV. CONCLUSION This study can help the health professionals to efficiently treat antenatal patients. Early diagnosis of disease in antenatal period is helpful for proper management and initiation of treatment to prevent transmission to newborn.

  16. Nucleic acid amplification tests (NAATs for gonorrhoea diagnosis in women: Experience of a tertiary care hospital in north India

    Directory of Open Access Journals (Sweden)

    Seema Sood

    2014-01-01

    Full Text Available Background & objectives: Gonorrhoea is among the most frequent of the estimated bacterial sexually transmitted infections (STIs and has significant health implications in women. The use of nucleic acid amplification tests (NAATs has been shown to provide enhanced diagnosis of gonorrhoea in female patients. However, it is recommended that an on-going assessment of the test assays should be performed to check for any probable sequence variation occurring in the targeted region. In this study, an in-house PCR targeting opa-gene of Neisseria gonorrhoeae was used in conjunction with 16S ribosomal PCR to determine the presence of gonorrhoea in female patients attending the tertiary care hospitals. Methods: Endocervical samples collected from 250 female patients with complaints of vaginal or cervical discharge or pain in lower abdomen were tested using opa and 16S ribosomal assay. The samples were also processed by conventional methods. Results: Of the 250 female patients included in the study, only one was positive by conventional methods (microscopy and culture whereas 17 patients were found to be positive based on PCR results. Interpretation & conclusions: The clinical sensitivity of conventional methods for the detection of N. gonorrhoeae in female patients was low. The gonococcal detection rates increased when molecular method was used giving 16 additional positives. Studies should be done to find out other gene targets that may be used in the screening assays to detect the presence of gonorrhoea.

  17. Use of miltefosine in the treatment of visceral leishmaniasis in children at a tertiary care hospital of Karachi.

    Science.gov (United States)

    Humayun, Khadija Nuzhat; Saleem, Taimur; Khalid, Umair; Jehan, Fyezah; Soofi, Sajid

    2010-06-01

    Existing standard treatment options for visceral leishmaniasis are less than optimal. We report here the use of oral miltefosine in the treatment of two paediatric cases of visceral leishmaniasis at a tertiary care hospital in Karachi, Pakistan. One patient came from Balochistan while the second patient was from Northern Pakistan. Both presented with a prolonged history of fever, massive hepatosplenomegaly, anaemia and thrombocytopenia. Visceral leishmaniasis was diagnosed with bone marrow studies. Amphotericin B was first started in the first patient; however severe hypokalaemia and allergic reaction occurred. Oral miltefosine was then administered. The child showed clinical improvement with regards to signs of leishmania infection but succumbed to a nosocomial infection during the hospital stay. In the second patient, miltefosine was started in the first instance. He showed remarkable clinical improvement. At 2 months follow-up, the child showed adequate weight gain along with successful resolution of hepatosplenomegaly and fever. Miltefosine has the potential to be considered a first line therapy for visceral leishmaniasis in developing countries; however larger studies are warranted to validate the trends observed in this small case series.

  18. Hepatitis B vaccination status among healthcare workers in a tertiary care hospital in Haldwani City of Nainital, Uttarakhand, India

    Directory of Open Access Journals (Sweden)

    Subhash Chandra Joshi

    2014-01-01

    Full Text Available Background: Healthcare workers (HCWs have a high risk of hepatitis B virus (HBV infection. The prevalence of HBV among HCWs in hospitals in developing countries is high. However, the vaccination status of these workers in hospitals in Haldwani city is not well documented. Objectives: The aim was to assess the hepatitis B vaccination status among HCWs in a tertiary care hospital in Haldwani city of Nainital, Uttarakhand, India. Materials and Methods: In this cross-sectional study, 367 HCWs were randomly selected. Information pertaining to demographic and vaccination status was collected by interviewing them with the help of predesigned and pretested interview schedule. Result: The overall proportions of complete, incomplete and unvaccinated respondents with hepatitis B vaccine were 48.5%, 21.8%, and 29.7% respectively. In relation to designation of respondents, 35 (53.8%, 65 (77.4%, 61 (51.7%, 12 (40.0% and 5 (7.2% of respondents who were residents, interns, nurses, technicians and nursing attendants respectively had received Hepatitis B vaccination as against those who had partially received and not received vaccination and this differences were statistically significant. The most common reason for acceptance of vaccine was protection against Hepatitis-B infection (39.9% and the commonest reason for not getting vaccinated was negligence (43.1% Conclusion: These results conclude that because of low immunization coverage, HCWs are at greater risk of getting Hepatitis B infection at the hospital.

  19. Candida infections in paediatrics: Results from a prospective single-centre study in a tertiary care children's hospital.

    Science.gov (United States)

    Mesini, Alessio; Bandettini, Roberto; Caviglia, Ilaria; Fioredda, Francesca; Amoroso, Loredana; Faraci, Maura; Mattioli, Girolamo; Piaggio, Giorgio; Risso, Francesco M; Moscatelli, Andrea; Loy, Anna; Castagnola, Elio

    2017-02-01

    To describe the epidemiology of invasive Candida infection in a tertiary care paediatric hospital. Prospective single-centre survey on all Candida strains isolated from normally sterile fluids and urines in the period 2005-2015 . A total of 299 ICI were documented in 262 patients. Urinary tract infection represented the most frequent diagnosis (62%), followed by fungaemia (34%) and peritonitis (4%). Fungaemia was most frequent in children with cancer (59%) or in low birth weight neonates (61%), while urinary tract infections were more frequent in patients with urinary tract malformation. C.albicans was the most frequently isolated species (60%) compared with C. non-albicans, but differences were present according to the site of isolation and underlying conditions. Overall 90-day mortality was 7%, 13% in fungaemias, 8% in peritonitis and 2% in urinary tract infections. The rates of invasive Candida infection increased during the study period. Invasive Candida infection is diagnosed with increasing frequency in children. Site of isolation and aetiology are frequently related with the presence of underlying, favouring conditions. Mortality was not negligible, especially in the presence of more invasive infections and specific underlying conditions. © 2016 Blackwell Verlag GmbH.

