Conclusion: This prospective point prevalence survey provided important baseline information on antimicrobial use within a large tertiary care teaching hospital and identified potential targets for future antimicrobial stewardship initiatives. A multi-center point prevalence survey should be considered to identify patterns of antimicrobial use in Canada and to establish the first steps toward international antimicrobial surveillance.
Udo, Magnus P.; Samson, Agatha; Baraya, Abdulmutallib Umar
This study investigated good and caring teaching behaviours as perceived by Business Education students in Tertiary Institutions in the North Eastern Nigeria. The latter needed good and caring teaching behaviours to reform the education sector that had been devastated by Boko Haram insurgency. The design of the study was survey. The research…
Bai Kirubha M
Full Text Available Background: Griseofulvin has been the mainstay of treatment for dermatophytosis since many years. Since it is a penicillium antibiotic and used commonly in the outpatient department, the prescription should be audited for its safety and quality. Clinical pharmacists being an important member of the healthcare system have an immense responsibility in delivering pharmaceutical care by auditing prescriptions in order to achieve rational and cost-effective medical care thereby improving patient′s Quality of Life (QOL. Aims: To study the utilization of griseofulvin by auditing prescriptions, to assess the impact of griseofulvin on the QOL of patients and to emphasize role and responsibilities of a clinical pharmacist in the treatment outcome of dermatophytosis. Methods: 120 patients prescribed with griseofulvin in the dermatology outpatient department were included in the study. On the basis of therapeutic response, improvement was graded at the end of the treatment regimen. Adverse drug reactions (ADRs during the treatment period were recorded. Laboratory investigations were performed at baseline and at the end of treatment. Quality of Life was measured at baseline and at the end of therapy. Results: 56.7% were females and 43.3% were males. The most common diagnosis was tinea corporis (44.17% followed by tinea cruris (14.17% and onychomycosis (9.17%. The most common ADR due to griseofulvin was headache (5.83%. 64.20% patients had complete cure following treatment with griseofulvin. The overall QOL score improved significantly following treatment with griseofulvin (P < 0.0001. Conclusion: Griseofulvin can be used extensively for the treatment of dermatophytosis as it has no serious adverse effects and has higher cure rates. Treatment with griseofulvin significantly improves the QOL in patients with dermatophytosis.
Bai Kirubha, M Hepsi
Griseofulvin has been the mainstay of treatment for dermatophytosis since many years. Since it is a penicillium antibiotic and used commonly in the outpatient department, the prescription should be audited for its safety and quality. Clinical pharmacists being an important member of the healthcare system have an immense responsibility in delivering pharmaceutical care by auditing prescriptions in order to achieve rational and cost-effective medical care thereby improving patient's Quality of Life (QOL). To study the utilization of griseofulvin by auditing prescriptions, to assess the impact of griseofulvin on the QOL of patients and to emphasize role and responsibilities of a clinical pharmacist in the treatment outcome of dermatophytosis. 120 patients prescribed with griseofulvin in the dermatology outpatient department were included in the study. On the basis of therapeutic response, improvement was graded at the end of the treatment regimen. Adverse drug reactions (ADRs) during the treatment period were recorded. Laboratory investigations were performed at baseline and at the end of treatment. Quality of Life was measured at baseline and at the end of therapy. 56.7% were females and 43.3% were males. The most common diagnosis was tinea corporis (44.17%) followed by tinea cruris (14.17%) and onychomycosis (9.17%). The most common ADR due to griseofulvin was headache (5.83%). 64.20% patients had complete cure following treatment with griseofulvin. The overall QOL score improved significantly following treatment with griseofulvin (P Griseofulvin can be used extensively for the treatment of dermatophytosis as it has no serious adverse effects and has higher cure rates. Treatment with griseofulvin significantly improves the QOL in patients with dermatophytosis.
Dhande Priti P, Beri Shirish G, Patel Hardik R
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.
Thomas, Arun Z
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.
Toufen Junior Carlos
Full Text Available OBJECTIVE: To determine the prevalence rates of infections among intensive care unit patients, the predominant infecting organisms, and their resistance patterns. To identify the related factors for intensive care unit-acquired infection and mortality rates. DESIGN: A 1-day point-prevalence study. SETTING:A total of 19 intensive care units at the Hospital das Clínicas - University of São Paulo, School of Medicine (HC-FMUSP, a teaching and tertiary hospital, were eligible to participate in the study. PATIENTS: All patients over 16 years old occupying an intensive care unit bed over a 24-hour period. The 19 intensive care unit s provided 126 patient case reports. MAIN OUTCOME MEASURES: Rates of infection, antimicrobial use, microbiological isolates resistance patterns, potential related factors for intensive care unit-acquired infection, and death rates. RESULTS: A total of 126 patients were studied. Eighty-seven patients (69% received antimicrobials on the day of study, 72 (57% for treatment, and 15 (12% for prophylaxis. Community-acquired infection occurred in 15 patients (20.8%, non- intensive care unit nosocomial infection in 24 (33.3%, and intensive care unit-acquired infection in 22 patients (30.6%. Eleven patients (15.3% had no defined type. The most frequently reported infections were respiratory (58.5%. The most frequently isolated bacteria were Enterobacteriaceae (33.8%, Pseudomonas aeruginosa (26.4%, and Staphylococcus aureus (16.9%; [100% resistant to methicillin]. Multivariate regression analysis revealed 3 risk factors for intensive care unit-acquired infection: age > 60 years (p = 0.007, use of a nasogastric tube (p = 0.017, and postoperative status (p = 0.017. At the end of 4 weeks, overall mortality was 28.8%. Patients with infection had a mortality rate of 34.7%. There was no difference between mortality rates for infected and noninfected patients (p=0.088. CONCLUSION: The rate of nosocomial infection is high in intensive care
Thakor, Dhaval R; Desai, Chetna K; Kapadia, Jigar D; Dikshit, Ram K; Mehariya, K M
To evaluate efficacy, safety and utilization pattern of deferasirox in paediatric patients of transfusion dependant β Thalassemia Major at a tertiary care teaching hospital in Gujarat. This observational, prospective-retrospective, single centre, continuous study was conducted in a tertiary care teaching hospital among paediatric patients of transfusion dependent β Thalassemia Major. Patients treated with deferasirox for not more than 12 weeks were enrolled. Details of blood transfusions, relevant investigations performed every 3 weeks and 3 months and drugs used were recorded in a pretested case record form. Parents were provided with a diary to record the details of ADRs. Data were analyzed for demographic characteristics, number and mean volume of blood transfusions, changes in serum ferritin and iron levels, number and types of ADRs and progression, causality, severity and preventability of ADRs. Of the 60 patients enrolled, one patient was lost to follow up and four withdrew their consent. Of the remaining 55 patients, 36 were boys and 19 were girls (mean age: 6 ± 3.14 years), including patients of 1-3 years (11), 4-6 years (24), 7-10 years (12) and 11-12 years (8). Thirty six patients were born of consanguineous marriages. Adherence to blood transfusion guidelines and deferasirox prescribing and administration guidelines was observed. A serial and significant decrease in mean serum ferritin and serum iron at 3 weeks and 3 months with deferasirox treatment was observed in all age groups except that of 11-12 years. A total of 117 ADRs were observed in 52 patients from 19498 doses, most common being diarrhea (24), raised serum creatinine (15), raised hepatic enzymes (14), abdominal pain (14) and rashes (14). A reduction in dose was required in 32 cases, while a temporary stoppage was indicated in 41 cases. Deferasirox was the possible and probable cause of 65 and 51 ADRs respectively as assessed by WHO-UMC scale. Majority of ADRs were definitely preventable
Vishal R Tandon
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.
Binit N Jhaveri
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.
Adhisivam, B; Vishnu Bhat, B; Poorna, Rachel; Thulasingam, Mahalakshmy; Pournami, Femitha; Joy, Rojo
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.
Merlin Shalini Ruth
Full Text Available Context: Patients are fasting for inappropriately long duration preoperatively despite the American Society of Anesthesiologists (ASA recommendations for liberal fasting guidelines. There is paucity of data on preoperative fasting duration in the day care patient population from India; hence, we studied the preoperative fasting status in the day care patient population. Aims: This study aims to study the preoperative fasting duration for solids and clear fluids and to compare the fasting times in the patients posted for the morning slot and the afternoon slot. Settings and Design: This was a prospective, observational, cross-sectional study at a tertiary care, teaching institute. Subjects and Methods: All Consenting adults, ASA grade 1 or 2, of either gender, presenting for day care surgery were included in the study. Data collected included the demographic profile, duration of fasting for solids, and clear fluids. The patients rated their hunger and thirst on a ten point numeric rating scale. We compared the fasting durations for solids and clear fluids in the patients presenting for the morning slot and afternoon slot for surgery. Statistical Analysis Used: T-test was used for analysis of continuous data with normal distribution and Mann–Whitney U-test for data with nonnormal distribution. Chi-square test was performed for categorical variables. Differences were considered significant at P < 0.05. Results: The mean duration of preoperative fasting for solids was 12.58 ± 2.70 h and for clear fluids was 9.02 ± 3.73 h. The mean fasting duration for solids in the patients presenting for the afternoon slot was significantly longer (P < 0.0001 than those presenting for the morning slot. The mean preoperative fasting duration for clear fluids was comparable among these patient groups (P = 0.0741. Conclusions: Patients are following inappropriately prolonged fasting routines, and there is a need to enforce liberal preoperative fasting guidelines
Khanna, Vishesh; Sambandam, Senthil N; Gul, Arif; Mounasamy, Varatharaj
Smartphones have emerged as essential tools providing assistance in patient care, monitoring, rehabilitation, communication, diagnosis, teaching, research and reference. Among innumerable communication apps, WhatsApp has been widely popular and cost effective. The aim of our study was to report the impact of introduction of a smartphone app "WhatsApp" as an intradepartmental communication tool on (1) awareness of patient-related information, (2) efficiency of the handover process and (3) duration of traditional morning handovers among orthopedic residents in a 300-bedded tertiary care teaching center. Written handovers and paging used for communication at our center led to occasional inefficiencies among residents. Widespread use, low cost, availability and double password protection (phone lock and WhatsApp lock) made WhatsApp's group conversation feature an ideal tool for intradepartmental patient-related communication. Twenty-five consecutive admissions before and after WhatsApp (BW, AW) were included in the study. Eight orthopedic residents attempted fifty randomly arranged questions based on the twenty-five patients in each study period. A null hypothesis that introduction of WhatsApp group would neither increase the awareness of patient-related information nor improve the efficiency of the handovers among residents was assumed. A significant improvement observed in scores obtained by residents in the AW group led to rejection of the null hypothesis. The residents also reported swifter and efficient handovers after the introduction of WhatsApp. Our results indicate that the introduction of a smartphone app "WhatsApp" as an intradepartmental communication tool can bring about an improvement in patient-related awareness, communication and handovers among orthopedic residents.
Ahuja, Rajeev B; Goswami, Prasenjit
There is an extreme paucity of studies examining cost of burn care in the developing world when over 85% of burns take place in low and middle income countries. Modern burn care is perceived as an expensive, resource intensive endeavour, requiring specialized equipment, personnel and facilities to provide optimum care. If 'burn burden' of low and middle income countries (LMICs) is to be tackled deftly then besides prevention and education we need to have burn centres where 'reasonable' burn care can be delivered in face of resource constraints. This manuscript calculates the cost of providing inpatient burn management at a large, high volume, tertiary burn care facility of North India by estimating all cost drivers. In this one year study (1st February to 31st January 2012), in a 50 bedded burn unit, demographic parameters like age, gender, burn aetiology, % TBSA burns, duration of hospital stay and mortality were recorded for all patients. Cost drivers included in estimation were all medications and consumables, dressing material, investigations, blood products, dietary costs, and salaries of all personnel. Capital costs, utility costs and maintenance expenditure were excluded. The burn unit is constrained to provide conservative management, by and large, and is serviced by a large team of doctors and nurses. Entire treatment cost is borne by the hospital for all patients. 797 patients (208 burn were admitted with a mean age of 23.04 years (range 18 days to 83 years). The mean BSA burn was 42.26% (ranging from 2% to 100%). 378/797 patients (47.43%) sustained up to 30% BSA burns, 216 patients (27.1%) had between 31 and 60% BSA and 203 patients (25.47%) had >60% BSA burns. 258/797 patients died (32.37%). Of these deaths 16, 68 and 174 patients were from 0 to 30%, 31 to 60% and >60% BSA groups, respectively. The mean length of hospitalization for all admissions was 7.86 days (ranging from 1 to 62 days) and for survivors it was 8.9 days. There were 299 operations
Palaniappan, Muthiah; Selvarajan, Sandhiya; George, Melvin; Subramaniyan, Ganesan; Dkhar, Steven Aibor; Pillai, Ajith Ananthakrishna; Jayaraman, Balachander; Chandrasekaran, Adithan
Cardiovascular diseases (CVD) are one of the leading causes of non-communicable disease related deaths globally. Patients with cardiovascular diseases are often prescribed multiple drugs and have higher risk for developing more adverse drug reactions due to polypharmacy. To evaluate the pattern of adverse drug reactions reported with cardiovascular drugs in an adverse drug reaction monitoring centre (AMC) of a tertiary care hospital. Adverse drug reactions related to cardiovascular drugs reported to an AMC of a tertiary care hospital were included in this prospective observational study. All cardiovascular drugs related adverse drug reactions (ADRs) received in AMC through spontaneous reporting system and active surveillance method from January 2011 to March 2013 were analysed for demographic profile, ADR pattern, severity and causality assessment. The study used descriptive statistics and the values were expressed in numbers and percentages. During the study period, a total of 463 ADRs were reported from 397 patients which included 319 males (80.4%) and 78 females (19.6%). The cardiovascular drug related reports constituted 18.1% of the total 2188 ADR reports. In this study, the most common ADRs observed were cough (17.3%), gastritis (7.5%) and fatigue (6.5%). Assessment of ADRs using WHO-causality scale revealed that 62% of ADRs were possible, 28.2% certain and 6.8% probable. As per Naranjo's scale most of the reports were possible (68.8%) followed by probable (29.7%). According to Hartwig severity scale majority of the reports were mild (95%) followed by moderate (4.5%). A system wise classification of ADRs showed that gastrointestinal system (20.7%) related reactions were the most frequently observed adverse reactions followed by respiratory system (18.4%) related adverse effects. From the reported ADRs, the drugs most commonly associated with ADRs were found to be enalapril (17.5%), atorvastatin (14.9%), aspirin (8.4%) and metoprolol (8.4%). The cardiovascular
Deshpande, Rushikesh Prabhakar; Motghare, Vijay Motiram; Padwal, Sudhir Laxman; Pore, Rakesh Ramkrishna; Bhamare, Chetanraj Ghanshyam; Deshmukh, Vinod Shivaji; Pise, Harshal Nutan
Objectives The study was carried out with the aim of evaluation of the adverse drug reaction profile of anti-snake venom serum (ASV) in a rural tertiary care hospital. Methods An observational study was conducted in SRTR Medical College, Ambajogai, Maharashtra, India. A total number of 296 indoor case papers of snake bite from February to September 2011 and June to August 2012 were retrieved from the record section and the antivenom reactions were assessed. In addition, basic epidemiological data and prescribing practices of ASV were also analyzed. Results Vasculotoxic snake bites were more common (50.61%) than neuroparalytic ones (22.56%). Mild envenomation was the commonest presentation. A total of 92 (56.10%) patients who received ASV suffered from antivenom reactions. The most common nature of reaction was chills, rigors (69.56%) followed by nausea and vomiting (34.8%). 10-15% patients suffered from moderate to severe reactions like hypotension and sudden respiratory arrest. We did not find any dose response relationship of ASV to risk of reactions (odds ratio 0.37). Intradermal sensitivity test was performed in about 72% cases. Conclusion Our study showed a higher incidence of reactions to ASV at our institute. PMID:24396245
Subramanian, Ansha; Adhimoolam, Mangaiarkkarasi; Kannan, Suresh
Aim: Drug–drug interactions (DDIs) are one of the major but preventable cause of adverse drug reaction. Study of prevalence and prediction of DDIs will make the physician easier to provide better patient care and mitigate patient's harm. Hence, the study was planned to evaluate the potential DDIs among medication prescribed to hypertensive patients in our hospital. Materials and Methods: A prospective, cross-sectional study was conducted among the hypertensive patients in medicine (outpatient/inpatient) department over the period of three months in a tertiary care hospital. Adult hypertensive patients of either sex with comorbidities were included in the study. The prescriptions were collected and analyzed for DDI using Medscape interaction checker. Data were analyzed using SPSS (version 16.0) software and expressed in percentage. Pearson's correlation and regression analysis were done. Results: Among 125 patients, 48% were exposed to at least one DDI. Totally 123 DDI were identified and majority of them were significant (85.36%). No serious interactions were identified. Pharmacodynamic and pharmacokinetic drug interactions were found to be 37.39% and 28.76%, respectively. Logistic regression analysis showed advanced male gender and polypharmacy was associated with increased risk of DDI. About 51 interacting pairs of DDI were identified and most frequently occurring pair was amlodipine with atenolol. Aspirin was found to have commonly involved in DDI with enalapril, atenolol, frusemide, spironolactone, carvedilol, and metoprolol. Conclusion: The study highlighted that patients with hypertension are particularly vulnerable to DDI. The comorbidities, advanced age, and polypharmacy are the important factors associated with the occurrence of DDI. PMID:29430412
Subramanian, Ansha; Adhimoolam, Mangaiarkkarasi; Kannan, Suresh
Drug-drug interactions (DDIs) are one of the major but preventable cause of adverse drug reaction. Study of prevalence and prediction of DDIs will make the physician easier to provide better patient care and mitigate patient's harm. Hence, the study was planned to evaluate the potential DDIs among medication prescribed to hypertensive patients in our hospital. A prospective, cross-sectional study was conducted among the hypertensive patients in medicine (outpatient/inpatient) department over the period of three months in a tertiary care hospital. Adult hypertensive patients of either sex with comorbidities were included in the study. The prescriptions were collected and analyzed for DDI using Medscape interaction checker. Data were analyzed using SPSS (version 16.0) software and expressed in percentage. Pearson's correlation and regression analysis were done. Among 125 patients, 48% were exposed to at least one DDI. Totally 123 DDI were identified and majority of them were significant (85.36%). No serious interactions were identified. Pharmacodynamic and pharmacokinetic drug interactions were found to be 37.39% and 28.76%, respectively. Logistic regression analysis showed advanced male gender and polypharmacy was associated with increased risk of DDI. About 51 interacting pairs of DDI were identified and most frequently occurring pair was amlodipine with atenolol. Aspirin was found to have commonly involved in DDI with enalapril, atenolol, frusemide, spironolactone, carvedilol, and metoprolol. The study highlighted that patients with hypertension are particularly vulnerable to DDI. The comorbidities, advanced age, and polypharmacy are the important factors associated with the occurrence of DDI.