  20. Treatment seeking behaviour of STI clients in a tertiary care centre of North India: A cross sectional study

    Directory of Open Access Journals (Sweden)

    Swastika Suvirya

    2016-01-01

    Full Text Available Objective:(1 To determine the treatment seeking behaviour of STI clients. (2 To ascertain the relationship of socio-demographic factors and sexual behaviours with the treatment seeking component in STI clients. Methods: This cross-sectional study was conducted in Department of Dermatology, Faculty of Medical Sciences, King George's Medical University, Lucknow, Uttar Pradesh. After obtaining approval from the Institutional Ethical Committee, the data collected daily from master register, STI/RTI patient wise register and counsellor's patient diary during the study period August 2013 to July 2015 was processed by Microsoft Excel program. The counsellor also recorded the source of information regarding STI Clinic. The information collected regarding bio-social characteristics, high risk sexual behaviours and source of knowledge about Suraksha clinic was analysed. Results: Our results showed that literacy, male sex, urban residence and employment were some of the parameters which significantly improved the health seeking behaviour of STI clients. These variables were associated with higher odds for seeking treatment when adjusted for other variables. Similarly group with bisexual and homosexual behaviour had significantly lower odds for seeking treatment when adjusted for other variables. Conclusion/Key Message: The optimal use of information, education and communication (IEC techniques needs to be strengthened to further improve the utilization of STI clinic services at tertiary care teaching hospitals.

  1. Treatment of Pancreatic and Periampullary Cancers at a Community Hospital: Successful Application of Tertiary Care Treatment Standards

    Directory of Open Access Journals (Sweden)

    Robert C. Moesinger

    2011-01-01

    Full Text Available Background. The treatment of pancreatic cancer and other periampullary neoplasms is complex and challenging. Major high-volume cancer centers can provide excellent multidisciplinary care of these patients but almost two-thirds of pancreatic cancer patients are treated at low volume centers. There is very little published data from low volume community cancer programs in regards to the treatment of periampullary cancer. In this study, a review of comprehensive periampullary cancer care at two low volume hospitals with comparison to national standards is presented. Methods. This is a retrospective review of 70 consecutive patients with periampullary neoplasms who underwent surgery over a 5-year period (2006–2010 at two community hospitals. Results. There were 51 successful resections of 70 explorations (73% including 34 Whipple procedures. Mortality rate was 2.9%. Comparison of these patients to national standards was made in terms of operative mortality, resectability rate, administration of adjuvant therapy, clinical trial participation and overall survival. The results in these patients were comparable to national standards. Conclusions. With adequate commitment of resources and experienced surgical and oncologic practitioners, community cancer centers can meet national tertiary care standards in terms of pancreatic and periampullary cancer care.

  2. Candida Species Prevalence Profile in HIV Seropositive Patients from a Major Tertiary Care Hospital in New Delhi, India

    Science.gov (United States)

    Maheshwari, Monika; Kaur, Ravinder; Chadha, Sanjim

    2016-01-01

    Candida is a common opportunistic pathogen during the course of human immunodeficiency virus (HIV) disease progression. Changes in the clinical severity of candidiasis and the Candida species prevalence profile may be a reflection of immunological changes in HIV positive patients. The aim of this study was to document the changing pattern of Candida species prevalence profile in HIV seropositive patients from a tertiary care hospital in North India. One hundred and twenty HIV seropositive subjects were recruited for Candida microbial screening. Clinical specimens including blood, oral swabs, expectorated or induced sputum/bronchoalveolar lavage specimens, and urine were collected depending on the patient's symptoms. A total of 128 Candida isolates were obtained from 88 cases and 7 different Candida species were identified. C. albicans (50%) was the most common species isolated followed by C. glabrata (17%) and C. dubliniensis (12.5%). Other species isolated were C. parapsilosis (7.8%), C. krusei, C. tropicalis (4.6% each), and C. kefyr (3%). Strong clinical suspicion along with optimal sampling of an accurate diagnosis of Candida species involved would go a long way in decreasing the morbidity associated with non-albicans Candida species. PMID:27092278

  3. The economic impact of periprosthetic infections following total knee arthroplasty at a specialized tertiary-care center.

    Science.gov (United States)

    Kapadia, Bhaveen H; McElroy, Mark J; Issa, Kimona; Johnson, Aaron J; Bozic, Kevin J; Mont, Michael A

    2014-05-01

    The purpose of this study was to measure the impact of periprosthetic joint infections (PJIs) on the length of hospitalization, readmissions, and the associated costs. Between 2007 and 2011, our prospectively collected infection database was reviewed to identify PJIs that occurred following primary total knee arthroplasty (TKA), which required a two-stage revision. We identified 21 consecutive patients and matched them to 21 non-infected patients who underwent uncomplicated primary TKA. The patients who had PJIs had significantly longer hospitalizations (5.3 vs. 3.0 days), more readmissions (3.6 vs. 0.1), and more clinic visits (6.5 vs. 1.3) when compared to the matched group, respectively. The mean annual cost was significantly higher in the infected cohort ($116,383; range, $44,416 to $269,914) when compared to the matched group ($28,249; range, $20,454 to $47,957). Periprosthetic infections following TKA represent a tremendous economic burden for tertiary-care centers and to patients.

  4. Spectrum of Microbial Flora in Diabetic Foot Ulcer and Its Antibiotic Sensitivity Pattern in Tertiary Care Hospital in Ahmedabad, Gujarat

    Directory of Open Access Journals (Sweden)

    Manisha Jain

    2012-06-01

    Full Text Available Introduction: A Prospective study “Spectrum of Microbial flora in diabetic foot ulcer and its antibiotic sensitivity pattern” was carried out in a tertiary care hospital, Ahmedabad on 125 patients in which 85 were male patients and 40 were female patients. Material and Methods: Swabs samples were collected from the edge and margins of ulcers and organism were identified by gram staining culture and biochemical reactions. Results: Out of 125 specimens 108 specimens showed growth of organisms. Total 157 aerobic organisms were isolated from culture positive specimens. It represents an average of 1.25 organisms per case. Among these organisms, 130 gram negative and 27 gram positive organisms were isolated. Pseudomonas aeruginosa (30.57% was predominant organism followed by Klebsiella spp. (22.29%. Staphylococcus aureus were 12.74% in which Methicillin resistant S. aureus (MRSA was 55%. Conclusion: incidence of growth was 86.4% in which Pseudomonas aeruginosa (30.57% is most common isolate. Organisms in mixed infections showed multidrug resistance as compared to single isolated strain. Diabetic foot infections are polymicrobial in nature. As the Wagner’s grade increased, the prevalence of isolates also increased. [National J of Med Res 2012; 2(3.000: 354-357

  5. Candida Species Prevalence Profile in HIV Seropositive Patients from a Major Tertiary Care Hospital in New Delhi, India.

    Science.gov (United States)

    Maheshwari, Monika; Kaur, Ravinder; Chadha, Sanjim

    2016-01-01

    Candida is a common opportunistic pathogen during the course of human immunodeficiency virus (HIV) disease progression. Changes in the clinical severity of candidiasis and the Candida species prevalence profile may be a reflection of immunological changes in HIV positive patients. The aim of this study was to document the changing pattern of Candida species prevalence profile in HIV seropositive patients from a tertiary care hospital in North India. One hundred and twenty HIV seropositive subjects were recruited for Candida microbial screening. Clinical specimens including blood, oral swabs, expectorated or induced sputum/bronchoalveolar lavage specimens, and urine were collected depending on the patient's symptoms. A total of 128 Candida isolates were obtained from 88 cases and 7 different Candida species were identified. C. albicans (50%) was the most common species isolated followed by C. glabrata (17%) and C. dubliniensis (12.5%). Other species isolated were C. parapsilosis (7.8%), C. krusei, C. tropicalis (4.6% each), and C. kefyr (3%). Strong clinical suspicion along with optimal sampling of an accurate diagnosis of Candida species involved would go a long way in decreasing the morbidity associated with non-albicans Candida species.

  6. Prescription Pattern of Antihypertensive Agents in T2DM Patients Visiting Tertiary Care Centre in North India

    Directory of Open Access Journals (Sweden)

    Ethiraj Dhanaraj

    2012-01-01

    Full Text Available Background. Hypertension management is of a paramount importance in diabetic patients for cardiovascular risk reduction. Aim. To evaluate prescribing pattern of antihypertensive in T2DM (type 2 diabetes patients and compare with existing recent guidelines. Methods. A cross-sectional study involving evaluation of all T2DM patients referred to endocrinology unit at tertiary care centre for hypertension, comorbid complications, and recording prescription. Utilization of 5 different antihypertensive drug classes was compared for all patients receiving 1, 2, 3, 4, or more drugs. Logistical regression was used to assess likelihood of prescription of drugs and/or therapy for specific conditions mentioned in the guidelines. Results. Out of 1358, T2DM enrolled patients 1186 (87% had hypertension (males 52%, females 48%. The median duration (IQ of hypertension diabetics was 4 (1–10 years. A total of 25% patients had controlled BP and 75% with uncontrolled blood pressure (13% isolated systolic hypertension, 6% isolated diastolic hypertension, and 55% both elevated. Overall, ACE inhibitors (ACEIs were prescribed the highest (59% followed by angiotensin receptor blockers (ARBs (52%, calcium channel blockers (CCBs (29%, diuretics (27%, and beta-blockers (14%. Overall, 55% of T2DM patients were on polytherapy, 41% on monotherapy, and 4% had no antihypertensive treatment. Polytherapy was more predominant with age, duration of diabetes, duration of hypertension, and comorbid complications. Conclusion. Although prescribing pattern of antihypertensive showed adherence to existing evidence-based guidelines, higher proportion of uncontrolled hypertensive patients was found.

  7. A Study to Identify, Assess & Analyze the Incidence of Poisoning Cases in a Tertiary Care Teaching Hospital at Davangere, Karnataka

    Directory of Open Access Journals (Sweden)

    Baishnab S

    2016-06-01

    Full Text Available Poison is any substance that causes harmful effect when administered either accidently or intentionally. In India, as agriculture is the main occupation, pesticides are used to a greater extent and the poisoning with such products is far more common. The objective was to identify and assess the incidence of accidental or intentional poisoning and also to assess the relation between socio economic factors and poisoning. This prospective cohort study was conducted in the departments of medicine, paediatric, emergency and ICU of a tertiary care teaching hospital for a period of 6 months. A total number of 150 cases were collected and categorized into different classes based on type of poisoning agents. In that organophosphate accounts more 31.3% (n=47, followed by snake bite 20% (n= 30. Male predominance were seen 58.7% (n=88, while comparing to female 41.3% (n= 62. Based on economic study, low socio economic peoples were more prone to poisoning i.e., 54.7% (n= 82. Rural people were far front in poisoning54.7% (n= 82 than urban and sub- urban. The literature status showed that 78.7% (n=118 was literate. Poisoning incidence are more in married subjects i.e., 50.7% (n=76. While considering occupation, farmers were most 30.7% (n= 46. The study highlighted the lacunae of poisoning information services in hospitals. Clinical pharmacist’s involvement can improve the identification of poison and toxicity rating.