Sonkar, Kamlesh Kumar; Bhoi, Sanjeev Kumar; Dubey, Deepanshu; Kalita, Jayantee; Misra, Usha Kant
Myasthenia gravis (MG) requires lifelong treatment. The cost of management MG is very high in developed countries but there is no information on the cost of management of MG in the developing countries. This study reports the direct and indirect cost and predictors of cost of MG in a tertiary care teaching hospital in India. In a prospective hospital based study, from a tertiary hospital in India 66 consecutive patient during 2014-2015 were included. The age of the patients ranged between 6 and 75years. The severity of MG was assessed by myasthenia gravis foundation association (MGFA) class (MGFA) I-V. The patient data was collected s and their direct cost was calculated from the computerized Hospital information system. The indirect cost was calculated from patient's memory, checking the bills of transportation and wages loss by the patient or the care giver. Total annual cost of MG ranged between INR (4560-532227) with median INR 61390.5 (US$911.64). The median cost of outpatient department (OPD) consultation of 16 patients was INR 20439.9 (US$303.53), of 50 admitted patients was INR 44311.8 (US$658.03) and 21 intensive care unit (ICU) patients was INR 59574.3 (US$ 884.6) and the direct cost of thymectomy was INR 45000 (US$ 668.25). Direct cost was related to indirect cost (r=0.55; p=0.0001). Predictors of patient outcome were severity of MG, ICU admission, and thymectomy. The total median cost for management of myasthenia gravis was INR 61390.5 (4560-532227, US$911.64) per year, and the cost was mainly determined by the severity of MG. Copyright © 2016 Elsevier Ltd. All rights reserved.
Full Text Available Background: Patients attend the Pain Clinic with varieties of complains of pain, like low back pain, knee pain, shoulder pain, headache, facial pain, different neuralgias and other neuropathic pain states. They receive a multimodal treatment for their pain, Multimodal pain therapy is an integrated multidisciplinary treatment in small groups with a closely coordinated therapeutic approach. Drugs that are prescribed for treatment are not only NSAIDS or Opioids, but also various groups of adjuvant pain medications like anti-epileptics, antidepressants etc. Aim: To find out the drug utilization pattern in the Pain Clinic of a tertiary care medical college hospital in Eastern India. Materials and Methods: A cross sectional; unicentric study was conducted in the Pain Clinic during April 2013 to June 2013. New patients who were willing to participate in the study were enrolled as per selection criteria. A copy of prescriptions were collected from the patients. The drugs prescription patterns were analyzed. Result: 319 patients were included in this study in three months period and their prescriptions were analyzed. Female patients (222 were more in number than male (97. As single prescription and also as combination therapy, paracetamol was found to be the most frequently prescribed drug. Frequently used adjuvant pain medications were found to be pregabalin (21.63% and amitriptyline (16.92%.. Antacid was commonly prescribed as gastroprotective agent. Among drug combinations paracetamol (325 mg + tramadol (37.5 mg combination was used most frequently. (55.17%. Conclusion: In this uncentric study we found that patacetamol, tramadol, pregabalin and amitriptyline are the commonly used medications in a pain clinic. We need more multi-centric and comparative Indian studies.
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.
Bhadade, Rakesh; Harde, Minal; deSouza, Rosemarie; More, Ashwini; Bharmal, Ramesh
Nosocomial pneumonia poses great challenge to an intensivist. Detailed information about hospital-acquired pneumonia (HAP) and ventilator-acquired pneumonia (VAP) is crucial for prevention and optimal management, thus improving quality Intensive Care Unit (ICU) care. Hence, we aimed to study the current trend of nosocomial pneumonia in ICU. It was a prospective observational cohort study, conducted in the ICU of a tertiary care teaching public hospital over a period of 18 months. We studied clinical profile and outcome of 120 adult patients who developed VAP/HAP during the study period. We also analyzed the causative organisms, antibiotic sensitivity, and resistance pattern in these patients. Out of 120 patients, 29 patients were HAP and 91 patients were VAP. Mortality was 60% (72), and development of VAP and requirement of mechanical ventilation showed significant association with mortality (P pneumoniae (49%). Maximum antibiotic sensitivity was found to piperacillin + tazobactam (58.8%), followed by imipenem (49.5%) and meropenem (41.8%), whereas maximum antibiotic resistance was found to cefepime (95.1%), followed by ceftazidime and amoxicillin (91.2%). Nosocomial pneumonia showed high incidence (17.44%) and mortality (60%). Common organisms identified were S. aureus and K. pneumoniae. Resistance was high for commonly used antibiotics and high antibiotic sensitivity for piperacillin + tazobactam and carbapenem. Contexte: La pneumonie nosocomiale pose un grand défi à un intensiviste. Des informations détaillées sur la pneumonie acquise dans les hôpitaux (HAP) et la pneumonie acquise par le ventilateur (VAP) sont essentielles pour la prévention et la gestion optimale, améliorant ainsi les soins de soins intensifs de qualité (UTI). Par conséquent, nous avons cherché à étudier la tendance actuelle de la pneumonie nosocomiale en UTI. Matériaux et méthodes: il s'agissait d'une étude de cohorte observationnelle prospective menée dans l'UCI d'un h
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.
Dhrubajyoti J Debnath
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.
Agrawal, Upasana; D'Souza, Brayal C; Seetharam, Arun Mavaji
The rights of a patient are a set of rules of conduct which govern the interaction between the patients' and healthcare professionals. Every patient has a right to be informed about their rights and also the responsibility of the healthcare provider. To assess awareness among inpatient about patients' rights at an academic accredited hospital. A questionnaire based cross-sectional study was carried out among 350 patients admitted to the wards of a Tertiary Care Teaching Hospital. A 21-point questionnaire was developed based on standards of the National Accreditation Board for Hospitals and Healthcare Providers (NABH) and patients' charter of rights and validated. This charter of rights is also displayed in the hospital for patient's awareness. Frequencies and percentages were depicted. Chi-square test was used for statistical analysis. Positive awareness among the patients ranged from 28% to 97.4%. Females were more aware of their rights than males for 11 out of the 21 patient rights items. Younger adults were more aware than any other age group participants. Participants who were admitted to wards of higher categories (deluxe rooms) had high degree of awareness about patients' rights and education. Patients from urban areas and higher educational status were more aware than patients coming from rural areas. The study concludes that effective measures should be taken to improve the overall awareness not only among patients but also among different stakeholders in the healthcare delivery system. Readability of the patients' rights charter with good readability score, developing and distributing patient education materials in simple language about the rights and responsibilities to the patient and their family/relatives during their stay in the hospital or at the time of registration.Continuing nursing and medical education in medical teaching institutions and hospitals should focus on patients' rights and its importance, its need for awareness and its consequences
Kumar, M Rajesh; Kumar, G P Vignan; Babu, P Ramesh; Kumar, S Satish; Subrahmanyam, B V; Veeraprasad, M; Rammohan, P; Srinivas, M; Agrawal, Amit
We have herein reported our experience with the pattern of presentation of cases of acute organophosphorus (OP) poisoning cases in a tertiary care hospital. This retrospective study evaluated the hospital records of patients with acute OP poisoning. In a pre-structured proforma, data regarding age, sex, time elapsed after intake, circumstances of poisoning, duration of hospitalization, severity, complications, and outcome of the patients were recorded. The data were presented as mean ± standard deviation, entered in the open office datasheet, and analyzed with PSPP software. A total 101 patients were included in the study. Young adult males were more commonly involved than females (M:F 2.5:1). The mean age of the patients was 28 years (range 2-72 years, SD ± 14.3 years). Mean time to receive treatment was 5.2 ± 7.4 (range 1-48 h). About 45.5% patients received first aid before coming to the hospital. The reason was suicide in 88.1% cases and accident in 12 (11.9%, all children). Seventy-nine patients received pralidoxime (PAM) and the mean duration was 1.7 ± 1.1 (range 1-4 days). Atropine was given in all patients. Mean duration was 5.1 ± 3.1 (range 1-19 days). Mean hospital stay was 7.5 ± 4.7 days (range 1-26 days). Mortality was 9.9% in the present series. Although the present study contribute substantial information regarding the epidemiology and outcome of acute OP poisoning in a tertiary care teaching hospital at a district level, its relatively small sample size and the retrospective record-based nature are the major limitations of the present study. There is a further need for prospective studies to understand the underlying socio-economic factors responsible for acute OP poisoning in our population, and, accordingly, address the problems to reduce the incidence of acute OP poisoning cases.
Ghataliya, Kunal J; Kapadia, Jigar D; Desai, Mira K; Mehariya, K M; Rathod, G H; Bhatnagar, Nidhi; Gajjar, M D
Use of blood and its components is lifesaving. However, their use is often associated with adverse events. To analyze the pattern of adverse reactions associated with transfusion of blood and its components in pediatric and surgical patients at a tertiary care teaching hospital. Patients receiving transfusion of blood or its components in a randomly selected unit each from Departments of Pediatrics, including thalassemia OPD and surgery, were monitored intensively for a period of 6 months. Clinical course, management, outcome, causality, severity, seriousness, and preventability of observed transfusion reactions (TRs) were analyzed. A total of 411 pediatric and 433 surgical patients received 594 and 745 transfusions respectively during the study period. Of these, TRs were observed in 69 (11.6%) children and 63 (8.4%) surgical patients. Majority of reactions in children (48, 69.5%) and surgical patients (51, 80.9%) were acute, developing within 24 h of transfusion. TRs were observed with packed cells (13.2%), cryoprecipitate (10%), platelet concentrate (14.3%) and fresh frozen plasma (1.3%) in pediatric patients and with packed cells (7.2%), whole blood (25%) and platelet concentrate (62.5%) in surgical patients. Most common TRs included febrile nonhemolytic TRs (FNHTRs) and allergic reactions. Reactions were more frequent in patients with a previous history of transfusion or those receiving more than one transfusion and in children, when transfusion was initiated after 30 min of issue of blood component. Majority of reactions were managed with symptomatic treatment, were nonserious, moderately severe, probably preventable and probably associated with the suspect blood component in both populations. Transfusion reactions in children and surgical patients are commonly observed with cellular blood components. Majority of reactions are acute and nonserious. FNHTRs and allergic reactions are the most common transfusion reactions. Risk of transfusion reactions is more in
Ghataliya, Kunal J.; Kapadia, Jigar D.; Desai, Mira K.; Mehariya, K. M.; Rathod, G. H.; Bhatnagar, Nidhi; Gajjar, M. D.
BACKGROUND: Use of blood and its components is lifesaving. However, their use is often associated with adverse events. OBJECTIVE: To analyze the pattern of adverse reactions associated with transfusion of blood and its components in pediatric and surgical patients at a tertiary care teaching hospital. MATERIALS AND METHODS: Patients receiving transfusion of blood or its components in a randomly selected unit each from Departments of Pediatrics, including thalassemia OPD and surgery, were monitored intensively for a period of 6 months. Clinical course, management, outcome, causality, severity, seriousness, and preventability of observed transfusion reactions (TRs) were analyzed. RESULTS: A total of 411 pediatric and 433 surgical patients received 594 and 745 transfusions respectively during the study period. Of these, TRs were observed in 69 (11.6%) children and 63 (8.4%) surgical patients. Majority of reactions in children (48, 69.5%) and surgical patients (51, 80.9%) were acute, developing within 24 h of transfusion. TRs were observed with packed cells (13.2%), cryoprecipitate (10%), platelet concentrate (14.3%) and fresh frozen plasma (1.3%) in pediatric patients and with packed cells (7.2%), whole blood (25%) and platelet concentrate (62.5%) in surgical patients. Most common TRs included febrile nonhemolytic TRs (FNHTRs) and allergic reactions. Reactions were more frequent in patients with a previous history of transfusion or those receiving more than one transfusion and in children, when transfusion was initiated after 30 min of issue of blood component. Majority of reactions were managed with symptomatic treatment, were nonserious, moderately severe, probably preventable and probably associated with the suspect blood component in both populations. CONCLUSION: Transfusion reactions in children and surgical patients are commonly observed with cellular blood components. Majority of reactions are acute and nonserious. FNHTRs and allergic reactions are the most
T S Panchabhai
Full Text Available 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 toward computer-aided learning (CAL. The data was classified on the basis of sex, native place, and year of medical school, and the computer resources were compared. The computer usage and attitudes toward computer-based learning were assessed on a five-point Likert scale, to calculate Computer usage score (CUS - maximum 55, minimum 11 and Attitude score (AS - maximum 60, minimum 12. The quartile distribution among the groups with respect to the CUS and AS was compared by chi-squared tests. The correlation between CUS and AS was then tested. Results: Eight hundred and seventy-five students agreed to participate in the study and 832 completed the questionnaire. One hundred and twenty eight questionnaires were excluded and 704 were analyzed. Outstation students had significantly lesser computer resources as compared to local students (P<0.0001. The mean CUS for local students (27.0±9.2, Mean±SD was significantly higher than outstation students (23.2±9.05. No such difference was observed for the AS. The means of CUS and AS did not differ between males and females. The CUS and AS had positive, but weak correlations for all subgroups. Conclusion: The weak correlation between AS and CUS for all students could be explained by the lack of computer resources or inadequate training to use computers for learning. Providing additional resources would benefit the subset of outstation students with lesser computer resources. This weak correlation between the attitudes
Acharya, Anita Shankar; Priyanka; Khandekar, Jyoti; Bachani, Damodar
Injuries caused by needle sticks and sharps due to unsafe injection practices are the most common occupational hazard amongst health care personnel. The objectives of our study were to determine the existing knowledge and practices of interns and change in their level following an information education and communication (IEC) package regarding safe injection practices and related biomedical waste management and to determine the status of hepatitis B vaccination. We conducted a follow-up study among all (106) interns in a tertiary care teaching hospital, Delhi. A predesigned semistructured questionnaire was used. IEC package in the form of hands-on workshop and power point presentation was used. A highly significant (P waste management. Almost two-thirds of interns were immunised against hepatitis B before the intervention and this proportion rose significantly after the intervention.
Talati, Shweta; Bhatia, Prateek; Kumar, Ashok; Gupta, A K; Ojha, Col D
As per the "Disaster Management Act, 2005" of India, it is mandatory for government hospitals in India to prepare a disaster plan. This study aimed to prepare a disaster manual of a 1 900 bed tertiary care hospital, in consultation and involvement of all concerned stakeholders. A committee of members from hospital administration, clinical, diagnostic and supportive departments worked on an initial document prepared according to the Act and gave their inputs to frame a final disaster manual. The prepared departmental standard operating procedures involved 116 people (doctors and paramedical staff), and were then synchronized, in 12 committee meetings, to produce the final hospital disaster manual. The present disaster manual is one of the few comprehensive plans prepared by the stakeholders of a government hospital in India, who themselves form a part of the disaster response team. It also helped in co-ordinated conduction of mock drills.
Chetan S. Urade
Full Text Available Objectives- To study the prescription pattern of antihypertensive drugs and analyze the medication adherence to antihypertensive drugs at rural tertiary care teaching hospital.Materials and Methods- Prospective, observational, 12 weeks, questionnaire based study, conducted in rural tertiary care teaching hospital of central India. 214 antihypertensive prescriptions were analyzed by Morisky medication adherence scale. Statistical analysis was done by MS Excel and Graph pad prism 6.0.Results- 28.03% patients were not aware about the medicines taken, 29.90% patients were unacquainted about dose and route of administration whereas 32.71% patients were unfamiliar about frequency of administration of medicines. 53.27% patients were unaware about precautions to be taken while consuming medicines. 58.68% & 12.67% patients consumed amlodipine & atenolol respectively. In 16.43% patients, atenolol + amlodipine combination therapy was prescribed. Amongst 214 patients 12, 58 & 144 showed high, medium & low adherence respectively. No significant difference was found on gender basis at any level of adherence.Conclusion- In this study, physicians given preference to amlodipine than other antihypertensive drugs. However, thiazide is a first line drug in stage 1 hypertension, recommended by JNC VII guideline. This indicates that there is need of creating awareness about current management of hypertension to clinicians by organizing various workshops. We observed only 5.60% patients showed high adherence to antihypertensive therapy. Therefore educational strategies must be carried out for physicians focusing on causes for nonadherence to antihypertensive medications. Also raising patient trust in their physicians may improve patient motivation to prescribed medication.
Dasgupta, Sugata; Das, Soumi; Chawan, Neeraj S; Hazra, Avijit
The increased morbidity and mortality associated with nosocomial infections in the intensive care unit (ICU) is a matter of serious concern today. To determine the incidence of nosocomial infections acquired in the ICU, their risk factors, the causative pathogens and the outcome in a tertiary care teaching hospital. This was a prospective observational study conducted in a 12 bedded combined medical and surgical ICU of a medical college hospital. The study group comprised 242 patients admitted for more than 48 h in the ICU. Data were collected regarding severity of the illness, primary reason for ICU admission, presence of risk factors, presence of infection, infecting agent, length of ICU and hospital stay, and survival status and logistic regression analysis was done. The nosocomial infection rate was 11.98% (95% confidence interval 7.89-16.07%). Pneumonia was the most frequently detected infection (62.07%), followed by urinary tract infections and central venous catheter associated bloodstream infections. Prior antimicrobial therapy, urinary catheterization and length of ICU stay were found to be statistically significant risk factors associated with nosocomial infection. Nosocomial infection resulted in a statistically significant increase in length of ICU and hospital stay, but not in mortality. Nosocomial infections increase morbidity of hospitalized patients. These findings can be utilized for planning nosocomial infection surveillance program in our setting.