  8. Sociodemographic profile, clinical factors, and mode of attempt in suicide attempters in consultation liaison psychiatry in a tertiary care center

    Directory of Open Access Journals (Sweden)

    Santosh Ramdurg

    2011-01-01

    Full Text Available Background: The objective was to study the sociodemographic data, psychiatric disorder, precipitating events, and mode of attempt in suicide attempted patients referred to consultation liaison psychiatric services. Settings and Design: A prospective study of 6-month duration was done in a tertiary care center in India. Materials and Methods: During the 6-month period all referrals were screened for the presence of suicide attempters in consultation liaison services. Those who fulfilled the criteria for suicide attempters were evaluated by using semistructured pro forma containing sociodemographic data, precipitating events, mode of attempt, and psychiatric diagnosis by using ICD-10. Results: The male-to-female ratio was similar. Adult age, urban background, employed, matriculation educated were more represented in this study. More than 80% of all attempters had psychiatric disorder. Majority had a precipitating event prior to suicide attempt. The most common method of attempt was by use of corrosive. Conclusions: Majority of suicide attempter patients had mental illness. Early identification and treatment of these disorders would have prevented morbidity and mortality associated with this. There is a need of proper education of relatives about keeping corrosive and other poisonous material away from patients as it was being commonest mode of attempt.

  9. Attitudes Toward Euthanasia Among Doctors in a Tertiary Care Hospital in South India: A Cross Sectional study.

    Science.gov (United States)

    Kamath, Sneha; Bhate, Priya; Mathew, Ginu; Sashidharan, Srijith; Daniel, Anjali B

    2011-09-01

    Advances in expertise and equipment have enabled the medical profession to exercise more control over the processes of life and death, creating a number of moral and ethical dilemmas. People may live for extended periods with chronic painful or debilitating conditions that may be incurable. This study attempts to study the attitudes of doctors toward euthanasia and the possible factors responsible for these attitudes. A cross-sectional survey of 213 doctors working at a tertiary care hospital was conducted to determine their attitudes toward euthanasia. A self-administered questionnaire was used to assess attitudes and personal perceptions about euthanasia. The Chi square test was used to assess factors influencing attitudes toward euthanasia. A majority of the respondents (69.3%) supported the concept of euthanasia. Relief from unbearable pain and suffering was the most commonly (80.3%) cited reason for being willing to consider the option of euthanasia. Majority of those who were against euthanasia (66.2%) felt that the freedom to perform euthanasia could easily be misused. Disapproval of euthanasia was associated with religious affiliation (Peuthanasia for the relief of unbearable pain and suffering. Religion and speciality appear to be significant in determining attitudes toward euthanasia.

  10. Off-Label Medicine Use in Pediatric Inpatients: A Prospective Observational Study at a Tertiary Care Hospital in India

    Directory of Open Access Journals (Sweden)

    Mohd Masnoon Saiyed

    2014-01-01

    Full Text Available Background. In the absence of standard pediatric prescribing information, clinicians often use medicines in an off-label way. Many studies have been published across the globe reporting different rates of off-label use. There is currently no study based on Indian drug formulary. Methods. The prospective observational study included pediatric patients in ages between 0 and 12 years admitted in a tertiary care hospital. Off-label use was assessed using the National Formulary of India (NFI. Predictors of off-label use were determined by logistic regression. Results. Of the 1645 medications prescribed, 1152 (70% were off-label based on 14 possible off-label categories. Off-label medicines were mainly due to dose difference and use in restricted age limits as indicated in NFI. Respiratory medicines (82%, anti-infectives (73%, and nervous system medicines (53% had higher off-label use. Important predictors of off-label prescribing were pediatric patients in age of 0 to 2 years (OR 1.68, 95% CI; P<0.001 and hospital stay of six to 10 days (OR 1.91, 95% CI; P<0.001. Conclusion. Off-label prescribing is common among pediatric patients. There is need to generate more quality data on the safety and efficacy of off-label medicines to rationalize pediatric pharmacotherapy.

  11. Candida Species Prevalence Profile in HIV Seropositive Patients from a Major Tertiary Care Hospital in New Delhi, India

    Directory of Open Access Journals (Sweden)

    Monika Maheshwari

    2016-01-01

    Full Text Available Candida is a common opportunistic pathogen during the course of human immunodeficiency virus (HIV disease progression. Changes in the clinical severity of candidiasis and the Candida species prevalence profile may be a reflection of immunological changes in HIV positive patients. The aim of this study was to document the changing pattern of Candida species prevalence profile in HIV seropositive patients from a tertiary care hospital in North India. One hundred and twenty HIV seropositive subjects were recruited for Candida microbial screening. Clinical specimens including blood, oral swabs, expectorated or induced sputum/bronchoalveolar lavage specimens, and urine were collected depending on the patient’s symptoms. A total of 128 Candida isolates were obtained from 88 cases and 7 different Candida species were identified. C. albicans (50% was the most common species isolated followed by C. glabrata (17% and C. dubliniensis (12.5%. Other species isolated were C. parapsilosis (7.8%, C. krusei, C. tropicalis (4.6% each, and C. kefyr (3%. Strong clinical suspicion along with optimal sampling of an accurate diagnosis of Candida species involved would go a long way in decreasing the morbidity associated with non-albicans Candida species.

  12. Effect of Educational Intervention on Postgraduates Regarding Bio-Medical Waste Management (BMW At a Tertiary Care Teaching Hospital, Bhopal

    Directory of Open Access Journals (Sweden)

    Vishal Bathma, Sanjay Agarwal, Umesh Sinha, Girjesh Gupta, Neeraj Khare

    2015-01-01

    Full Text Available "Introduction: The waste produced in the course of health care activities carries a higher potential for infection and injury than any other type of waste. Objectives: To assess the existing level of knowledge and evaluate the effectiveness of educational inter-vention and also find out association between pre test and post test knowledge score. Material And Methods: An interventional trail was conducted using video lecture and slide show as a tool. Pre and post questionnaire for evaluation was used with scoring. The study was conduct in a tertiary care hospital attached to the medical college, in Bhopal. All 1st year PG students were included in study from different departments. Total 30 PG students were included from all departments. Study was conducted in phase manner with objective of imparting knowledge regarding waste management practices. Results: There was significant increase in knowledge about bio-medical waste management before and after educational intervention which was statistically highly significant (p<0.0001 except symbol of biohazard Conclusion: The knowledge of the 1st year PG medical student regarding BMW management varied and was not found to be satisfactory. The intervention proved to improve their knowledge to significant level. Training of UG & PG students should be specially emphasized. "

  13. Development of a Cost-Effective Database Software for Psychiatric Research: A Study From Tertiary Care Teaching Hospital

    Directory of Open Access Journals (Sweden)

    Sabu Karakkamandapam

    2010-10-01

    Full Text Available Background: Technological progression made drastic changes in health care. Still there is a growing concern about proper utilization of health information within hospitals for various research activities. Huge volumes of such health information in majority of hospitals are redundant due to lack of appropriate and cost-effective technological tools for retrieving relevant health information for research purpose. Objective: To develop a cost-effective and user-friendly computerized medical record database for psychiatry using available technology with the department. Methodology: Study performed at a tertiary care teaching hospital in Udupi district of South India. Various datasets from psychiatry medical records were utilized for the design and creation of database. A computerized database called PsyCase was developed with the help of technology available within the department. A 4612 patient’s data were entered into the PsyCase and subjected to various analyses. Results: Applications of PsyCase in various epidemiological studies were explored through performing numerous analyses with actual data. PsyCase was found effective in supporting psychiatric research as well as routine clinical and administrative activities. Conclusion: This study emphasizes need of appropriate use of technology available within a healthcare system to facilitate medical research in psychiatry and role of health information professional in such initiatives. Healthcare organization must focus on collective utilization of resources within the system to improve the utilization of health information for medical research.

  14. Incidence, etiology and risk factors associated with mortality of nosocomial candidemia in a tertiary care hospital in Istanbul, Turkey.

    Science.gov (United States)

    Erdem, Ilknur; Oguzoglu, Naz; Ozturk Engin, Derya; Ozgultekin, Asu; Inan, Asuman Sengoz; Ceran, Nurgul; Kaya, Fatma; Genc, Ipek; Goktas, Pasa

    2010-01-01

    The aim of this study was to determine the incidence, etiology and risk factors for mortality of patients with nosocomial candidemia. This observational study was performed at Haydarpasa Numune Training and Research Hospital, a tertiary care hospital with 750 beds, between the years 2004 and 2007. Fifty defined cases with a nosocomial bloodstream infection caused by Candida species were included in the study. All demographic, microbiological and clinical records for each patient were collected using a standardized form. Blood culture was performed by automated blood culture system, and those samples positive for yeast were subcultured on Sabouraud agar. The mean incidence density of nosocomial candidemia was 0.58/10,000 patient-days/year (range 0.17-1.4). Candidemia episodes increased from 0.17/10,000 to 1.4/10,000 patient-days/year (p < 0.0001). Candida albicans and non-albicans Candida accounted for 15 (30%) and 35 (70%) cases, respectively. The overall mortality was 56% and was significantly associated with stayingin the intensive care unit (odds ratio: 3.667, 95% confidence interval: 1.07-12.54, p = 0.034). This study showed that there was a significantly increased trend in the incidence of candidemia with high mortality during the study period. Copyright © 2010 S. Karger AG, Basel.

  15. Evaluation of Electronic Prescribing Decision Support System at a Tertiary Care Pediatric Hospital: The User Acceptance Perspective.

    Science.gov (United States)

    Omar, Abdurahman; Ellenius, Johan; Lindemalm, Synnöve

    2017-01-01

    This study aims to evaluate pediatrician's acceptance, perception and use of Electronic Prescribing Decision Support Systems (EPDSS) at a tertiary care using Extended Technology Acceptance Model (TAM2). Qualitative research methodology was applied. Semi-structured questions were developed according to TAM2 model. Pediatricians perceived that the EPDSS is useful and they showed a favorable attitude. However, perceived ease of use and output quality appeared to affect use of EPDSS. Concerns were expressed about complicated screens, difficulty to read and view medication overview of the patient, the navigation requires many clicks and medication system don't meet their need. End users have difficulty of ordering drugs for ploy-clinical patients and they were unable to cancel or stop medications. Junior pediatricians were influenced by senior colleague since they can get better advice about medication order than the system. Applying TAM2 framework has revealed that pediatrician's attitude and acceptance of electronic prescribing system. This study has identified factors that are important for end user acceptance as well as suggestions for system improvement. Although pediatricians are positive to the usefulness of EPDSS, it appears there are some acceptance problems due to ease of use concern and usability issues of the system.

  16. COMMON ORGANISMS AND ANTIBIOTIC SENSITIVITY OF E COLI IN URINARY TRACT INFECTION, IN A TERTIARY CARE TEACHING HOSPITAL, NORTHERN KERALA

    Directory of Open Access Journals (Sweden)

    Shanavas

    2015-11-01

    Full Text Available Urinary tract infection (UTI includes a spectrum of Asymptomatic Bacteruria (ABU, Cystitis, Prostitis and Pyelonephritis. Except in ABU, UTI is represented by symptomatic disease that warrants antimicrobial therapy. 1 Many of the studies have shown increasing antibiotic resistance to these agents. This study consists of a retrospective observational study of culture and sensitivity of 150 urinary samples, collected from patients who presented with symptoms of UTI, in a tertiary care teaching hospital, Northern Kerala, irrespective of their age and sex for a period of six months from June 2015 to November 2015. These results are then analyzed to find common organisms causing UTI in different age groups in either sex and their respective antibiotic resistance are noted. Out of 150 urinary samples 69.34% were sterile, while 30.66% were culture positive. Among the culture positive patients sex distribution was almost equal, with a slight female predominance, having a contribution of 54.35% females and 45.65% males. The most common organism was found to be E.coli, which contributed more than 50 per cent of total culture positivity (54.35%. Others include Staphylococci, Klebsiella Pnuemoniae, Proteus species, Pseudomonas, Enterococci, Candida Albicans etc. Collateral damage is an ecological adverse effect that resist the use of a highly efficacious drug to be considered as first line agent. Our study shows that drugs causing minimal collateral damages like Nitrofurantoin and Fosfomycin can be used as first line agent for treatment of UTI.