Wong, J L; Siti Azrin, A H; Narizan, M I; Norliah, Y; Noraida, M; Amanina, A; Nabilah, I; Habsah, H; Siti Asma, H
Hands of Health Care Personnel (HCP) are one of the most common vehicles for the transmission of infection. Microorganisms can survive well on the hands of HCP for a certain duration. Therefore, the purpose of this study is to bring awareness to HCP that their hands can actually be contaminated with many microorganisms. These microbes on the hands of HCP can potentially infect their patients if they do not comply with the proper hand hygiene practice. This cross-sectional study was conducted at a randomly selected Intensive Care Unit (ICU) and general ward in a hospital. Twenty five HCP from each ward were randomly selected and their hands were imprinted on blood culture plates. Microorganism growth were quantified and identified. Data were analyzed and presented as descriptive analysis. One hundred blood agar plates were processed and analyzed. Majority (71%) of the samples had more than 50 colony-forming units (CFU) and only 17% of the samples had less than 25 CFU. Microorganisms identified include Staphylococcus spp., Acinetobacter spp., Enterobacteriaceae, Pseudomonas spp., Moraxella, Delftiaacidovorans and fungi. All isolated microorganisms were antibiotic sensitive strain. This study showed that the hands of HCP were contaminated with many microorganisms. Therefore, it is imperative that HCP must practice proper hand hygiene when taking care of their patients in the wards.
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.
Mandal, Ananya; Kundu, Tania Sur; Sengupta, Parama; Ghosh, Arijit; Das, Nina
World Health Organization (WHO) defines what is drug and what is not. Second year MBBS students learn the principles of Pharmacology that they use in their later clinical practice life. The aim of the survey was to determine how medical students classify a range of preparations they might encounter in their professional lives and whether a brand name or a commercial preparation of a drug would influence their decision in the categorization of the preparation as a 'drug' or 'not a drug'. To assess the knowledge of medical students, if a substance or product is a drug. We surveyed 2 concurrent years of medical students to classify 60 candidate medicinal preparations into "drug" and "not-drug" from a validated questionnaire. The candidate preparations were named either in generic or in their commercially available forms and they were all essential drugs as per WHO definition. The two groups of students, A and B, included 192 and 215 students respectively. Demographically there was little difference in the two groups. Agents like Aspirin, Paracetamol, Amphetamine, Salbutamol, Atropine, Dextromethorphan, Codeine, Diazepam, Ciprofloxacin ear drops, Levonorgestrol, Neosporin eye ointment, Furosemide, Metronidazole, Penicillin, Sorbitrate, Lignocaine, Methotrexate, Penicillin, Zolpidem and Thalidomide received almost unanimous votes as drugs. Arsenic trioxide, Fentanyl and petroleum jelly were considered to be "non-drugs" by most participants. The two groups did not differ significantly in their responses. Some major lacunae were noted in the knowledge of the participating students despite book teaching on the definition of a drug. Drugs used for prophylaxis and those used in physiological conditions or topically, were often missed. These gaps need to be filled by more emphasis on definition of a drug and its clinical applicability based on example and case based studies.
Alam, K; Mishra, P; Prabhu, M; Shankar, P R; Palaian, S; Bhandari, R B; Bista, D
To analyze the prescriptions of out-patients for rational prescribing and dispensing and to evaluate the patient's knowledge regarding use of drugs, using INRUD indicators. A cross-sectional, descriptive study was conducted at the Manipal Teaching Hospital, Pokhara, Nepal during the time period from June 10th to August 19th 2004. Totally 247 prescriptions were randomly selected for analysis, wherein 720 drugs were prescribed. Only 15% of drugs were prescribed by generic name, 21.67% of the total drugs consisted of fixed-dose combinations, only 40% of drugs were from the Essential drug list of Nepal and 29.44% (n=212) were from the WHO Essential drug list. It was found that more than half (54.17%) of the drugs were from Nepalese National Formulary and 35.69% were from WHO model formulary. Dermatological products were most commonly prescribed followed by drugs acting on central nervous system, antimicrobials and drugs acting on cardiovascular system. Among the drugs dispensed, 79.16% were oral followed by topical (18.19%) and parenteral forms (2.98%). Diagnosis was mentioned only in 3.23% (n=8) of the prescriptions and the average cost per prescription was found to be 241.11 Nepalese rupees (US$ 3.26). It was found out that pharmacist labelled only 0.4% of the medication envelopes with the name of the patient. However, 82.6% of the medication envelopes were labelled with name of the drug and 87.0% with drug strength. Only 53.8% (n=133) of the patient knew both the duration of the therapy and administration time of drugs. There is a need for educational intervention for prescribers and both managerial and educational intervention for the hospital pharmacists to improve prescribing and dispensing.
B Sujith Anand
Full Text Available Introduction: The dental health care providers and their community service in any nation play a pivotal role in bridging the gap between the oral health care and social service system. Understanding that there is a shortage and disparity in the oral health services provided, a greater emphasis on its awareness and education is the present need; thus, the aim of the study is to assess the attitude toward community service among dental students. Methodology: A cross-sectional questionnaire-based study was conducted among undergraduate dental students who were present on the day of study, and their attitude toward community service was assessed using a standardized Community Service Attitude Scale which consists of eight domains. Data were analyzed using descriptive statistics, Chi-square test, and ANOVA. The level of significance was set at P < 0.05. Results: The total participants included were 171. The levels of attitude toward community service among the study participants based on year (P = 0.0492, gender (P = 0.00482, and voluntary activity (P = 0.042 were found to be statistically significant. Conclusion: The attitude toward community service is influenced by gender and year of study. Hence, any practical training program with regard to service learning in their undergraduate curriculum would highly contribute to influence their attitude toward community service.
hypertensive disorder and 58.3% of them were diagnosed as uncontrolled hypertension.Conclusion: The current DUE study found that cabergoline was mainly used to inhibit lactation for patients with stillbirth, abortion, and neonatal death. In mothers who use medications for other medical conditions, benefits and risks of breastfeeding should be carefully balanced before prescribing cabergoline. Current prescribing pattern can be further enhanced through informing health care providers regarding appropriate cabergoline dosage regimen and its safety in patients with uncontrolled hypertension. Keywords: lactation inhibition, cabergoline, drug use evaluation, breastfeeding inhibition
Full Text Available A single-day hospital-acquired infections (HAIs point prevalence study was conducted in a tertiary care hospital in China. The overall prevalence rate of HAIs was 3.53% (95% confidence interval 2.80–4.26% among 2434 inpatients surveyed. Respiratory system infection was the most common type of HAI (49.43%, followed by surgical site infection (22.99%. The pathogen detection results for 50 patients showed Pseudomonas aeruginosa to account for 24.00% of isolates, followed by Klebsiella pneumoniae (14.00% and Escherichia coli (14.00%.
A non-clinical randomised controlled trial to assess the impact of pharmaceutical care intervention on satisfaction level of newly diagnosed diabetes mellitus patients in a tertiary care teaching hospital in Nepal.
Upadhyay, Dinesh Kumar; Mohamed Ibrahim, Mohamed Izham; Mishra, Pranaya; Alurkar, Vijay M
Patient satisfaction is the ultimate goal of healthcare system which can be achieved from good patient-healthcare professional relationship and quality of healthcare services provided. Study was conducted to determine the baseline satisfaction level of newly diagnosed diabetics and to explore the impact of pharmaceutical care intervention on patients' satisfaction during their follow-ups in a tertiary care teaching hospital in Nepal. An interventional, pre-post non-clinical randomised controlled study was designed among randomly distributed 162 [control group (n = 54), test 1 group (n = 54) and test 2 group (n = 54)] newly diagnosed diabetes mellitus patients by consecutive sampling method for 18 months. Diabetes Patient Satisfaction Questionnaire was used to evaluate patient's satisfaction scores at baseline, three, six, nine and, twelve months' follow-ups. Test groups patients were provided pharmaceutical care whereas control group patients only received their usual care from physician/nurses. The responses were entered in SPSS version 16. Data distribution was not normal on Kolmogorov-Smirnov test. Non-parametric tests i.e. Friedman test, Mann-Whitney U test and Wilcoxon signed rank test were used to find the differences among the groups before and after the intervention (p ≤0.05). There were significant (p patients' satisfaction scores in the test groups on Friedman test. Mann-Whitney U test identified the significant differences in satisfaction scores between test 1 and test 2 groups, control and test 1 groups and, control and test 2 groups at 3-months (p = 0.008), (p satisfaction level of diabetics in the test groups compare to the control group. Diabetic kit demonstration strengthened the satisfaction level among the test 2 group patients. Therefore, pharmacist can act as a counsellor through pharmaceutical care program and assist the patients in managing their disease. This will not only modify the patients' related outcomes and their
This study examined the attitudes and level of commitment of lecturers towards teaching in tertiary educational institutions in south Eastern Nigeria. Five hypotheses guided the study. The sample consisted of 1991 lecturers and 828 students drawn through proportionate stratified random sampling techniques. Three sets of ...
Purpose: The paper seeks to demonstrate the characteristics of group work that are required to teach the attributes of real world venture teamwork in tertiary entrepreneurship programmes. Design/methodology/approach: One-tailed Spearman correlation analysis is used to assess the associations between students' grades in four group assessment tasks…
Anna Y. Polenova
Full Text Available The article looks at some principles of constructivism philosophy and the ways they are realized in ESP teaching at tertiary school. The purpose of this article is to describe constructivist teaching approach in enhancing students’ use of appropriate ESP learning strategies. Constructivism is a theory that emphasizes the active role of students in building understanding and making sense of the information. The constructivist teaching is learner-centered where students are actively involved in knowledge construction rather than passive listeners. Students construct knowledge by transforming, organizing, reorganizing previous knowledge through social interaction in construction of knowledge and understanding. The paper is an attempt to examine the principles of constructivist teaching and learning by providing analysis of features of constructivist theory and the organization of a constructivist classroom.
Self care activities among patients with diabetes attending a tertiary care hospital in Mangalore Karnataka, India. ... Conclusions: Self‑care practices were found to be unsatisfactory in almost all aspects except for blood sugar monitoring and treatment adherence. As these practices are essential for prevention of ...
Kapoor, Urvasi; Ramasamy, Gomathi; Selvaraj, Kalaiselvi; Sahoo, Jaya Prakash; Kar, Sitanshu Sekhar
The study was aimed to capture the effect of using injection pads as a tool in educating the diabetic patients who were on insulin. The attitude and practice of the patients in storage of insulin vials and disposal of insulin syringes were also assessed. A facility based Quasi-experimental study was carried out among the diabetic patients on insulin, attending diabetic clinic in endocrinology OPD in a tertiary care hospital, Puducherry. One to one intervention was given to the study participants or their attendants (who were involved in injecting insulin), by a trained investigator regarding all the steps of insulin administration. The insulin administration practices before and immediately after the intervention was assessed using a checklist. In total 91 patients were included for the study with mean (SD) age of 53.9 (10.6) years and of them 76% were females. The attitude and practices of the study participants, such as hand washing before handling insulin, checking the expiry date, storage of insulin, inspection of injection site, rolling and cleaning the vial, withdrawal of the syringe up to the required dose, pushing the plunger after inserting the syringe into the vial, checking and removal of air bubbles, cleaning the injection site and allow to dry and injection technique improved significantly after the intervention ( P insulin administration. The findings from the study can be applied in routine care and has to be explored further in diabetic patient management.
Kundu, Tania Sur; Sengupta, Parama; Ghosh, Arijit; Das, Nina
Introduction World Health Organization (WHO) defines what is drug and what is not. Second year MBBS students learn the principles of Pharmacology that they use in their later clinical practice life. The aim of the survey was to determine how medical students classify a range of preparations they might encounter in their professional lives and whether a brand name or a commercial preparation of a drug would influence their decision in the categorization of the preparation as a ‘drug’ or ‘not a drug’. Aim To assess the knowledge of medical students, if a substance or product is a drug. Materials and Methods We surveyed 2 concurrent years of medical students to classify 60 candidate medicinal preparations into “drug” and “not-drug” from a validated questionnaire. The candidate preparations were named either in generic or in their commercially available forms and they were all essential drugs as per WHO definition. Results The two groups of students, A and B, included 192 and 215 students respectively. Demographically there was little difference in the two groups. Agents like Aspirin, Paracetamol, Amphetamine, Salbutamol, Atropine, Dextromethorphan, Codeine, Diazepam, Ciprofloxacin ear drops, Levonorgestrol, Neosporin eye ointment, Furosemide, Metronidazole, Penicillin, Sorbitrate, Lignocaine, Methotrexate, Penicillin, Zolpidem and Thalidomide received almost unanimous votes as drugs. Arsenic trioxide, Fentanyl and petroleum jelly were considered to be “non-drugs” by most participants. The two groups did not differ significantly in their responses. Conclusion Some major lacunae were noted in the knowledge of the participating students despite book teaching on the definition of a drug. Drugs used for prophylaxis and those used in physiological conditions or topically, were often missed. These gaps need to be filled by more emphasis on definition of a drug and its clinical applicability based on example and case based studies. PMID:27656461
K.S. Sahana, Kutty Ghaliyah, Prabhu Anitha, Saldanha Prakash
"Background: Anemia is a significant public health problem that occurs worldwide with higher prevalence noted in children less than 3 years. Objective of the study was to determine the occurrence, pattern and severity of anemia among hospitalized infants and the risk factors for development of anemia. Methods: This is a prospective study of hospitalized infants between 6-12 months of age admitted at a tertiary care teaching hospital, Mangalore, Karnataka. between December 2013 to Nove...
Full Text Available Objectives: The study was aimed to capture the effect of using injection pads as a tool in educating the diabetic patients who were on insulin. The attitude and practice of the patients in storage of insulin vials and disposal of insulin syringes were also assessed. Materials and Methods: A facility based Quasi-experimental study was carried out among the diabetic patients on insulin, attending diabetic clinic in endocrinology OPD in a tertiary care hospital, Puducherry. One to one intervention was given to the study participants or their attendants (who were involved in injecting insulin, by a trained investigator regarding all the steps of insulin administration. The insulin administration practices before and immediately after the intervention was assessed using a checklist. Results: In total 91 patients were included for the study with mean (SD age of 53.9 (10.6 years and of them 76% were females. The attitude and practices of the study participants, such as hand washing before handling insulin, checking the expiry date, storage of insulin, inspection of injection site, rolling and cleaning the vial, withdrawal of the syringe up to the required dose, pushing the plunger after inserting the syringe into the vial, checking and removal of air bubbles, cleaning the injection site and allow to dry and injection technique improved significantly after the intervention (P < 0.05. Conclusion: This study findings shows that using injection pads for educating patients helps them to practise better insulin administration. The findings from the study can be applied in routine care and has to be explored further in diabetic patient management.
Tertiary Care Hospital – a Prospective Study. SP Shah*, MK Desai and ... drug reactions manifest as skin rashes and/or eruptions. The incidence ..... Safety Monitoring on. Medicinal Products. Geneva (Switzerland):. Office of Publications, World Health. Organization; 2002. 6. Hartwig SC, Siegel J, Schneider PJ. Preventability.
Cuervo-Pardo, L; Barcena-Blanch, M; Radojicic, C
The treatment of antihistamine and steroid resistant Chronic Idiopathic Urticaria (CIU) during pregnancy poses a challenge due to teratogenicity of immunosuppressants. Omalizumab is a recently FDA approved therapy for CIU and is classified as pregnancy category B. We present an initial series of subjects treated at a tertiary care center for antihistamine and steroid resistant CIU with omalizumab who became pregnant during therapy.
Objective. To determine the characteristics of obstetric patients admitted to the intensive care unit (ICU) at a tertiary hospital in the Limpopo Province, South Africa. Methods. Hospital files of all obstetric patients admitted to the Pietersburg provincial referral hospital ICU from 1 January 2008 to 31 December 2012 were ...
Conclusion: This study brings out the clinical profile of keratoconus patients in a tertiary eye-care center in south India. The findings in this study stresses out the importance of defining the treatment options in keratoconus with the appropriate contact lenses.
continuous data were reported as mean (standard deviation (SD)). Statistical software (STATA 9.0, StataCorp, USA) was ... causes of admission into ICUs, accounting for 8 - 30%;[1,12,21,22,23] however, in our .... Critically ill obstetric patients in Australia: A retrospective audit of 8 years experience in a tertiary intensive care ...
Crawford, Renée; Jenkins, Louise
Increased accessibility of advanced technology, the targeted use of online learning platforms, student flexible learning expectations and the pressures of faculty budget constraints and priorities have called into question the effectiveness of traditional tertiary teaching and learning models. The tertiary education context must evolve at a pace…
Abrams, Elissa M.; Becker, Allan B.
Background Oral food challenges are the clinical standard for diagnosis of food allergy. Little data exist on predictors of oral challenge failure and reaction severity. Methods A retrospective chart review was done on all pediatric patients who had oral food challenges in a tertiary care pediatric allergy clinic from 2008 to 2010. Results 313 oral challenges were performed, of which the majority were to peanut (105), egg (71), milk (41) and tree nuts (29). There were 104 (33%) oral challenge...
Santoshkumar R Jeevangi
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.
Rizvi, M.F.; Hassan, Y.; Abdullah, M.; Shakeel, J.; Memon, A.R.; Razvi, M.F.; Saleem, S.; Shakeel, J.
To determine the pattern of nosocomial infections in two ICUs' of a teaching hospital in terms of frequency, common sites of infection, the pathogens involved and the antibiotic sensitivity patterns. It was conducted in two medical ICUs (Neurology and Nephrology) of a public tertiary care hospital. Data was collected prospectively on patients suspected to have developed nosocomial infection after 48 hours of admission to the ICU according to objective. There were 101 cases of suspected nosocomial infection out of a total of 254 patients. The frequency of nosocomial infection was 39.7%. UTI developed in 44.6%, while 27% had blood stream infection, and 21% had pneumonia. Each of the three major sites of infection was strongly associated with the use of invasive devices. Escherichia (E.) coli was the most common organism isolated followed by Pseudomonas aeruginosa and Klebsiella. E. coli and Klebsiella showed a maximum sensitivity to Imipenem followed by Tazocin (pipericillin + tazobactam). Pseudomonas aeruginosa was sensitive to Amikacin and Fosfomycin. The high frequency of nosocomial infection suggests that more strict measures regarding invasive devices should be taken in future to control the infection and limit the emergence of antibiotic resistant organisms. (author)
Ferri, Rita Borromeo
Since 2003 mathematical modelling in Germany is not only a topic for scientific disciplines in university mathematics courses, but also in school starting with primary school. This paper shows what mathematical modelling means in school and how it can be taught as a basis for complex modeling problems in tertiary education.
Background: About 19 million children worldwide live with visual impairments resulting from different ocular morbidities. This study aimed to identify the different causes of eye diseases in children visiting a tertiary eye centre at Jimma University Hospital. Methods: We conducted a retrospective review of charts of patients of ...
Background: Cancer is a public health problem worldwide affecting all categories of persons. It is the second common cause of death in developed countries and among the three leading causes of death in developing countries. Objective: To compare the patterns of malignant childhood tumours in two tertiary hospitals in ...
Full Text Available Teaching pronunciation is one the most challenging parts of ELT in Bangladesh. Very few research and least attention on pronunciation teaching has instigated those challenges more. Moreover, setting an ambitious target to achieve native like pronunciation and teaching without considering the Bangladeshi context are more specific reasons for creating those problems. Therefore, this paper concentrates on the discussion of the existing condition of teaching pronunciation in Bangladesh. Consequently, it starts with presenting existing circumstances of pronunciation teaching in Bangladesh, and showing what the achievable and realistic goal should be for this situation. Then, it talks about the challenges that the teachers face while teaching pronunciation in ELT classroom. This discussion provides deep insight into those challenges which are only applicable to Bangladeshi students. Finally, the paper suggests some contextual and practical solutions to those specific problems.
Eyck, J. van; Bloemenkamp, K.W.; Bolte, A.C.; Duvekot, J.J.; Heringa, M.P.; Lotgering, F.K.; Oei, S.G.; Offermans, J.P.L.G.; Schaap, A.H.; Sollie-Szarynska, K.M.
OBJECTIVE: To compare the actual situation in tertiary perinatal care in the Netherlands with the objectives laid down in the 2001 decree on perinatal care by the Dutch Ministry of Health, Welfare and Sport. DESIGN: Descriptive, retrospective. METHOD: Data on tertiary perinatal care, the transfer or
Ascione, Judith; Bramley, Nicolette
The primary objective of this study is to identify the effect of reducing teaching hours from five to four face-to-face teaching hours in a beginners' Japanese course at the University of Canberra, Australia. The results of 2007, 2008 and 2009 cohorts of Japanese students' results are compared to consider the effect of the reduction in classroom…
Purpose: To assess the culture of safety among nurses in a tertiary teaching hospital in Saudi Arabia. Methods: A cross-sectional survey was conducted in King Khaled University Hospital in Riyadh, Saudi Arabia. A random sample of 492 nurses was included in the survey using a pre-validated instrument, Safety Attitudes ...
Arubayi, D. O.
The purpose of this research is to find out how students appraise the teaching of Clothing and Textiles in Tertiary Institutions in Delta State, Nigeria. To do this two research questions and two hypotheses were formulated to give direction to the study. The target population consisted of 660 Home Economics Students enrolled in Home Economics in…
V. Kosse; Iyer, Mahalinga-Iyer; P. Yarlagadda
Purpose: In this paper we discuss the innovative curriculum structure, teaching and learning approaches ofcoherent delivery of manufacturing in conjunction with engineering design and materials from year one to yearfour, including specializations, real life projects and final year projects.Design/methodology/approach: Tertiary institutions now face serious challenges. Modern industry requiresengineering graduates with strong knowledge of modern technologies, highly practical focus, management...
Siju V Abraham
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.
Business school curricula have traditionally emphasized functional skills for people who will work in functional departments and general management skills for people who will organize interdepartmental work. Recently, some business schools have begun to develop programs that teach cross-functional work and team skills to functional specialists. Students educated in such programs will be well prepared to meet the new challenges that health care organizations will face.
Full Text Available This study assessed the perception of two tertiary institutions prospective teachers’ on the Benefits of Teaching Practice in Ogun State. Survey research design was adopted for the study. A sample of four hundred students was randomly selected for the study. Prospective Teachers Perception on Teaching practice Benefits Questionnaire (PTPTPBQ with the reliability coefficient of 0.80 was administered on the respondents. Data collected was analyzed using Mean Score, Charts, Percentages and t-test of significance. The study reveals that prospective teachers have low perception on the benefits of teaching practice also, finance and housing were the two major challenges faced by prospective teachers.. It is evident from the findings that there is need for concerted effort by school to orientate prospective teachers on the benefits of teaching practice. Also the major challenges faced by prospective teachers should also be addressed to allow them have good grasp from the benefits of teaching practice.
Cutler, David M.
Health care is one of the economy's biggest industries, so it is natural that the health care industry should play some role in the teaching of introductory economics. There are many ways that health care can appear in such a context: in the teaching of microeconomics, as a macroeconomic issue, to learn about social welfare, and even to learn how…
Bowles, Terence V.; Brindle, Kimberley A.
Factors which impact student retention in tertiary level teaching courses are complex. This study examined facilitating factors and barriers to student retention for students studying education. Due to a limited number of studies, the search was extended to factors impacting students undertaking tertiary education. A systematic review was…
Quddus, M. B.; Mahmud, S. M.
Objective: To describe the results of laparoscopic procedures at a Urology - Nephrology tertiary care centre. Study Design: Case series / observational study. Place and Duration of Study: The Kidney Centre Postgraduate Training Institute, Karachi, from August 2007 to March 2012. Methodology: Medical records of all planned laparoscopic surgery conducted during the study period were reviewed. Those cases which to open surgery were excluded. All were performed by a single surgeon, initially as supervised and later independently. Data was maintained for demographic data, procedure details, length of hospital stay, and complications including conversion to open surgeries. Data was analyzed through SPSS 17.0. Results: There were 36 planned laparoscopic surgeries in the specified period. Out of 36 cases, 8 were converted to open surgery. Those who underwent laparoscopic surgery include two diagnostic procedures and renal cyst deroofing each, four ureterolithotomy, nineteen simple nephrectomy and one radical nephrectomy. So in total 28 cases were performed on 15 females and 13 males with mean age of 33.01 A +- 10.9 years. The mean operative time was 216 A +- 100 minutes and mean length of hospital stay was as 2.7 A +- 1.04 days. There were 10 complications in 28 cases, majority being Clavien Grade II including 7% (2/28) blood transfusion. Conclusion: There are technical challenges in learning laparoscopy for practicing urologists. Following some learning model in a systematic manner will help surmounting the technical challenges in learning laparoscopy. (author)
Abrams, Elissa M; Becker, Allan B
Oral food challenges are the clinical standard for diagnosis of food allergy. Little data exist on predictors of oral challenge failure and reaction severity. A retrospective chart review was done on all pediatric patients who had oral food challenges in a tertiary care pediatric allergy clinic from 2008 to 2010. 313 oral challenges were performed, of which the majority were to peanut (105), egg (71), milk (41) and tree nuts (29). There were 104 (33%) oral challenge failures. Children were more likely to fail an oral challenge if they were older (P = .04), had asthma (P = .001) or had atopic dermatitis (P = .03). Risk of challenge failure was significantly different between food allergens, with more failures noted for peanut than for tree nuts, milk or egg (P = .001). Among challenge failures, 19% met criteria for anaphylaxis. Significantly more tree nut and peanut challenges met criteria for anaphylaxis than milk or egg (P Skin test size and specific IgE level were significantly higher in those who failed oral challenges (P < .001). The highest rate of challenge failure and severity of failure was to cashew, with 63% of cashew challenges reacting, of which 80% met clinical criteria for anaphylaxis. The risk of challenge failure differed with type of food studied, with peanut and tree nut having a higher risk of challenge failure and anaphylaxis. Cashew in particular carried a high risk and caution must be exercised when performing these types of oral challenges in children.
Patel, Atul K; Patel, Ketan K; Patel, Kamlesh; Gohel, Swati; Chakrabarti, Arunaloke
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.
Ornelas-Aguirre, José Manuel
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.
AlMatham, Khalid I; AlFayez, Ali F; AlHarthi, Raghdah A; AlMutairi, Falah S; Alrasheedi, Fahad S; Mustafa, Abdulrehman; Ahmed, Mustafa; AlMatouq, Basim A; AlRowaei, Fadil A
To assess changes in the pattern of glomerular diseases to help guide optimal allocation of resources, to focus future reasearch, and improve outcomes. Methods: A retrospective chart review was conducted on kidney biopsies taken between 2007 and 2016 at a single tertiary care center in Saudi Arabia (King Fahad Medical City, Riyadh) to evaluate the prevalence and pattern of glomerulonephritis (GN). Results: The most common primary GN in 102 biopsies from adult patients with a mean age of 28.9 ± 13.6 years and 40.2% female, was focal and segmental glomerulosclerosis (35.3%). Among 64 patients with systemic lupus erythematosus associated nephritis, of whom most (82.8%) were female, lupus nephritis (LN) 4 (46.9%), and (LN) 3 (32.8%) were the most common lupus nephritis classes. Conclusion: Establishing prospective GN registries from which robust diagnosis, treatment, and outcomes data can be acquired is warranted; however, registry development and maintenance are often precluded by resource limitations. Accordingly, retrospective analysis of administrative data will continue to provide important complementary information on GN epidemiology.
Holman, Nathan; Wallace, Kristin; Moore, J Matthew; Brock, Andrew S
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.
Nashrath, Mariyam; Akkadechanunt, Thitinut; Chontawan, Ratanawadee
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.
Lee, Ji-Hyun; Kim, Eun-Kyung; Song, In-Kyung; Kim, Eun-Hee; Kim, Hee-Soo; Kim, Chong-Sung; Kim, Jin-Tae
Analysis of critical incidents provides valuable information to improve the quality and safety of patient care. This study identified and analyzed pediatric anesthesia-related critical incidents including cardiac arrests in a tertiary teaching children's hospital. All pediatric anesthesia-related critical incidents reported in a voluntary departmental reporting system between January 2008 and August 2013 were included in the analysis. A critical incident was defined as (i) any incident that altered patients' vital signs and affected the management of patients while they were under the care of an anesthesiologist, and (ii) human factor: where patient injury or accidents were as a result of human error. Changes in vital signs that recovered spontaneously were excluded. During the 6-year study period, a total of 229 critical incidents were reported from 49,373 anesthetic procedures. The most frequently reported incidents were associated with the respiratory system (55%), with tracheal tube-related events accounting for 40.9% of respiratory incidents followed by laryngospasm (17.3% of respiratory incidents). Cardiac arrest occurred in 42 cases in this study (8.5 cases per 10,000 anesthetics). Cardiovascular problems were the major causes of cardiac arrest (66.7%), and incidents of cardiogenic shock and hemorrhage/hypotension contributed equally to the cardiac arrest induced by cardiovascular problems (each 16.7%). Human factor-related events accounted for 58.5% of all critical incidents of which 53.7% were respiratory events. Despite recent improvements in safety of pediatric anesthesia, many preventable factors still remain that can lead to critical incidents. © 2016 John Wiley & Sons Ltd.
M S Maputle
Full Text Available The purpose of the study was to explore and describe experiences of mothers during childbirth in a tertiary hospital in the Limpopo Province. This was achieved through a qualitative research study which was exploratory, descriptive, contextual and inductive in nature. A sample of 24 mothers participated in this study. Data obtained from unstructured in-depth interviews were analysed according to the protocol by Tesch (1990, cited in Cresswell, 1994:155. Five themes were identified, namely mutual participation and responsibility sharing, dependency and decision-making; information sharing and empowering autonomy and informed choices; open communication and listening; accommodative/non-accommodative midwifery actions; and maximising human and material infrastructure. The themes indicated experiences that foster or promote dependency on midwifery care. Guidelines on how to transform this dependency into a mother-centered care approach during childbirth are provided. Opsomming Die doel van die studie was om moeders se belewenis van kindergeboorte in ’n tersiêre hospitaal in die Limpopo Provinsie te verken en te beskryf. Dit is gedoen deur middel van kwalitatiewe navorsing wat verkennend, beskrywend, en kontekstueel was. ‘n Steekproef van 24 moeders het aan die studie deelgeneem. Inligting is verkry deur middel van ongestruktureerde in-diepte onderhoude. Hierdie inligting is geanaliseer aan die hand van Tesch (1990: aangehaal in Creswell, 1994:155 se protokol. Die volgende kategorieë is geïdentifiseer, wedersydse deelname en gedeelde verantwoordelik- hede, afhanklikheid en besluitneming, deel van inligting, bemagtiging tot outonomie en ingeligte keuse, oop kommunikasie en luister, akkommoderende/nie-akkommoderende vroedvrou-aksies en bevordering van menslike en materiële infrastrukture. Die resultate van die onderhoude het belewenisse blootgelê wat dui op die bevordering van afhanklikheid in vroedvrouversorging. Riglyne om hierdie
Moudi, Z; Tabatabaei, S M
The aim of this study was to compare the outcomes of childbirth care in a tertiary teaching hospital and Safe Delivery Posts (SDPs) to determine the safety of out-of-hospital care by midwives in Zahedan, Iran. A quasi-experimental design was applied in this study. In this study, 2063 women who gave birth in SDPs, along with 983 women who underwent vaginal delivery in a tertiary teaching hospital, were evaluated in 2011-2012. Retrospective chart review was applied to collect data from the medical records of mothers and neonates. Only low-risk women with a singleton live birth, cephalic presentation, gestational age ≥37 weeks, spontaneous labour, and no prior history of uterine scar were recruited. Based on the findings, episiotomy, perineal tear, cervical laceration, postpartum haemorrhage and need for blood transfusion (or hysterectomy) were less commonly reported in the SDP group, compared to the hospital group. In the SDP group, 15 (0.73%) women were transferred to the hospital after delivery. Overall, one (0.10%) case from the hospital group and two (0.10%) cases from the SDP group were admitted to the intensive care unit. One-minute Apgar score lower than seven, resuscitation, NICU admission and neonatal death were more commonly reported in the hospital group, compared to the SDP group. Overall, hospital transfer was reported in 12 (0.58%) neonates born in SDPs. In the present study, women who gave birth in SDPs had more opportunities to experience natural birth with fewer adverse outcomes. However, considering the possibility of life-threatening complications for mothers and newborns, substantial evidence is required to improve the quality of care before implementing such novel strategies in different settings. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Davy, Zowie; Amsler, Sarah; Duncombe, Karen
Increasingly, Lesbian, Gay, Bisexual, and Transgender (LGBT) health care is becoming an important quality assurance feature of primary, secondary and tertiary healthcare in Britain. While acknowledging these very positive developments, teaching LGBT curricula content is contingent upon having educators understand the complexity of LGBT lives. The…
Tammelin, E; Handolin, L; Söderlund, T
Injuries are often missed during the primary and secondary surveys in trauma patients. Studies have suggested that a formal tertiary survey protocol lowers the number of missed injuries. Our aim was to determine the number, severity, and consequences of injuries missed by a non-formalized trauma tertiary survey, but detected within 3 months from the date of injury in trauma patients admitted to a trauma intensive care unit. We conducted a cohort study of trauma patients admitted to a trauma intensive care unit between 1 January and 17 October 2013. We reviewed the electronic medical records of patients admitted to the trauma intensive care unit in order to register any missed injuries, their delay, and possible consequences. We classified injuries into four types: Type 0, injury detected prior to trauma tertiary survey; Type I, injury detected by trauma tertiary survey; Type II, injury missed by trauma tertiary survey but detected prior to discharge; and Type III, injury missed by trauma tertiary survey and detected after discharge. During the study period, we identified a total of 841 injuries in 115 patients. Of these injuries, 93% were Type 0 injuries, 3.9% were Type I injuries, 2.6% were Type II injuries, and 0,1% were Type III injuries. Although most of the missed injuries in trauma tertiary survey (Type II) were fractures (50%), only 2 of the 22 Type II injuries required surgical intervention. Type II injuries presumably did not cause extended length of stay in the intensive care unit or in hospital and/or morbidity. In conclusion, the missed injury rate in trauma patients admitted to trauma intensive care unit after trauma tertiary survey was very low in our system without formal trauma tertiary survey protocol. These missed injuries did not lead to prolonged hospital or trauma intensive care unit stay and did not contribute to mortality. Most of the missed injuries received non-surgical treatment. © The Finnish Surgical Society 2016.
Doyle, Mary-Anne; Brez, Sharon; Sicoli, Silvana; De Sousa, Filomena; Keely, Erin; Malcom, Janine C
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.