  17. Profile of skin biopsies and patterns of skin cancer in a tertiary care center of Western Nepal.

    Science.gov (United States)

    Kumar, Ajay; Shrestha, Prashanna Raj; Pun, Jenny; Thapa, Pratichya; Manandhar, Merina; Sathian, Brijesh

    2015-01-01

    Skin biopsy is the method to assist clinicians to make definite dermatological diagnosis which further helps in holistic management. Skin cancers are relatively rare clinical diagnosis in developing countries like Nepal, but the prevalence is on rise. To investigate the profile of skin biopsies and frequencies and pattern of skin cancers in a tertiary care centre of Western Nepal. The materials consisted of 434 biopsies (1.37%) out of 31,450 OPD visits performed in the Department of Dermatology, Manipal Teaching Hospital, Pokhara, Nepal, during the period of Dec 2011-Nov 2014. Data were collected and analyzed using SPSS-16 with reference to incidence, age, sex, race and clinical and histopathological features. The commonest disorders observed in biopsies were papulosquamous lesions, skin tuberculosis of different types, benign skin tumors, leprosy, collagen and fungal diseases. Viral diseases were rarely seen, probably due to straight forward clinical diagnosis. Dermatological malignancies accounted for 55/434 (12.67%) of biopsies. Skin disorders in general were commoner in females 280/434 (64%), including malignancies 32/55(58.2%). Mean age of patients with skin cancer was 54.5 years. Facilities for proper laboratory investigation of dermatological disorders will improve the quality of life. The most prevalent lesion in skin biopsies was papulosquamous disorders followed by skin tuberculosis of different types. Dermatological malignancy constituted 55/434 (12.67%) cases. The prevalence of skin malignancy is on rise in Nepalese society probably due to increase in life expectancy and better diagnostic services.

  18. CHARACTERISTICS OF PATIENTS HOSPITALIZED WITH 2009 H1N1 INFLUENZA IN A TERTIARY CARE HOSPITAL IN SOUTHERN SAUDI ARABIA

    Directory of Open Access Journals (Sweden)

    Adnan Agha

    2012-01-01

    Full Text Available

    Background

    Pandemic influenza A (H1N1 virus emerged and spread globally in the spring of 2009.  We describe the clinical features of the patients who were hospitalized with 2009 H1N1 influenza July 2009 to June 2010 in a tertiary care hospital in Khamis Mushyt, Saudi Arabia.  We analyzed the clinical and laboratory variables in order to determine predictors of poor outcome

    Methods

    We performed a prospective study in all patients who were hospitalized for at least 48 hours  and with a positive test for 2009 H1N1 virus through RT-PCR(real time polymerase chain reaction.  Their epidemiological, clinical, biochemical characteristics were collected and the hospital course of the patients with eventual outcome (discharge or death was observed. We applied a logistic regression analysis to determine the best predictor of death.

  19. CLINICAL PROFILE OF PLEURAL EFFUSION PATIENTS: A TERTIARY CARE HOSPITAL STUDY

    Directory of Open Access Journals (Sweden)

    Harish

    2016-02-01

    Full Text Available OBJECTIVE Pleural effusion refers to the excessive or abnormal accumulation of fluid in the pleural space. Pleural effusion is commonly encountered medical problem and caused by a variety of underlying pathological conditions. It is important to establish an accurate etiological diagnosis, so that the patient may be treated in the most appropriate and rational manner. METHODS This was a prospective study of 56 pleural effusion patients who are attending OPD and admitted cases in the Pulmonary Medicine department in Bhagwan Mahaveer Jain Hospital, Bangalore. The patients were subjected to through clinical history and examination. Thoracocentesis did under aseptic conditions and pleural fluid sent for investigations like protein, sugar, LDH (Lactate Dehydrogenase, ADA (Adenosine Deaminase, gram staining, AFB smear and culture by BACTEC method, cell type, cell count, and malignant cytology. Pleural biopsy was done for those who are willing for the same. Depending upon the history and clinical examinations and laboratory investigations, patients were classified as having exudates and transudates. RESULTS The total of 56 patients with pleural effusion was studied. Mean age of the study group was 43±14.6 years. 39(69.42% patients were male and 17(30.58% patients were female. The commonest type of effusion being tuberculosis (34 followed by malignancy (8, transudative effusion (7, synpneumonic (5 and 2 cases of empyema. The commonest presenting complaints were cough (78.32% and breathlessness (74.76%. Polymorphs were predominant in synpneumonic effusion and empyema and lymphocytes in tubercular effusion. Pleural fluid cytology revealed elevated lymphocytes in tubercular and polymorphs in acute infections. Cytology for malignant cells was positive in 4 cases. The mean increase in ADA level in tubercular pleural effusion, malignant pleural effusion and transudative pleural effusion were 79±19.9 IU/L, 42.6±9.3 and 28.4±8.2 respectively and it was

  20. Hemosuccus Pancreaticus: 15-Year Experience from a Tertiary Care GI Bleed Centre

    Science.gov (United States)