Ngonzi, Joseph; Tornes, Yarine Fajardo; Mukasa, Peter Kivunike; Salongo, Wasswa; Kabakyenga, Jerome; Sezalio, Masembe; Wouters, Kristien; Jacqueym, Yves; Van Geertruyden, Jean-Pierre
Maternal mortality is highest in sub-Saharan Africa. In Uganda, the WHO- MDG 5 (aimed at reducing maternal mortality by 75 % between 1990 and 2015) has not been attained. The current maternal mortality ratio (MMR) in Uganda is 438 per 100,000 live births coming from 550 per 100,000 in 1990. This study sets out to find causes and predictors of maternal deaths in a tertiary University teaching Hospital in Uganda. The study was a retrospective unmatched case control study which was carried out at the maternity unit of Mbarara Regional Referral Hospital (MRRH). The sample included pregnant women aged 15-49 years admitted to the Maternity unit between January 2011 and November 2014. Data from patient charts of 139 maternal deaths (cases) and 417 controls was collected using a standard audit/data extraction form. Multivariable logistic regression analysis was used to assess for the factors associated with maternal mortality. Direct causes of mortality accounted for 77.7 % while indirect causes contributed 22.3 %. The most frequent cause of maternal mortality was puerperal sepsis (30.9 %), followed by obstetric hemorrhage (21.6 %), hypertensive disorders in pregnancy (14.4 %), abortion complications (10.8 %). Malaria was the commonest indirect cause of mortality accounting for 8.92 %. On multivariable logistic regression analysis, the factors associated with maternal mortality were: primary or no education (OR 1.9; 95 % CI, 1.0-3.3); HIV positive sero-status (OR, 3.6; 95 % CI, 1.9-7.0); no antenatal care attendance (OR 3.6; 95 % CI, 1.8-7.0); rural dwellers (OR, 4.5; 95 % CI, 2.5-8.3); having been referred from another health facility (OR 5.0; 95 % CI, 2.9-10.0); delay to seek health care (delay-1) (OR 36.9; 95 % CI, 16.2-84.4). Most maternal deaths occur among mothers from rural areas, uneducated, HIV positive, unbooked mothers (lack of antenatal care), referred mothers in critical conditions and mothers delaying to seek health care. Puerperal sepsis is
Sivaranjini, R; Jaisankar, Tj; Thappa, Devinder Mohan; Kumari, Rashmi; Chandrasekhar, Laxmisha; Malathi, M; Parija, Sc; Habeebullah, S
Vaginal discharge is one of the common reasons for gynecological consultation. Many of the causes of vaginitis have a disturbed vaginal microbial ecosystem associated with them. Effective treatment of vaginal discharge requires that the etiologic diagnosis be established and identifying the same offers a precious input to syndromic management and provides an additional strategy for human immunodeficiency virus prevention. The present study was thus carried out to determine the various causes of vaginal discharge in a tertiary care setting. A total of 400 women presenting with vaginal discharge of age between 20 and 50 years, irrespective of marital status were included in this study and women who had used antibiotics or vaginal medication in the previous 14 days and pregnant women were excluded. Of the 400 women with vaginal discharge studied, a diagnosis was established in 303 women. Infectious causes of vaginal discharge were observed in 207 (51.75%) women. Among them, bacterial vaginosis was the most common cause seen in 105 (26.25%) women. The other infections observed were candidiasis alone (61, 15.25%), trichomoniasis alone (12, 3%), mixed infections (22, 5.5%) and mucopurulent cervicitis (7 of the 130 cases looked for, 8.46%). Among the non-infectious causes, 72 (18%) women had physiological vaginal discharge and 13 (3.3%) women had cervical in situ cancers/carcinoma cervix. The pattern of infectious causes of vaginal discharge observed in our study was comparable with the other studies in India. Our study emphasizes the need for including Papanicolaou smear in the algorithm for evaluation of vaginal discharge, as it helps establish the etiology of vaginal discharge reliably and provides a valuable opportunity to screen for cervical malignancies.
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.
Anjan Adhikari; Shailendra Singh; Sharmistha Biswas; Tarit Bhowal; Kanchan Kumar Mondal; Anup Kumar Das; Susanta Kumar Bandyopadhyay
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...
Sanghavi, Dhara R; Dhande, Priti P; Pandit, Vijaya A
One of the important pillars of an efficient pharmacovigilance system is contribution by healthcare professionals in the form of spontaneous reporting. This study was aimed at investigating the knowledge, attitude and practice of spontaneous ADR reporting among doctors in a teaching hospital in Pune, and to analyze the effect of an informative lecture about Pharmacovigilance on the same. This was an interventional study conducted among 220 doctors at a tertiary care teaching hospital, Pune. Each participant was explained the purpose of study and asked to fill in a questionnaire about their knowledge, attitude and practice of pharmacovigilance. Only 80 of them attended the interventional lecture on Pharmacovigilance and again filled up the questionnaire after a period of one month from this intervention. Merely 7.5% of the participants knew ADR reporting system in India. Majority of the respondents (95%) knew that, as doctors, they could report ADRs but were unaware about the methodology to report (92.5%) which affected their practice of Pharmacovigilance. All (100%) the participants expressed that proper training should be provided to clinicians for ADR reporting & 81% felt ADR reporting should be made mandatory. Only 80 participants (36.4%) attended the interventional lecture which reflected a poor response. Intervention improved their (96%) knowledge about ADR reporting system and now majority of them (92%) agreed that all sort of ADRs should be reported (p pharmacovigilance.
Patil, D P; Ajantha, G S; Shubhada, C; Jain, P A; Kalabhavi, A; Shetty, P C; Hosamani, M; Appannanavar, S; Kulkarni, R D
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. 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. 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. 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.
Full Text Available Increasingly our landscape architecture teaching and educational pedagogies are facing an internationalisation in approach and expectation. We are positioned within a tertiary learning layer in a tripartite educational system for which each layer assumes certain expectations and outcomes. But their vertical linkages are unclear, and we incorrectly assume continuity of knowledge and skill learning strategies. It is a horizontally stratified teaching setting that we have to work within and while we can think of internationalisation as occurring within our level we need to appreciate that internationalisation is also occurring at the secondary level. This paper discusses the educational environment within which globalisation is occurring, and reviews a project model that builds bridges vertically between secondary and tertiary learning environments. The project displays possibilities in both secondary and tertiary educational sectors, but especially in enhancing and improving the design fluency of our annual incoming cohorts who often possess a naive understanding of built environmental design. Commencing in 1998 as an experimental project, it has been recognised at the South Australian state level as a forward-thinking initiative that has radically transformed secondary school Design teacher's perspectives as to educational possibilities, and substantially matured attitudes to landscape design by both suites of participants. As a consequence, it is an educational project that has experienced requests from numerous secondary schools around the State to participate.
Gestational age at initiation of antenatal care in a tertiary hospital, Southwestern Nigeria. ... care is still prevalent in our environment. Therefore, pregnant women should be adequately informed about the concept of early antenatal registration. Keywords: Antenatal care, gestational age, initiation, Nigeria, Southwestern ...
van Eyck, J; Bloemenkamp, K W M; Bolte, A C; Duvekot, J J; Heringa, M P; Lotgering, F K; Oei, S G; Offermans, J P M; Schaap, A H P; Sollie-Szarynska, K M
To compare the actual situation in tertiary perinatal care in the Netherlands with the objectives laid down in the 2001 decree on perinatal care by the Dutch Ministry of Health, Welfare and Sport. Descriptive, retrospective. Data on tertiary perinatal care, the transfer or refusal of women with very endangered pregnancies and the personnel of obstetric high care (OHC) units in 2006 were compared with the targets laid down in the planning decree on perinatal care and in a report by the Dutch Health Council from 2000. Parameters of tertiary perinatal care output were the number of admissions, and the number of beds in OHC units and neonatal intensive care units (NICU). In 2006, 128 of the 250 beds intended for OHC had been obtained. The degree of capacity utilisation was 94%, while the norm is 80%. 312 women were transferred due to lack of capacity of OHC units and NICU. The number of staff, specialised physicians as well as nurses, was considerably lower than the planned capacity. But training for obstetric perinatologists and OHC nurses was given. The targets for the number of beds for tertiary obstetric care and associated medical personnel have not been achieved as yet. As a consequence, the number of transfers is still too high. The funding of OHC units is not attuned to the complexity of tertiary perinatal care. Closer supervision of the execution of the planning decree and an adequate financing system are needed to achieve the objectives of the planning decree in the next 3 years.
Full Text Available BACKGROUND Childhood blindness constitutes a burden on the economy of the country and produces psychosocial and emotional disturbance to the child and family at large. Similar to the visual impairment produced by vitamin deficiency state in children, ocular injuries form another group which if identified early and treated promptly can reduce irreversible damage. Eye injuries are responsible for the large scale ocular morbidity worldwide. At extremes of age, the incidence of eye injuries are common because of the negligence in their care. The aim of the study is to determine the prevalence, various mechanisms, agents of injury and environmental influence causing eye injuries in children brought to Ophthalmic Outpatient Department of Chengalpattu Medical College in Kanchipuram District, Tamilnadu. MATERIALS AND METHODS A retrospective review of medical records of 230 children who attended Ophthalmic Outpatient in Chengalpattu Medical College Hospital between 01.09.2015 to 30.09.2016. Records of children of both genders between the age group of (0 to 12 years who attended the Ophthalmic Outpatient Department with history of ocular injury coming from both rural and urban areas of the district. Their data was collected and analysed and tabulated based on demography, mechanism and place of injury. RESULTS School going age groups (5-12 years, 84% sustained injuries more commonly. Children from rural areas sustained 54.7% injuries. Blunt trauma accounted for 65% injuries. 52.6% injuries occurred at home. 41.7% were due to stick and wood. Children were admitted to hospital for a mean of 4 days, range (1-25 days, 96% >6/12 v/a, 3% children had v/a (6/18-6/60, 1% blind 6/60 vision. Bilateral blindness was not reported. 1% visual impairment registered. CONCLUSION This study showed that rural children suffered more ocular injuries;commonest were injuries due to sticks followed by cracker injuries. Home-based injuries were more common. Visual prognosis was
Kumar, Sushil; Chakravarty, A
The modern system of medicine has evolved into a complex, sophisticated and expensive treatment modality in terms of cost of medicines and consumables. In any hospital, approximately 33% of total annual budget is spent on buying materials and supplies including medicines. ABC (Always, Better Control)-VED (Vital, Essential, Desirable) analysis of medical stores of a large teaching, tertiary care hospital of the Armed Forces was carried out to identify the categories of drugs needing focused managerial control. Annual consumption and expenditure data of expendable medical stores for one year was extracted from the drug expense book, followed by classification on its annual usage value. Subsequently, the factor of criticality was applied to arrive at a decision matrix for understanding the need for selective managerial control. The study revealed that out of 1536 items considered for the study, 6.77% (104), 19.27% (296) and 73.95% (1136) items were found to be A, B and C category items respectively. VED analysis revealed that vital items (V) accounted for 13.14% (201), essential items (E) for 56.37% (866) and desirable accounted for 30.49% items (469). ABC-VED matrix analysis of the inventory reveals that only 322 (21%) items out of an inventory of 1536 drugs belonging to category I will require maximum attention. Scientific inventory management tools need to be applied routinely for efficient management of medical stores, as it contributes to judicious use of limited resources and resultant improvement in patient care.
Sheila Z. Chang
Full Text Available Background: Pediatric subspecialists can participate in the care of obese children. Objective: To describe steps to help subspecialty providers initiate quality improvement efforts in obesity care. Methods: An anonymous patient data download, provider surveys and interviews assessed subspecialty providers’ identification and perspectives of childhood obesity and gathered information on perceived roles and care strategies. Participating divisions received summary analyses of quantitative and qualitative data and met with study leaders to develop visions for division/service-specific care improvement. Results: Among 13 divisions/services, subspecialists’ perceived role varied by specialty; many expressed the need for cross-collaboration. All survey informants agreed that identification was the first step, and expressed interest in obtaining additional resources to improve care. Conclusions: Subspecialists were interested in improving the quality and coordination of obesity care for patients across our tertiary care setting. Developing quality improvement projects to achieve greater pediatric obesity care goals starts with engagement of providers toward better identifying and managing childhood obesity.
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.
Background: Postoperative nausea and vomiting is one of the most distressing morbidities associated with surgery. This descriptive prospective study was conducted to determine the incidence, predictors and management of postoperative nausea and vomiting among patients attending a tertiary hospital in north-western ...
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
Full Text Available Stroke is the third leading cause of morbidity and mortality in Thailand accounting for a significant and increasing share of hospital costs. The purpose of this project is to study the epidemiology of the prevalence and its predicting factors of working aged hemorrhagic stroke (HS patients admitted at a tertiary teaching hospital in Chiang Mai, Thailand. We conducted a five-year retrospective descriptive study. The subjects in this study were patients diagnosed with HS, between 15-59 years of age, and admitted to a tertiary teaching hospital in Chiang Mai, Thailand from January 2009 to December 2013. A total of 404 working aged adults who had HS were admitted to the hospital during this review period; 60.9% males and 39.1% females. Nearly 70% of patients were between 46-59 years of age (M = 47.5, SD = 9.8. Of the patients admitted to the hospital, 76.7% were transferred there from other hospitals. Intracerebral hemorrhage was present in 59.7% of patients. Severe HS occurred in 35.9% of the patients with a Glasgow Coma Score from 3-8. Approximately 69% of the working aged HS patients required surgery. The top five identified risk factors for HS were hypertension (83.4%, hyperlipidemia (38.9%, alcohol consumption (21.5%, smoking (15.3 %, and drug non-adherence (14.9%. We found significantly associated risk factors in working-aged HS by multivariate analysis among male gender (p < .001, drug non-adherence (p = .047, and hypertension (p = .048. Raising awareness to reduce risk behavior and health promotion in the community are the keynotes for health care providers in working-aged HS prevention.
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.
Poudyal, Yogesh; Ranjit, Annu; Pathak, Santosh; Chaudhary, Nagendra
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.
Abduljabbar, Hassan S; Bahkali, Nedaa M; Al-Basri, Samera F; Al Hachim, Estabrq; Shoudary, Ibrahim H; Dause, Wesam R; Mira, Mohammed Y; Khojah, Mohammed
To review cases of placenta previa in the last 13 years in a tertiary teaching hospital to identify risk factors for maternal morbidity. A retrospective analysis of all cases of placenta previa managed at King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia from January 2001 to December 2013. The total number of deliveries was 55,862 deliveries, and 11,412 (20.3%) delivered by cesarean section (C/S). The charts of 230 cases diagnosed with placenta previa was reviewed, and different variables were collected and analyzed. Diagnoses were achieved in 94% of them using ultrasound. The prevalence rate of placenta previa was 4.1 per 1000 births. Cesarean section was carried out as an emergency procedure in 130 (56.5%) women and as elective in 100 (43.5%) women. Of them, 26 patients were admitted to the intensive care unit (ICU) (11.3%), all of which received blood transfusion >6 units and 22 patients had a hysterectomy for uncontrollable bleeding. Placenta previa is one of the leading causes of maternal morbidity and mortality. Every hospital must have a protocol, or algorithm for the management of placenta previa. Risk factors for maternal morbidity included complete previa, history of previous C/S, emergency C/S at a gestational age of less than 36 weeks, and estimated blood loss more than 2000 ml.
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.
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.
Paudel, B; Shrestha, G K
Background Consent for care procedures is mandatory after receipt of adequate information. It maintains patient's rights and autonomy to make thoughtful decisions. Poor communication often leads to poor health quality. Objective To assess hospitalized patients' perception on informed consent regarding nursing care practices in a tertiary care center. Method This is a descriptive cross-sectional study among 113 admitted patients conducted in February 2012 at Dhulikhel Hospital, Nepal. Patients of various wards were selected using purposive non-probability sampling with at least 3 days of hospitalization. Close ended structured questionnaire was used to assess patients' perception on three different areas of informed consent (information giving, opportunity to make decision and taking prior consent). Result Among the participants 71.6% perceived positively regarding informed consent towards nursing care practices with a mean score of 3.32 ± 1.28. Patients' perception on various areas of informed consent viz. information giving, opportunities to make specific decision and taking prior consent were all positive with mean values of 3.43±1.12, 2.88±1.23, 3.65±1.49 respectively. Comparison of mean perception of informed consent with various variables revealed insignificant correlation (p-value >0.05) for age, educational level and previous hospitalization while it was significant (p-value perception on informed consent towards nursing care practices. Communication skills of nurses affect the perception of patients' regardless of age, education level and past experiences.
Lange Fredrik; Lövgren Peter W; Jørgensen Kristian; Halasz Laszlo; Eklund Andreas; Jensen Irene B; Axén Iben; Rosenbaum Annika; Leboeuf-Yde Charlotte
Abstract Background Among chiropractors the use of long-term treatment is common, often referred to as "maintenance care". Although no generally accepted definition exists, the term has a self-explanatory meaning to chiropractic clinicians. In public health terms, maintenance care can be considered as both secondary and tertiary preventive care. The objective of this study was to explore what factors chiropractors consider before recommending maintenance care to patients with low back pain (L...
Ornelas-Aguirre, José Manuel; Zárate-Coronado, Olivia; Gaxiola-González, Fabiola; Neyoy-Sombra, Venigna
The World Health Organisation (WHO) 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 levels in 2 different intensive care units at a tertiary care centre. Using a cross-sectional design study, an analysis was made of the maximum noise level was within the intensive coronary care unit and intensive care unit using a digital meter. A measurement was made in 4 different points of each room, with 5minute intervals, for a period of 60minutes 7:30, 14:30, and 20:30. The means of the observations were compared with descriptive statistics and Mann-Whitney U. An analysis with Kruskal-Wallis test was performed to the mean noise level. The noise observed in the intensive care unit had a mean of 64.77±3.33dB (P=.08), which was similar to that in the intensive coronary care unit, with a mean of 60.20±1.58dB (P=.129). Around 25% or more of the measurements exceeded the level recommended by the WHO by up to 20 points. Noise levels measured in intensive care wards 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 environmental noise. Copyright © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.
D P Patil
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.
Full Text Available Context: Hand hygiene (HH is the most important measure to prevent hospital-acquired infections but the compliance is still low. Aims: To assess the compliance, identify factors influencing compliance and to study the knowledge, attitude and perceptions associated with HH among health care workers (HCW. Settings and Design: Cross-sectional study conducted in 42 bedded Medical (Pulmonary, Medicine and Stroke intensive care units (ICU of a tertiary care hospital. Materials and Methods: HCWs (doctors and nurses were observed during routine patient care by observers posted in each ICU and their HH compliance was noted. Thereafter, questionnaire regarding knowledge, perception and attitudes toward HH was filled by each HCW. Statistical Analysis: Percentages and χ2 test. Results: The overall compliance was 43.2% (394/911 opportunities. It was 68.9% (31/45 in the intensivists, 56.3% (18/32 in attending physicians, 40.0% (28/70 in the postgraduate residents and 41.3% (301/728 in the nurses. Compliance was inversely related to activity index. Compliance for high, medium and low risk of cross-transmission was 38.8% (67/170, 43.8% (175/401 and 44.7% (152/340, respectively. Conclusions: Compliance of the study group is affected by the activity index (number of opportunities they come across per hour and professional status. The HCWs listed less knowledge, lack of motivation, increased workload as some of the factors influencing HH.
Pandey, Anita; Ahuja, Sanjiv; Madan, Molly; Asthana, Ajay Kumar
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
Zaidi Adnan A
Full Text Available Abstract Introduction The emotional burden associated with the diagnosis of cancer is sometimes overshadowed by financial burden sustained by patient and the family. This is especially relevant for a developing country as there is limited state support for cancer treatment. We conducted this study to estimate the cost of cancer care for two major types of cancer and to assess the perception of patients and families regarding the burden of the cost for undergoing cancer treatment at a private tertiary care hospital. Methods This cross-sectional study was conducted at day care and radiotherapy unit of Aga Khan University, Hospital (AKUH Karachi, Pakistan. All adult patients with breast and head & neck cancers diagnosed for 3 months or more were included. Data was collected using a structured questionnaire and analysed using SPSS. Results Sixty seven patients were interviewed during the study period. The mean and median monthly income of these patients was 996.4 USD and 562.5 USD respectively. Comparatively the mean and median monthly cost of cancer care was 1093.13 USD and 946.42 USD respectively. The cost of the treatment either fully or partially was borne by the family in most cases (94%. The financial burden of cancer was perceived as significant by 28 (42% patients and unmanageable by 18 (27% patients. This perceived level of burden was associated significantly with average monthly income (p = Conclusion Our study indicates that the financial burden of cancer care is substantial and can be overwhelming. There is a desperate need for treatment support programs either by the government or other welfare organisations to support individuals and families who are already facing a difficult and challenging situation.
Background: The 'open' intensive care unit (ICU) predominates in most low and middle economy societies. This is associated with paucity of personnel and cost challenges involved for its maintenance and smooth running despite the great public demand for this service. Data on neurocritical care in scare in Nigeria and the ...
Diaz-Olavarrieta, Claudia; Garcia-Pina, Corina A.; Loredo-Abdala, Arturo; Paz, Francisco; Garcia, Sandra G.; Schilmann, Astrid
Objectives: Determine the prevalence, clinical signs and symptoms, and demographic and family characteristics of children attending a tertiary care hospital in Mexico City, Mexico, to illustrate the characteristics of abusive head trauma among this population. Methods: This is a cross-sectional descriptive study of infants and children under 5,…
Level of health care and services in a tertiary health setting in Nigeria. ... responded to questions on the clinical, support and corporate services ... Also low were the level of medical and environmental research, informal relationship and security, but the management had a high level of social responsibility in form of ...
Samuelson, Madeleine B; Chandra, Rakesh K; Turner, Justin H; Russell, Paul T; Francis, David O
Chronic rhinosinusitis (CRS) has a high prevalence and significant cost and quality of life implications. Many types of practitioners care for patients with rhinosinusitis; however, patients with chronic or complicated conditions are often referred for tertiary rhinology services. It is unclear how social determinants of health affect access and utilization of these services. A better understanding of social barriers to tertiary rhinology care is needed to reduce health care disparities and improve health outcomes. The aim of the present study was to measure whether income, insurance status, race, and education affect utilization of tertiary rhinology care. All adult patients diagnosed with CRS by rhinologists at a single tertiary care hospital were identified (2010-2014). Patient characteristics (age, gender, race, insurance status) were compared with population-level data from the hospital and from Davidson County, Tennessee, which includes Nashville. Rhinology utilization rates were calculated for each ZIP code within the county. The association between determinants of health (race, insurance status, education, median income) and tertiary rhinology utilization were measured by using multivariable regression analyses. A total of 1341 unique patients with CRS (median age, 50 years; 55% women, 80% white, 82% with private insurance) from Davidson County used tertiary rhinology services. These patients were significantly older and more likely to be female, white, and privately insured than patients seen hospital-wide or among the population of Davidson County (p education. However, in adjusted analysis, only attainment of a college education was independently associated with utilization of tertiary rhinology services. Utilization was 4% higher for every 1% increase in college-educated population (coefficient 0.04 [95% CI, 0.01-0.07]; p = 0.01). Results of this study indicated that some social determinants of health (race, income, educational level, insurance status
Full Text Available BACKGROUND Birth defects are responsible for increased perinatal mortality and long-term morbidities. To reduce its incidence, which is the need of the hour we should know more about them and possible risk factors, which can be prevented. The aim of the study is to study the overall frequency of birth defects in a tertiary hospital and search for association with certain risk factors. MATERIALS AND METHODS All newborns/stillborns with birth defects during one year were enrolled for the study. Similar number of newborns without birth defect during this period was taken as control. Relevant information was documented in both the groups and analysed. RESULTS Out of 11,008 births, congenital anomaly was found in 130 cases. The prevalence of birth defects was 1.18 percent. Association of occurrence of birth defects with increased paternal age, consanguinity, fever and drug intake in first trimester was found. 57.6% of the newborns with birth defects were stillborn, born at an earlier gestational age (33.6 week v/s. 37.5 weeks. Commonest system to be affected was CNS (49.2%. CONCLUSION Screening for aneuploidy and birth defects should be universal. Routine folic acid supplementation and pregnancy termination of malformed babies will reduce the incidences.
Full Text Available Introduction: Diabetes mellitus is a major public health problem worldwide. Diabetic patients are at risk of developing blindness from diabetic retinopathy. While occurrence of diabetic retinopathy cannot be prevented, its complications can be minimized. This requires awareness of the sight-threatening potential of diabetes and the need for regular eye examinations. Aim: To study the knowledge of ocular complications of diabetes, among type II diabetics visiting a tertiary level hospital. Settings and Design: This was a prospective study in a tertiary care teaching hospital. Methods and Material: This was a questionnaire based study on 350 type II diabetics. All patients were interviewed by the same investigator. Statistical analysis used: The data was analysed using chi square test. Results: With increase in the duration of illness, the awareness about diabetic retinopathy is more. Even though the awareness of the disease increased with increasing duration of the disease, 51.4% of the diabetics did not know how diabetes can affect the eye, 49.7% of diabetics did not know if diabetic retinopathy can be treated and 67.4% had not heard of any treatment modality for diabetic retinopathy. This shows that lack of knowledge about the disease was significant. Conclusions: Prevention of non-communicable disease through increased awareness needs to be the thrust of the effort in resource poor contexts, where the treatment can be prohibitively costly. These measures would help to bring about more awareness and understanding about the disease among the patients and therefore prevent sight-threatening complications by timely intervention and management.
medication and maintenance of prescription records. The cost associated with ADRs is high. ADR monitoring is essential to reduce patient suffering as well as to achieve the substantial savings in health care cost. Keywords: Cutaneous adverse ...
Neonatal sepsis is the most challenging neonatal disease in developing countries despite the progress in the neonatal management. The aim of the study is to demonstrate the most common organisms causing severe neonatal sepsis in a tertiary neonatal intensive care unit. The study conducted in the neonatal intensive care unit (ICU) unit of pediatric department in Suez Canal University Hospital in the period from December 2013 to November 2014.Blood cultures showed the growth of Escherichia coli...
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.
Rema Nair Sarkar
Full Text Available BACKGROUND Cancer is one of the leading cause of death both in developed and developing countries. In India, it accounts for 0.3 million deaths per year. Cancers of lung, GIT and oral cancers dominated among men while breast, cervix, ovary and oral cavity were commonest cancer seen in women. Among the gastrointestinal cancers, cancers of the oesophagus, stomach, colon, rectum and liver cancers were commonest. The aim of the study is to evaluate the incidence of the various GIT cancers in a tertiary hospital of Coastal Andhra when compared to other studies. MATERIALS AND METHODS In this retrospective study, a total of 509 health records of patients affected by cancers were studied and relevant details noted. RESULTS A total of 509 cancer cases were reported in this period of 18 months (January 2016 - June 2017 of which 85 cases (16.3% were of Gastrointestinal (GIT cancers. The age group between 40 and 60 recorded the maximum incidence of 47 cancers (55.1%. The incidence of gastrointestinal cancers were significantly higher in the men (56 cases (65.8% than the women (29 cases (34.11%. The commonest site of GIT cancers was the colorectal region (30 cases (35.7%. The most common type of cancer seen was adenocarcinoma seen in 73 cases (85.8%. CONCLUSION Public education and awareness for the warning symptoms should be increased to prevent reduction of the life span and health caused by the gastrointestinal cancers with intense awareness drive using various means including social media undertaken to educate the public regarding the warning symptoms and screening of such group for GIT cancers.
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.
Labi, Appiah-Korang; Obeng-Nkrumah, Noah; Bjerrum, Stephanie; Aryee, Nii Armah Adu; Ofori-Adjei, Yaw Adjei; Yawson, Alfred E; Newman, Mercy J
Understanding the knowledge, attitudes and practices of physicians towards antibiotic resistance is key to developing interventions aimed at behavior change. The survey aimed to investigate physicians' knowledge and attitudes towards antibiotic resistance in a tertiary-care hospital setting in Ghana. We conducted a cross-sectional respondent-driven survey using a 40-item, anonymous, voluntary, traditional paper-and-pencil self-administered questionnaire among 159 physicians at Korle-Bu Teaching Hospital. Single and multi-factor analysis were conducted to assess the study objectives. The survey was completed by 159 of 200 physicians (response rate of 79.5%). Of physicians, 30.1% (47/156) perceived antibiotic resistance as very important global problem, 18.5% (29/157) perceived it as very important national problem and only 8.9% (14/157) thought it as a very important problem in their hospital. Methicillin resistant Staphylococcus aureus was the most known about antibiotic resistant bacteria of public health importance followed by extended-spectrum beta-lactamase-producing Enterobacteriaceae, carbapenem resistant Enterobacteriaceae (CRE) and vancomycin resistant enterococci (VRE). In multiple logistic regression analysis, senior physicians were nearly 3 times more likely to know about CRE than junior physicians. The odds of knowing about VRE increased over 4.5 times from being a junior to becoming senior physician. Among junior physicians, age had no associated effect on their knowledge of VRE or CRE. Physicians in this survey showed variable knowledge and perceptions on antibiotic resistance. Introducing educational programs on antibiotic resistance would be a useful intervention and should focus on junior physicians.
Akshaya, K M; Majra, J P
The tobacco epidemic is one of the biggest public health threats in the present world with a substantial contribution to mortality and morbidity. Patients' visits to their doctors for illnesses and health check-ups offer a great opportunity to screen them for tobacco use and also counsel them to quit tobacco use. This cross sectional study was carried out in out-patient departments of General Medicine and Pulmonary Medicine of a tertiary care medical college teaching hospital in Dakshina Kannada district of Karnataka state of India between April 2012 and July 2012 among the patients aged 18 years or above who were diagnosed as suffering from tobacco related diseases. Exit interview was conducted on the patients after obtaining a written informed consent using a pre designed semi-structured questionnaire. Data was entered, analyzed using SPSS v17 and Descriptive statistics, Fisher Exact test, Bivariate and multivariable logistic regression analyses were used. The present study reveals that 305 (87.1 %), 281 (80.3 %) and 257 (73.1 %) of the 350 participants were asked, assessed and advised respectively by the treating physicians to quit tobacco use where as only 18 (15.1 %) were assisted in their efforts to quit tobacco. Physician's counseling inventions were significantly associated with patient's age, sex, education, marital status and socio economic status of the patients as well as the treating physician's experience of more than 3 years. There is a need to incorporate tobacco history taking as a vital sign during medical history taking and this should be made as a routine in medical schools.
Wani, Mohammad Ashraf; Tabish, S A; Jan, Farooq A; Khan, Nazir A; Wafai, Z A; Pandita, K K
Cancer remains a major health problem in all communities worldwide. Rising healthcare costs associated with treating advanced cancers present a significant economic challenge. It is a need of the hour that the health sector should devise cost-effective measures to be put in place for better affordability of treatments. To achieve this objective, information generation through indigenous hospital data on unit cost of in-patient cancer chemotherapy in medical oncology became imperative and thus hallmark of this study. The present prospective hospital based study was conducted in Medical Oncology Department of tertiary care teaching hospital. After permission from the Ethical Committee, a prospective study of 6 months duration was carried out to study the cost of treatment provided to in-patients in Medical Oncology. Direct costs that include the cost of material, labor and laboratory investigations, along with indirect costs were calculated, and data analyzed to compute unit cost of treatment. The major cost components of in-patient cancer chemotherapy are cost of drugs and materials as 46.88% and labor as 48.45%. The average unit cost per patient per bed day for in-patient chemotherapy is Rs. 5725.12 ($125.96). This includes expenditure incurred both by the hospital and the patient (out of pocket). The economic burden of cancer treatment is quite high both for the patient and the healthcare provider. Modalities in the form of health insurance coverage need to be established and strengthened for pooling of resources for the treatment and transfer of risks of these patients.
Vosler, Peter S; Kass, Jason I; Wang, Eric W; Snyderman, Carl H
We compare the management of patients with severe epistaxis before and after the implementation a clinical care pathway (CCP) to standardize care, minimize hospital stay, and decrease cost. Single prospective analysis with historical control. Tertiary academic hospital. Patients treated for epistaxis between October 2012 to December 2013 were compared with a prospective analysis of patients treated for severe epistaxis after implementation of a CCP from June 2014 to February 2015. Severe epistaxis was defined as nasal bleeding not able to be controlled with local pressure, topical vasoconstrictors, or simple anterior packing. Severe epistaxis was similar in the pre- and post-CCP cohorts: 24.7% (n = 42) vs 18.9% (n = 22), respectively. Implementation of early sphenopalatine artery ligation resulted in decreased number of days packed (3.2 ± 1.6 to 1.4 ± 1.6; P = .001), decreased hospital stay (5.2 ± 3.9 to 2.1 ± 1.3 days; P vs 54.5%; P = .035), admission to an appropriate hospital location with access to key resources (41.7% vs 83.3%; P = .007), and decreased overall cost of hospitalization by 66% ($9435 saved). No patients received embolization after the CCP was implemented. Implementation of a CCP decreased hospital stay and days of packing, facilitated definitive care in patients with severe epistaxis, improved patient safety, and decreased cost. The results of this study can serve as a model for the management of severe epistaxis and for future quality improvement measures. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.
Background: Global attention is being drawn to the use of internet resource because of its overwhelming benefits. Individuals, families, social groups, patients as well as research teams spend quality time on a daily basis exploring the internet. Objective: We carried out a study to determine internet use among primary care ...
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.
Bana, Shazia; Yakoob, Javed; Jivany, Nourin; Faisal, Asima; Jawed, Humeira; Awan, Safia
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.
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
Khan, N.S.; Ashraf, R.N.; Rahman, M.U.; Mashhadi, S.F.; Rashid, Z.; Nazar, A.F.; Syed, R.
Background: Low birth weight is a major public health problem in Pakistan. So there is a need for identification of its modifiable risk factors like periodontitis which will reduce its burden on the society. The objectives of the study were to find out the association between maternal periodontitis and low birth weight in new-borns of all gestational ages delivered in a tertiary care hospital of Abbottabad as well as to see the frequency of periodontitis severity in these subjects. Methods: A hospital-based matched case-control study was conducted among 160 postpartum mothers in Gynaecology/Obstetrics-B ward Ayub Teaching Hospital, Abbottabad. The 80 cases were mothers of low birth weight babies (<2,500 g), the 80 controls were mothers of normal weight babies (=2,500 g) matched with maternal age and gestational age. Data was collected through the hospital records, interview and a periodontal examination. Results: Periodontitis was more in the cases than in the controls (OR: 4.167, 95 percentage CI: 2.142-8.109, ρ=0.000). On multivariate logistic regression, periodontitis was found to be a significant independent risk factor for low birth weight (aOR: 3.173, 95 percentage CI: 1.429-7.047, ρ=0.005). Other significant risk factors were educational level (aOR: 3.408, 95 percentage CI: 1.452-7.996, ρ=0.005), socioeconomic status (aOR: 3.173, 95 percentage CI: 1.366-7.368, ρ=0.007), maternal nutrition (aOR: 3.071, 95 percentage CI: 1.392-6.778, ρ=0.005) and moderate/severe anaemia (aOR: 3.035, 95 percentage CI: 1.052-8.756, p=0.040). Conclusions: Periodontitis is found to be a strong, independent, and clinically significant risk factor for low birth weight. So periodontal therapy should form a part of the antenatal care of the pregnant women in Abbottabad. (author)
Mazhar, Faizan; Akram, Shahzad; Al-Osaimi, Yousif A; Haider, Nafis
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
Mithun N; Pattanashetty; Reshmina; Sharath Babu; Harikrishna; Sreedhar Reddy; Ramakrishna J
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...
Qureshi, Fawad; Shafi, Azhar; Ali, Sheeraz; Siddiqui, Neelam
Objective: To determine the clinical predictors of anticipatory emesis in patients treated with chemotherapy at a tertiary care cancer hospital. Methods: This was a cross-sectional study conducted on 200 patients undergoing first line chemotherapy with minimum of two cycles at inpatient department and chemotherapy bay of Shaukat Khanum Memorial Cancer Hospital and Research Centre Pakistan. Anticipatory nausea and vomiting develops before administration of chemotherapy. Clinical signs and symp...
Ahmed, Aliya; Latif, Naveed; Khan, Robyna
Background: Post-operative pain is often inadequately treated. Optimal utilization of the available resources is essential for improving pain management. Aims: The aim of our study was to determine pain management strategies employed after major abdominal surgeries at our institute and their efficacy and safety. Settings and Design: Prospective observational study conducted at a tertiary care hospital. Materials and Methods: Patients undergoing elective major abdominal surgeries w...