    Palaniappan, Ravichandran; Ramaswami, Sukumar; Perumal, Senthil Kumar; Lakshmanan, Anand; Srinivasan, U. P.; Ramasamy, Ravi; Sathyanesan, Jeswanth

    2013-01-01

    Background. Hemosuccus pancreaticus (HP) is a very rare and obscure cause of upper gastrointestinal bleeding. Due to its rarity, the diagnostic and therapeutic strategy for the management of this potentially life threatening problem remains undefined. The objective of our study is to highlight the challenges in the diagnosis and management of HP and to formulate a protocol to effectively and safely manage this condition. Methods. We retrospectively reviewed the records of all patients who presented with HP over the last 15 years at our institution between January 1997 and December 2011. Results. There were a total of 51 patients with a mean age of 32 years. Nineteen patients had chronic alcoholic pancreatitis; twenty-six, five, and one patient had tropical pancreatitis, acute pancreatitis, and idiopathic pancreatitis, respectively. Six patients were managed conservatively. Selective arterial embolization was attempted in 40 of 45 (89%) patients and was successful in 29 of the 40 (72.5%). 16 of 51 (31.4%) patients required surgery. Overall mortality was 7.8%. Length of followup ranged from 6 months to 15 years. Conclusions. Upper gastrointestinal bleeding in a patient with a history of chronic pancreatitis could be caused by HP. All hemodynamically stable patients with HP should undergo prompt initial angiographic evaluation, and if possible, embolization. Hemodynamically unstable patients and those following unsuccessful embolization should undergo emergency haemostatic surgery. Centralization of GI bleed services along with a multidisciplinary team approach and a well-defined management protocol is essential to reduce the mortality and morbidity of this condition. PMID:24959558

  1. Feto-Maternal Outcome of Jaundice in Pregnancy in a Tertiary Care Hospital.

    Science.gov (United States)

    Parveen, T; Begum, F; Akhter, N

    2015-07-01

    Acute viral hepatitis is the most common cause of jaundice in pregnancy. Amongst hepatitis E bears a deadly combination with pregnancy, leading to loss of very young lives. There is almost no data available in this aspect documenting prevalence, profile and effect of jaundice on outcome of pregnancy in Bangladesh. This observational study was done to determine and analyze the frequency, cause and outcome of jaundice in pregnancy among the admitted patients in the feto-maternal medicine wing of Bangabandhu Sheikh Mujib Medical University, for a 2 years period from August 2009 to July 2011. Management was done in collaboration with the hepatologists, hematologists and intensive care unit specialist. Outcome was noted in terms of the mode of delivery, maternal complications, need of blood transfusion and fresh frozen plasma and maternal end result. Fetal outcome was assessed by birth weight, Apgar score, neonatal admission, and perinatal mortality. Prevalence of jaundice was found 2.5% among all high risk and 1.3% among all obstetric admissions. Hepatitis E was the commonest cause and responsible for 80.4% cases of jaundice and next was cholestatic jaundice. Almost half of the patients (43.4%) faced complications like post partum haemorrhage (15.3%), hepatic encephalopathy (10.8%), ante partum hemorrhage (6.5%). Preterm delivery was noted in 71.1% cases. Out of 46 patients with jaundice four (4) mothers died due to hepatic encephalopathy in hepatitis E group. Regarding perinatal outcome 55.8% were of low birth weight, 35.3% had low Apgar score and perinatal mortality was 6.4%.

  2. Profile of young suicide attempt survivors in a tertiary care hospital in Puducherry

    Directory of Open Access Journals (Sweden)

    Anand Lingeswaran

    2016-01-01

    Full Text Available Context: Puducherry has the highest suicide prevalence rate in India by 2014, predominantly among the 14-30 years age group. Aims: The aim of the present study is to study the characteristics of adolescent and youth suicide attempters in Puducherry and measure the suicide intent. Settings and Design: An observational study of 6 months duration was conducted in the Department of Psychiatry, at Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India. Materials and Methods: Modified version of World Health Organizations SUicide PREvention Multisite Intervention Study on Suicidal questionnaire was used to collect sociodemographic data and Beck's suicide intent scale was used to measure the suicide intent scores. International Classification of Diseases-10 was used for diagnosis. Statistical Analysis: Statistical Package for the Social Sciences version 13 was used for descriptive analysis and correlation statistics. P value was set as <0.05. Results: Of 56 eligible participants, 40 formed the sample, their mean age was 18. 13 (±2.50, more females (1.1:1, rural, literate, lower socioeconomic status (67.5%, mostly single (90%, living in nuclear (95%, and Hindu (87.5%. One hundred percent had psychosocial stressors before suicide attempt. Acute stress disorder/adjustment disorder was the most common diagnosis. Emotionally unstable and anankastic personality traits were seen in 12%. Pesticide ingestion (45% was the most common suicide method. Sixty percent attempted suicide within <30 min of suicidal contemplation. Statistical associations were found between the alleged purpose, seriousness, attitude toward living/dying, conception about medical rescuability, and the overall suicide intent. Conclusions: Adolescent and youth suicide attempts occur due to psychosocial stressors rather than due to the past or on-going mental health disorders with above personality traits suggest poor coping skills and resilience taken to deal with stressful