Farzaneh Motamed; Naheid Kazemi; Raheleh Nabavizadeh
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...
Chintha Sujatha; Jacquilene Vadasseril; Govind Jayaprakash; John K. Joy
BACKGROUND Needlestick Injury (NSI) is a major occupational health and safety issue among Healthcare Workers (HCWs). In India, incidence of NSI is high, but surveillance is poor with scarce authentic data. The aim of the study is to determine the occurrence of NSI, its associated factors and assessment of knowledge and practice of preventive measures and post exposure prophylaxis among HCWs in a tertiary care hospital in Kerala. MATERIALS AND METHODS A cross-sectional study ...
Qadeer, Imrana; Reddy, Sunita
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
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
Paidi Ramesh Chandra
Full Text Available BACKGROUND Myringoplasty is the surgical procedure performed for the closure of perforations of pars tensa of the tympanic membrane. Various graft materials are used such as temporalis fascia, periosteum, perichondrium, vein, dura and adipose tissue (fat. Fat myringoplasty is a simple, cost effective and outpatient procedure. This study is performed to evaluate the operative outcome of fat myringoplasty in patients with Chronic Suppurative Otitis Media (CSOM. The aim of the study is to assess graft uptake to assess hearing improvement and to assess the operative outcome in relation to the site of perforation after fat myringoplasty. MATERIALS AND METHODS This study was performed in Government ENT Hospital, Andhra Medical College, Visakhapatnam. A total of 20 patients between the age group of 18-50 years suffering from tubotympanic type of chronic suppurative otitis media were taken up for study. The study period was for 18 months from October 2015 to March 2017. RESULTS Results were analysed in terms of graft uptake and hearing improvement. Average audiometric gain after 6 months was 10.58 dB. Successful closure of perforation was achieved in 90% cases. Perforations involving posterior quadrant showed 100% graft uptake, compared to anterior quadrant perforations, which showed 75% graft uptake. No major postoperative complications were noted. CONCLUSION Fat myringoplasty can be safely performed in dry, small central perforations of tympanic membrane especially belonging to posterior quadrant. Ear lobule constitutes convenient source of fat graft. The procedure can be performed as a day care surgery. Proper selection of cases is necessary to obtain good results.
The objective of this study was to assess the effectiveness of mask ventilation performed by 112 doctors with clinical responsibilities at a tertiary referral teaching hospital. Participant doctors were asked to perform mask ventilation for three minutes on a Resusci Anne mannequin using a facemask and a two litre self inflating bag. The tidal volumes generated were quantified using a Laerdal skillmeter computer as grades 0-5, corresponding to 0, 334, 434, 561, 673 and > 800 ml respectively. The effectiveness of mask ventilation (i.e. the proportion of ventilation attempts which achieved a volume delivery of > 434 mls) was greater for anaesthetists [78.0 (29.5)%] than for non anaesthetists [54.6 (40.0)%] (P = 0.012). Doctors who had attended one or more resuscitation courses where no more effective at mask ventilation than their colleagues who had not undertaken such courses. It is likely that first responders to in-hospital cardiac arrests are commonly unable to perform adequate mask ventilation.
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
Full Text Available Objectives: Antimicrobial stewardship programs have been designed to measure and improve the use of antimicrobials to achieve optimal clinical outcomes and reduce bacterial resistance. The aim of this study was to review patterns of antimicrobial prescribing for hospitalized patients in the acute care setting and assess the appropriateness of antimicrobial use among prescribers in a tertiary care hospital in Oman. Methods: We conducted a retrospective audit of the appropriateness of antimicrobial prescribing in patients admitted to acute care settings in a tertiary care hospital in Oman over a four-week period (1 November to 28 November 2012. The data of all discharged patients were retrieved from the department databases. Patient records and prescriptions were reviewed by an infectious disease consultant. The rationality of antimicrobial use was evaluated, analyzed, and judged based on local standard guidelines and the experience of the evaluating consultant. Results: There were 178 patients discharged from acute medical teams over the study period. Sixty-four percent of the patients received a total of 287 antimicrobial agents during admission. The average number of antimicrobials prescribed per patient in those prescribed antimicrobials was 2.5±1.1. The most commonly prescribed antimicrobial agent was piperacillin/tazobactam. Most patients had infections from gram-negative organisms, and high rates of extended spectrum beta-lactamase producing organisms were observed. Cultures were obtained before antimicrobial initiation in 25% of patients. Variability in antimicrobial selection for common infections was observed. Conclusions: National guidelines for the management of common infections are needed to minimize the overuse and misuse of antimicrobial agents in tertiary care hospitals. A large surveillance study on antimicrobial prescribing appropriateness in different hospital settings is warranted.
Full Text Available Background: Postpartum period is the critically important part of obstetric care but most neglected period for majority of Pakistani women. Only life threatening complications compel them to seek for tertiary hospital care. We describe the nature of these obstetric morbidities in order to help policymakers in improving prevailing situation. Objective: To find out the frequency and causes of severe post-partum maternal morbidity requiring tertiary hospital care and to identify the demographic and obstetrical risk factors and adverse fetal outcome in women suffering from obstetric morbidities. Materials and Methods: This prospective cross-sectional study was carried out in the Department of Gynecology and Obstetrics, Liaquat University Hospital Hyderabad, between April 2008-July 2009. The subjects comprised of all those women who required admission and treatment for various obstetrical reasons during their postpartum period. Women admitted for non-obstetrical reasons were excluded. A structured proforma was used to collect data including demographics, clinical diagnosis, obstetrical history and feto-maternal outcome of index pregnancy, which was then entered and analyzed with SPSS version 11. Results: The frequency of severe postpartum maternal morbidity requiring tertiary hospital care was 4% (125/3292 obstetrical admissions. The majority of them were young, illiterate, multiparous and half of them were referred from rural areas. Nearly two third of the study population had antenatal visits from health care providers and delivered vaginally at hospital facility by skilled birth attendants. The most common conditions responsible for life threatening complications were postpartum hemorrhage (PPH (50%, preeclampsia and eclampsia (30% and puerperal pyrexia 14%. Anemia was associated problem in 100% of cases. Perinatal death rate was 27.2% (34 and maternal mortality rate was 4.8%. Conclusion: PPH, Preeclampsia, sepsis and anemia were important causes
Li, Danni; Elliott, Tom; Klein, Gerri; Ur, Ehud; Tang, Tricia S
To examine the effects of a 6-month nurse case manager (NCM) intervention compared to standard care (SC) on glycemic control and diabetes distress in a Canadian tertiary-care setting. We recruited 140 adults with type 2 diabetes and glycated hemoglobin (A1C) levels >8% (64 mmol/mol) from 2 tertiary care facilities and randomized them to: 1) a 6-month NCM intervention in addition to SC or 2) SC by the primary endocrinologists. Assessments were conducted at baseline and at 6 months. Primary outcomes included A1C levels and diabetes distress scores (DDS). Secondary outcomes included body mass index, blood pressure, diabetes-related behaviour measures, depressive symptoms, self-motivation and perception of support. At the 6-month follow up, the NCM group experienced larger reductions in A1C levels of -0.73% compared to the SC group (p=0.027; n=134). The NCM group also showed an additional reduction of -0.40 (26% reduction) in DDS compared to those in the SC group (p=0.001; n=134). The NCM group had lower blood pressure, ate more fruit and vegetables, exercised more, checked their feet more frequently, were more motivated, were less depressed and perceived more support. There were no changes and no group differences in terms of body mass index, medication compliance or frequency of testing. Compared to SC, NCM intervention was more effective in improving glycemic control and reducing diabetes distress. It is, therefore, a viable adjunct to standard diabetes care in the tertiary care setting, particularly for patients at high risk and with poor control. Copyright © 2017 Diabetes Canada. Published by Elsevier Inc. All rights reserved.
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
Cranwell, Kate; Polacsek, Meg; McCann, Terence V
Medical comorbidity in people with long-term mental illness is common and often undetected; however, these consumers frequently experience problems accessing and receiving appropriate treatment in public health-care services. The aim of the present study was to understand the lived experience of mental health consumers with medical comorbidity and their carers transitioning through tertiary medical to primary care services. An interpretative, phenomenological analysis approach was used, and semistructured, video-recorded, qualitative interviews were used with 12 consumers and four primary caregivers. Four main themes and related subthemes were abstracted from the data, highlighting consumer's and carers' experience of transition through tertiary medical to primary care services: (i) accessing tertiary services is difficult and time consuming; (ii) contrasting experiences of clinician engagement and support; (iii) lack of continuity between tertiary medical and primary care services; and (iv) Mental Health Hospital Admission Reduction Programme (MH HARP) clinicians facilitating transition. Our findings have implications for organisational change, expanding the role of MH HARP clinicians (whose primary role is to provide consumers with intensive support and care coordination to prevent avoidable tertiary medical hospital use), and the employment of consumer and carer consultants in tertiary medical settings, especially emergency departments. © 2016 The Authors International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd. on behalf of Australian College of Mental Health Nurses Inc.
Campbell, Lauren; Bunston, Rebecca; Colangelo, Sarah; Kim, Dorothy; Nargi, Jessica; Hill, Kylie; Brooks, Dina
To describe the provision of weekend physiotherapy (PT) services in tertiary-care hospitals in Canada. A prospective cross-sectional survey was conducted across tertiary-care hospitals, defined as those with university affiliation and at least one intensive care unit (ICU). Data were collected via telephone-administered questionnaires addressing hospital demographics, weekend staffing, workload, and weekend referral criteria. A response rate of 84% (n=36) was obtained. Of facilities providing weekend PT services (97%), 35 (100%) provided care on Saturdays, 32 (91%) on Sundays, and 33 (94%) on statutory holidays. Weekend services were staffed using permanent full-time (n=35; 100%) or part-time (n=28; 80%) in-patient staff or outsourced staff (n=1; 3%). The number of physiotherapists available on the weekend was smaller than the number available during the week (p<0.001). Common weekend referral criteria included cardiorespiratory problems (n=35; 100%), postoperative assessment of patients at risk for deterioration (n=32; 91%), and patients scheduled for discharge pending PT assessment (n=30; 86%). Both the scope and the number of staff available to provide PT services were less on the weekend than during the week. Despite the use of common criteria for weekend referral, variability in this service exists. Knowledge pertaining to current weekend PT services provides opportunities for harmonization of service delivery.
Shifa, Jemal Zeberga; Gezmu, Alemayehu Mekonnen
Retinoblastoma is a primary malignant intraocular neoplasm that arise from immature retinoblasts with in developing retina. The commonest presenting sign in developing country is proptosis which is the late presenting sign. We report presenting signs of retinoblastoma in Ethiopian children seen at a tertiary level teaching hospitals in Ethiopia. Prospective case series study was done on children who presented with retinoblastoma between May 1, 2005 and September 1, 2006. This study was done as part of requirement for partial fulfilment of certificate of specialty study in ophthalmology during the year 2005 to 2006. SPSS 11 statistical package was used to analyse the data. Among 41 patients seen during the study period, 24 (58.5%) were males and 17(41%) were females. Unilateral retinoblastoma was found in 32 (78%) patients and bilateral cases were found in 9(22%). Mean age of onset for right eye was 27.5 months and left eye 33.7 months. The mean ages of presentation at time of diagnosis for right and left eye were 34.4 and 40.2 months, respectively .In bilateral retinoblastoma mean age of presentation was 33.3 months. The commonest presenting sign was proptosis 22(53.7%) followed by leucocorea nine (22%),ocular inflammation four (9.0 %), strabismus three (7.3%), glaucoma one (2.4%), loss of vision one (2.4%)and hyphemaone (2.4%). The commonest presenting signs of retinoblastoma in our set up were Proptosis followed by leucocorea. This is due to late presentation of patient and late referral by medical professionals. Health education to the public and health professionals will help early detection of retinoblastoma.
Full Text Available Objective: To study the obstetrical and perinatal outcomes of teenage Omani girls with singleton pregnancies at a tertiary teaching hospital. Methods: This is a retrospective case control study. We reviewed obstetric and perinatal outcomes of teenage nulliparous pregnant Omani girls with singleton pregnancies aged 14 to 19 years, delivered at Sultan Qaboos University Hospital, between 1 July 2006 and 30 June 2013. We compared their outcomes with outcomes of pregnant nulliparous Omani women with singleton pregnancies aged 20 to 25 years old delivered at the same hospital during the same period. Results: When compared with pregnant women (n=307, teenage pregnant girls (n=307 were found to have higher proportion of preterm delivery <32 weeks (7% vs. 3%, p=0.040, preterm pre-labor rupture of membranes (PPROM (19% vs. 11%, p=0.005 and anemia (58% vs. 44%, p=0.005. Cesarean section rate was higher in women than teenager girls (20% vs. 10%, p=0.001. Teenager girls had lighter babies (mean weight ± standard deviation 2,750±690 vs. 2,890±480, p=0.020, incidence of very low birth weight babies (<1,500g was higher in teenagers (3.9% vs. 0.3%, p=0.003, but perinatal mortality rate was similar in the two groups. Conclusion: Teenage pregnant Omani women are at increased risk of preterm delivery before 32 weeks gestation, PPROM, anemia, and delivering very low birth weight babies.
Axén, Iben; Jensen, Irene B; Eklund, Andreas; Halasz, Laszlo; Jørgensen, Kristian; Lange, Fredrik; Lövgren, Peter W; Rosenbaum, Annika; Leboeuf-Yde, Charlotte
Among chiropractors the use of long-term treatment is common, often referred to as "maintenance care". Although no generally accepted definition exists, the term has a self-explanatory meaning to chiropractic clinicians. In public health terms, maintenance care can be considered as both secondary and tertiary preventive care. The objective of this study was to explore what factors chiropractors consider before recommending maintenance care to patients with low back pain (LBP). Structured focus group discussions with Swedish chiropractors were used to discuss pre-defined cases. A questionnaire was then designed on the basis of the information obtained. In the questionnaire, respondents were asked to grade the importance of several factors when considering recommending maintenance care to a patient. The grading was done on a straight line ranging from "Very important" to "Not at all important". All members of the Swedish Chiropractors' Association (SCA) were invited to participate in the discussions and in the questionnaire survey. Thirty-six (22%) of SCA members participated in the group discussions and 129 (77%) returned the questionnaires. Ninety-eight percent of the questionnaire respondents claimed to believe that chiropractic care can prevent future relapses of back pain. According to the group discussions tertiary preventive care would be considered appropriate when a patient improves by 75% or more. According to the results of the questionnaire survey, two factors were considered as "very important" by more than 70% of the respondents in recommending secondary preventive care, namely frequency past year and frequency past 10 years of the low back pain problem. Eight other factors were considered "very important" by 50-69% of the respondents, namely duration (over the past year and of the present attack), treatment (effect and durability), lifestyle, work conditions, and psychosocial factors (including attitude). The vast majority of our respondents believe
Full Text Available Abstract Background Among chiropractors the use of long-term treatment is common, often referred to as "maintenance care". Although no generally accepted definition exists, the term has a self-explanatory meaning to chiropractic clinicians. In public health terms, maintenance care can be considered as both secondary and tertiary preventive care. The objective of this study was to explore what factors chiropractors consider before recommending maintenance care to patients with low back pain (LBP. Method Structured focus group discussions with Swedish chiropractors were used to discuss pre-defined cases. A questionnaire was then designed on the basis of the information obtained. In the questionnaire, respondents were asked to grade the importance of several factors when considering recommending maintenance care to a patient. The grading was done on a straight line ranging from "Very important" to "Not at all important". All members of the Swedish Chiropractors' Association (SCA were invited to participate in the discussions and in the questionnaire survey. Results Thirty-six (22% of SCA members participated in the group discussions and 129 (77% returned the questionnaires. Ninety-eight percent of the questionnaire respondents claimed to believe that chiropractic care can prevent future relapses of back pain. According to the group discussions tertiary preventive care would be considered appropriate when a patient improves by 75% or more. According to the results of the questionnaire survey, two factors were considered as "very important" by more than 70% of the respondents in recommending secondary preventive care, namely frequency past year and frequency past 10 years of the low back pain problem. Eight other factors were considered "very important" by 50–69% of the respondents, namely duration (over the past year and of the present attack, treatment (effect and durability, lifestyle, work conditions, and psychosocial factors (including
Stevens, Kym; Huddy, Avril
Despite tertiary institutions acknowledging that reflective practice is an essential component of undergraduate dance teacher training, there is often a disparity between the tertiary students' reflective skills and the more sophisticated reflective ability needed to navigate the twenty-first-century workforce. This paper charts the evolution of a…
Rabin, Colette; Smith, Grinell
An ethic of care acknowledges the centrality of the role of caring relationships in moral education. Care ethics requires a conception of "care" that differs from the quotidian use of the word. In order to teach care ethics more effectively, this article discusses four interrelated ways that teachers' understandings of care differ…
Rao, Suchitra; Williams, Joshua T B; Torok, Michelle R; Cunningham, Maureen A; Glodè, Mary P; Wilson, Karen M
To identify the extent and characteristics of missed opportunities for influenza vaccination among children hospitalized with influenza at a tertiary children's hospital. We conducted a retrospective cohort study of hospitalized patients with polymerase chain reaction-confirmed influenza admitted to Children's Hospital Colorado from 2010 to 2014. We reviewed medical records for vaccination status and previous visits. The primary outcome was the proportion of underimmunized patients hospitalized with influenza with at least 1 missed opportunity visit (visit before influenza diagnosis in which an eligible patient did not receive the influenza vaccine). The relationship between sociodemographic characteristics and the primary outcome were examined using χ(2) tests and nonparametric tests, and variables with P vaccination. Multivariate analysis demonstrated that high-risk status (adjusted odds ratio 6.9, 95% confidence interval 3.8-12.4) was associated with increased odds of having a missed opportunity visit. Most missed opportunity visits were to subspecialty clinics (42%), and most visits (71%) occurred from September to November. More than 40% of hospitalizations for influenza in children are associated with at least 1 missed opportunity visit at a tertiary center. Our findings highlight the potential role of tertiary care institutions in increasing influenza vaccination rates among children. Copyright © 2016 by the American Academy of Pediatrics.