  3. CLINICAL FEATURES AND OUTCOMES OF H1N1 PNEUMONIA IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Dhanasekar

    2016-05-01

    Full Text Available Influenza virus causes mild-to-severe acute respiratory illness. H1N1 bronchopneumonia carries a higher mortality. MATERIALS AND METHODS Study was a prospective observational study conducted in a 24 bedded multidisciplinary ICU from January 2010 to December 2010. We included all adult patients admitted to our intensive care unit presenting with clinical features/suspicion of H1N1 bronchopneumonia and respiratory failure. These patients also subsequently tested positive for H1N1 Reverse-Transcriptase Polymerase Chain Reaction (RT-PCR assay. Data was collected on demography, co-morbid illness, APACHE II and SOFA scores, organ failure and support. Outcome data on mortality, ICU LOS and ventilator days was also collected. RESULTS 28 patients with H1N1 bronchopneumonia required intensive care treatment. Majority of patients were females 60.7 % (n=17; of these 17 patients 7 patients were pregnant. Mean age of our patients was 50.6 (±19.1 years. Most common co-existing illnesses were diabetes mellitus (32.1% and hypertension (32.1% followed by bronchial asthma (10.7%; 85.7% patients had at least one organ dysfunction on admission, of which respiratory system was involved in 96.5% followed by renal system 57.1%. Patients were sick on admission as indicated by high APACHE II (17.75±6.5 and SOFA (5.25±1.8 scores. Mean PaO2/FiO2 on admission was 148.9±77.2. Severe ARDS (PaO2/FiO2 <100 was seen in 39.35% of patients. Of the 28 patients, 27 patients required ventilator support; 17 patients died out of 28 patients (mortality rate 60.7%. Higher APACHE II, SOFA scores and low PaO2/FiO2 on admission were identified as significant risk factors for mortality. CONCLUSION Critically ill H1N1 pneumonia patients present with multisystem involvement and they had a high mortality in our study.

  4. Clinical, hematological, and cytogenetic profile of adult myelodysplastic syndrome in a tertiary care center

    Science.gov (United States)

    Narayanan, Santhosh

    2017-01-01

    Background Myelodysplastic syndrome (MDS), a disorder of clonal hematopoiesis, is an important clinical entity, but most of the studies available are conducted among the Western population. Its etiological factors and clinicohematological profile in the Indian population are quite diverse. The information regarding its prognostic factors and cytogenetics is very scarce. Objectives (1) To assess the clinicohematological profile, cytogenetics, prognostic factors, and outcome of MDS and (2) to study its progression to acute myeloid leukemia (AML) in the selected patients over the study period. Methods A prospective observational study was performed with patients from Department of Medicine and Hematology, Government Medical College, Kozhikode, who were diagnosed with MDS within the study period (from 1 January 2014 to 31 July 2015). Secondary causes of dysplasia were excluded. In possible cases, the international prognostic scoring system was followed. These patients were followed up for an additional 6 months to assess the progression of MDS to AML based on symptoms, signs, hemogram, or repeat peripheral smear/bone marrow studies. Results Of the 60 patients, 73% were aged >60 years. Disease was common in males, with a male:female ratio of 7:3. Thirty-five percent of the patients were working in agricultural and allied fields and had pesticide exposure. Patients with prior radiation exposure had significant association with adverse outcome. Fatigue was the prominent symptom and was reported by 90% of the patients. Blasts were >5% in peripheral smear; bone marrow cytopenia and dysplasia at the time of diagnosis had significant association with risk of transforming to AML. Refractory anemia (RA), observed in 22 patients, was the most common type of MDS. Most of the patients with RA with excess blasts type-1 and RA with excess blasts type-2 transformed to AML, and the association was statistically significant. Deletion of short arm of fifth chromosome (5q deletion) was

  5. Clinical, hematological, and cytogenetic profile of adult myelodysplastic syndrome in a tertiary care center

    Directory of Open Access Journals (Sweden)

    Narayanan S

    2017-02-01

    Full Text Available Santhosh Narayanan Department of Medicine, Government Medical College, Kozhikode, Kerala, India Background: Myelodysplastic syndrome (MDS, a disorder of clonal hematopoiesis, is an important clinical entity, but most of the studies available are conducted among the Western population. Its etiological factors and clinicohematological profile in the Indian population are quite diverse. The information regarding its prognostic factors and cytogenetics is very scarce.Objectives: (1 To assess the clinicohematological profile, cytogenetics, prognostic factors, and outcome of MDS and (2 to study its progression to acute myeloid leukemia (AML in the selected patients over the study period.Methods: A prospective observational study was performed with patients from Department of Medicine and Hematology, Government Medical College, Kozhikode, who were diagnosed with MDS within the study period (from 1 January 2014 to 31 July 2015. Secondary causes of dysplasia were excluded. In possible cases, the international prognostic scoring system was followed. These patients were followed up for an additional 6 months to assess the progression of MDS to AML based on symptoms, signs, hemogram, or repeat peripheral smear/bone marrow studies.Results: Of the 60 patients, 73% were aged >60 years. Disease was common in males, with a male:female ratio of 7:3. Thirty-five percent of the patients were working in agricultural and allied fields and had pesticide exposure. Patients with prior radiation exposure had significant association with adverse outcome. Fatigue was the prominent symptom and was reported by 90% of the patients. Blasts were >5% in peripheral smear; bone marrow cytopenia and dysplasia at the time of diagnosis had significant association with risk of transforming to AML. Refractory anemia (RA, observed in 22 patients, was the most common type of MDS. Most of the patients with RA with excess blasts type-1 and RA with excess blasts type-2 transformed to AML

  6. MATERNAL NEAR MISS IN A TERTIARY CARE HOSPITAL: A CROSS SECTIONAL STUDY

    Directory of Open Access Journals (Sweden)

    Namrata

    2016-06-01

    Full Text Available BACKGROUND Maternal mortality is one of the important indicators of maternal health. To overcome the challenge of reduction of maternal mortality, nationwide notion of SAMM (Severe Acute Maternal Morbidity and near miss event was introduced to access maternal health care. Maternal near miss case is defined as “A woman who nearly died, but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy.” SAMM refers to a life-threatening disorder that can end up in near miss with or without residual morbidity or mortality. Women who develop SAMM during pregnancy share many pathological and circumstantial factors related to their condition. Although some of these women die, a proportion of them narrowly escape death. Near miss c