Polis, Suzanne; Higgs, Megan; Manning, Vicki; Netto, Gayle; Fernandez, Ritin
Effective nursing teamwork is an essential component of quality health care and patient safety. Understanding which factors foster team work ensures teamwork qualities are cultivated and sustained. This study aims to investigate which factors are associated with team work in an Australian acute care tertiary hospital across all inpatient and outpatient settings. All nurses and midwives rostered to inpatient and outpatient wards in an acute care 600 bed hospital in Sydney Australia were invited to participate in a cross sectional survey between September to October 2013. Data were collected, collated, checked and analysed using Statistical Package for the Social Sciences (SPSS) Version 21. Factors reporting a significant correlation with where p team leadership were 3.6 (S.D. 0.57) and 3.8 (SD 0.6) respectively. Leadership and communication between nurses were significant predictors of team work p team work.
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.
Bahalkani, Habib Akhtar; Kumar, Ramesh; Lakho, Abdul Rehman; Mahar, Benazir; Mazhar, Syeda Batool; Majeed, Abdul
Job satisfaction greatly determines the productivity and efficiency of human resource for health. It literally means: 'the extent to which Health Professionals like or dislike their jobs'. Job satisfaction is said to be linked with employee's work environment, job responsibilities, and powers; and time pressure among various health professionals. As such it affects employee's organizational commitment and consequently the quality of health services. Objective of this study was to determine the level of job satisfaction and factors influencing it among nurses in a public sector hospital of Islamabad. A cross sectional study with self-administered structured questionnaire was conducted in the federal capital of Pakistan, Islamabad. Sample included 56 qualified nurses working in a tertiary care hospital. Overall 86% respondents were dissatisfied with about 26% highly dissatisfied with their job. The work environments, poor fringe benefits, dignity, responsibility given at workplace and time pressure were reason for dissatisfaction. Poor work environment, low salaries, lack of training opportunities, proper supervision, time pressure and financial rewards reported by the respondents. Our findings state a low level of overall satisfaction among workers in a public sector tertiary care health organization in Islamabad. Most of this dissatisfaction is caused by poor salaries, not given the due respect, poor work environment, unbalanced responsibilities with little overall control, time pressure, patient care and lack of opportunities for professional development.
Gaona-Flores, Verónica Alejandra; Campos-Navarro, Luz Arcelia; Ocampo-Martínez, Joaquín; Alcalá-Martínez, Enrique; Patiño-Pozas, Margarita
The Advance Directive is generally conceptualized as the respect that all human beings deserve in the use of their faculties, to deliberate, choose, and decide upon everything that pertains to their existence, including their life goals and personal health. To identify knowledge about the AD that Medical Residents at tertiary care facilities of the Mexican Social Security Institute (Instituto Mexicano del Seguro Social, IMSS) in the District Capital (Mexico City), possess. Written survey with 10 questions for Medical Residents (MR) of different specialties at tertiary care hospitals. Survey. The questionnaire was applied to 280 MR of more than ten different specialties, at the La Raza and the S XXI Medical Centres (Centro Médico La Raza y Centro Médico Siglo XXI). The majority of respondents were first-year MR (67.5%), and the minority were sixth-year Residents (1.9%). Incomplete knowledge about the Federal AD Law exists. In Mexico, like on an international plane, the contemporary, social dynamic has fundamentally influenced the practice of healthcare professions. The responsibilities that health care professionals take on obligate them to be current in areas like the rights of healthy and sick individuals to be involved in and decide on aspects related to the phase at the end of their lives. The AD, Vital Testament, Living Will, will push doctors to improve the doctor-patient relationship since the establishment of an AD is not possible without a good patient-doctor rapport.
Full Text Available Most learners studying English language feel that their educators use irrelevant, uninteresting, and culturally unfamiliar reading materials for teaching reading. As a result, most of them struggle to comprehend the English language texts used by the teachers. Therefore, the aim of this research is to investigate the genre and content preferences of ESL tertiary learners in UiTM Kedah, Malaysia. A two-part questionnaire was administered to 132 respondents aged 20 to 23 years old who are presently furthering their undergraduate studies in Accountancy, Administrative Science and Policy Studies, Business Management, Industrial Design, and Information Management. The results of the study show that these ESL tertiary learners prefer texts from the websites and blogs; and their preferred reading contents are dealing with Business Management, watching movies and listening to music. This article offers guidance to ESL teachers to select L2 reading texts based on the students’ preferred genre and content.
Background: Critically ill patients are a significant source of morbidity and mortality in hospitals. In resource-challenged economies like Nigeria, the number of deaths due to conditions requiring critical care is alarming. As in most other tertiary hospitals, critically ill patients are usually admitted into the Intensive Care Unit ...
Jawad, A.; Nisar, Y.B.
Objective: To determine the frequency of fungal infection in nasal polyposis patients undergoing polypectomy in a tertiary care ENT unit. Methodology: This cross sectional study was conducted in the department of ENT, Pakistan Institute of Medical Sciences, Islamabad. A total of 60 patients with nasal polyposis were enrolled. Patients who did not give consent, with sinonasal malignancy, diabetes, and pregnant or lactating women were excluded from study. All the patients were operated and specimens of polypectomies were sent to the Department of Pathology for fungal culture, direct microscopy and histopathology. Data was entered and analysed using SPSS version 20. (author)
Benjamin Louis Moresco; Benjamin Louis Moresco; Clinton Woosley; Clinton Woosley; Morris Sauter; Utpal Bhalala; Utpal Bhalala
ObjectivesThis study aimed to assess factors related to adherence to the Pediatric Advanced Life Support guidelines for severe sepsis and septic shock in an emergency room (ER) of a tertiary care children’s hospital.MethodsThis was a retrospective, observational study of children (0–18 years old) in The Children’s Hospital of San Antonio ER over 1 year with the International Consensus Definition Codes, version-9 (ICD-9) diagnostic codes for “severe sepsis” and “shocks.” Patients in the adhere...
Fernandez, Leonor; Irby, David M.; Harleman, Elizabeth; Fernandez, Alicia
Clinical teachers often observe interactions that may contribute to health care disparities, yet may hesitate to teach about them. A pedagogical model could help faculty structure teaching about health care disparities in the clinical setting, but to our knowledge, none have been adapted for this purpose. In this paper, we adapt an established model, Time-Effective Strategies for Teaching (TEST), to the teaching of health care disparities. We use several case scenarios to illustrate the core components of the model: diagnose the learner, teach rapidly to the learner’s need, and provide feedback. The TEST model is straightforward, easy to use, and enables the incorporation of teaching about health care disparities into routine clinical teaching. PMID:20352501
Selkirk, Stephen M; Washington, Monique O; McClellan, Frances; Flynn, Broderick; Seton, Jacinta M; Strozewski, Richard
This study was undertaken to determine if ALS patients evaluated via telemedicine received the same quality of care as patients evaluated by traditional face-to-face encounters. A retrospective cohort study design was used. Participants were patients diagnosed with ALS that received multidisciplinary care at the tertiary Cleveland VA ALS Centre between 1 March 2008- and 31 anuary 2015. Participants were not randomised, but chose telemedicine based on preference, disability level or distance from the clinic. Telemedicine in this study consisted of a video conferencing platform enabling remote rather than face-to-face encounters with participants. There was no significant association between receiving quality ALS care and the mode of care. There was a trend for telemedicine patients to utilise home health care less often than those that received clinic care (AOR 0.50; 95% CI 0.16-1.59). There was no significant difference in survival time between the two groups (log-rank test χ 2 = 3.62, df = 1, p = 0.05). Patients receiving telemedicine had a higher probability of remaining stable or having ALS care.
Sarit, Sharma; Shruti, Sharma; Deepinder, Chhina; Chhina, R S
Varicella-zoster virus (VZV) causes 2 clinically and epidemiologically distinct forms of diseases. Chickenpox (varicella) is the disease that results from primary infection with the VZV. Herpes zoster (HZ) results from the reactivation of VZV latently infecting the dorsal root ganglia. We are reporting an outbreak of varicella infection among the health care workers (HCWs) in the Intensive Care Unit (ICU) of a tertiary care hospital. We found transmission of varicella among eight HCWs of pulmonary ICU. They had a history of contact with a patient having HZ infection. Investigation of the outbreak was conducted as per guidelines. Better dissemination of information on disease transmission, isolation of infected patients inside the hospital, and adequate protection (including vaccination) for susceptible employees are important to prevent such outbreaks.
Choudhuri, Anirban Hom; Chakravarty, Mitali; Uppal, Rajeev
The prevalence of nosocomial infection is higher in the Intensive Care Unit (ICU) than other areas of the hospital. The present observational study was undertaken to describe the epidemiology and characteristics of nosocomial infections acquired in a tertiary care ICU and the impact of the various risk factors in their causation. A retrospective study was conducted on the prospectively collected data of 153 consecutive patients admitted in a tertiary care ICU between July 2014 and December 2015. The primary objective was to assess the epidemiology of ICU-acquired bacterial infections in terms of the incidence of new infections, causative organism, and site. The secondary end point was to assess the risk factors for developing ICU-acquired infections. Out of the 153 patients enrolled in the study, 87 had an ICU-acquired nosocomial infection (58.86%). The most common organism responsible for infection was Klebsiella pneumoniae (37%), and the most common infection was pneumonia (33%). The duration of mechanical ventilation and length of ICU stay were significantly prolonged in patients developing nosocomial infections. There was no difference in mortality between the groups. The multivariate analyses identified intubation longer than 7 days, urinary catheterization >7 days, duration of mechanical ventilation more than 7 days, and ICU length of stay longer than 7 days as independent risk factors for nosocomial infections. The study demonstrated a high incidence of nosocomial infection in the ICU and identified the risk factors for acquisition of nosocomial infections in the ICU.
Acheampong, Franklin; Tetteh, Ashalley Raymond; Anto, Berko Panyin
This study determined the incidence, types, clinical significance, and potential causes of medication administration errors (MAEs) at the emergency department (ED) of a tertiary health care facility in Ghana. This study used a cross-sectional nonparticipant observational technique. Study participants (nurses) were observed preparing and administering medication at the ED of a 2000-bed tertiary care hospital in Accra, Ghana. The observations were then compared with patients' medication charts, and identified errors were clarified with staff for possible causes. Of the 1332 observations made, involving 338 patients and 49 nurses, 362 had errors, representing 27.2%. However, the error rate excluding "lack of drug availability" fell to 12.8%. Without wrong time error, the error rate was 22.8%. The 2 most frequent error types were omission (n = 281, 77.6%) and wrong time (n = 58, 16%) errors. Omission error was mainly due to unavailability of medicine, 48.9% (n = 177). Although only one of the errors was potentially fatal, 26.7% were definitely clinically severe. The common themes that dominated the probable causes of MAEs were unavailability, staff factors, patient factors, prescription, and communication problems. This study gives credence to similar studies in different settings that MAEs occur frequently in the ED of hospitals. Most of the errors identified were not potentially fatal; however, preventive strategies need to be used to make life-saving processes such as drug administration in such specialized units error-free.
In Young Jung
Full Text Available Background. Adverse drug reactions (ADRs are any unwanted/uncomfortable effects from medication resulting in physical, mental, and functional injuries. Antibiotics account for up to 40.9% of ADRs and are associated with several serious outcomes. However, few reports on ADRs have evaluated only antimicrobial agents. In this study, we investigated antibiotic-related ADRs at a tertiary care hospital in South Korea. Methods. This is a retrospective cohort study that evaluated ADRs to antibiotics that were reported at a 2400-bed tertiary care hospital in 2015. ADRs reported by physicians, pharmacists, and nurses were reviewed. Clinical information reported ADRs, type of antibiotic, causality assessment, and complications were evaluated. Results. 1,277 (62.8% patients were considered antibiotic-related ADRs based on the World Health Organization-Uppsala Monitoring Center criteria (certain, 2.2%; probable, 35.7%; and possible, 62.1%. Totally, 44 (3.4% patients experienced serious ADRs. Penicillin and quinolones were the most common drugs reported to induce ADRs (both 16.0%, followed by third-generation cephalosporins (14.9%. The most frequently experienced side effects were skin manifestations (45.1% followed by gastrointestinal disorders (32.6%. Conclusion. Penicillin and quinolones are the most common causative antibiotics for ADRs and skin manifestations were the most frequently experienced symptom.
Ghosh, Sudip Kumar; Dey, Sunil Kumar; Saha, Indranil; Barbhuiya, Jayasree Nath; Ghosh, Arghyaprasun; Roy, Aloke Kumar
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. 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. 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. 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.
Joaquim Prado P Moraes-Filho
Full Text Available INTRODUCTION: Several aspects of gastroesophageal reflux disease (GERD have been studied, but the frequency of comorbidities is not yet fully understood. OBJECTIVES: To study the prevalence of GERD comorbidities in a tertiary care hospital. METHODS: We prospectively studied 670 consecutive adult patients from the outpatient department of our facility. A diagnosis was established using clinical, endoscopic and/or pHmetry-related findings. Each patient's medical file was reviewed with respect to the presence of other medical conditions and diagnoses. RESULTS: Of the 670 patients, 459 (68.6% were female, and the mean age was 55.94 (17-80 years. We registered 316 patients (47.1% with the erosive form of GERD and 354 patients (52.9% with the non-erosive form. A total of 1,664 instances of comorbidities were recorded in 586 patients (87.5%, with the most common being arterial hypertension (21%, hypercholesterolemia (9%, obesity (9%, type II diabetes mellitus (5% and depression (4%. Two or more comorbidities were present in 437 individuals (64.8%. The occurrence of comorbidities increased with age and was higher in patients with the non-erosive form of GERD. CONCLUSIONS: In a tertiary referral population, comorbidities were very common, and these may have worsened the already impaired health-related quality of life of these patients. Clinicians caring for GERD patients in this setting must be aware of the likelihood and nature of comorbid disorders and their impact on disease presentation and patient management.
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.
Patil, Milind; Sahoo, Jayaprakash; Kamalanathan, Sadishkumar; Selviambigapathy, Jayakumar; Balachandran, Karthik; Kumar, Ritesh; Vivekanandan, Muthupillai; Ajmal, K
The efficacy of insulin therapy in diabetes depends on proper storage and injection technique. The purpose of this study was to assess the practice of insulin administration among diabetes patients in a tertiary care center. This observational study was done in Endocrinology department of a tertiary care center during April-June 2015. The consecutive patients using insulin for at least three months by either syringe or pen were recruited. All of them underwent a survey by the questionnaire which focused on key insulin injection parameters. One hundred and sixty eight (74.67%) patients were storing insulin vials properly. The thigh was the most common site of insulin injection and 209(92.89%) study participants were rotating at the injection sites. Only 48.57% (34/70) subjects were mixing insulin properly before injection. The practice of hand washing and the cleaning of the injection site was practiced by 158(70%) & 171(76.44%) subjects respectively. One hundred and fifty six (69%) patients were injecting with the proper skin fold and 123(55%) subjects were injecting insulin at 90° angle. The majority of patients (91%) were throwing the needle and syringes directly into the garbage and public drainage system. There was a significant gap between the insulin administration guidelines and current insulin injection practice. The diabetic education and counseling about proper insulin injection techniques should be provided to all diabetic subjects. Copyright © 2016 Diabetes India. Published by Elsevier Ltd. All rights reserved.
Pravin K. Nair
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
Sadoughi, Farahnaz; Ebrahimi, Kamal
Self esteem (SE) and organizational commitment (OC)? have significant impact on the quality of work life. This study aims to gain a better understanding of the relationships between SE and OC among health information management staff in tertiary care hospitals in Tehran (Iran). This was a descriptive correlational and cross sectional study conducted on the health information management staff of tertiary care hospitals in Tehran, Iran. A total of 155 participants were randomly selected from 400 staff. Data were collected by two standard questionnaires. The SE and OC was measured using Eysenck SE scale and Meyer and Allen's three component model, respectively. The collected data were analyzed with the SPSS (version 16) using statistical tests of of independent T-test, Pearson Correlation coefficient, one way ANOVA and F tests. The OC and SE of the employees' were 67.8?, out of 120 (weak) and 21.0 out of 30 (moderate), respectively. The values for affective commitment, normative commitment, and continuance commitment were respectively 21.3 out of 40 (moderate), 23.9 out of 40 (moderate), and 22.7 out of 40 (moderate). The Pearson correlation coefficient test showed a significant OC and SE was statistically significant (Pwork experience with SE and OC. This research showed that SE and OC ?are moderate. SE and OC have strong correlation with turnover, critical thinking, job satisfaction, and individual and organizational improvement. Therefore, applying appropriate human resource policies is crucial to reinforce these measures.
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
Koh, Young Rae; Kim, Shine Young; Kim, In Suk; Chang, Chulhun L; Lee, Eun Yup; Son, Han Chul; Kim, Hyung Hoi
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.
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.
Ortiz-Brizuela, Edgar; Quiroz-Compeán, Alejandro; Vilatobá-Chapa, Mario; Alberú-Gómez, Josefina
Here, we describe the presentation, treatment, and outcomes of acute appendicitis in kidney transplant recipients at a tertiary care hospital in Mexico City. We conducted a retrospective case series study at a tertiary care hospital in Mexico City from January 2000 to January 2015. During our study period, 1186 patients received a kidney transplant; among these patients, we identified 10 cases of acute appendicitis (0.008%). Four patients (40%) were diagnosed on day 5 of symptom onset. Nine patients (90%) showed abdominal pain, 2 patients (20%) presented with a typical migratory pattern, and 2 patients (20%) showed symptoms of small bowel intestinal obstruction. Thirty percent of patients (3/10) presented a rule-out Alvarado score (≤ 3 points). A computed tomography scan was performed in all but one patient; among these 9 patients, 1 (11.1%) had a false-negative result. Among all patients with acute appendicitis, 50% (5/10) presented with a periappendiceal abscess and 40% (4/10) showed localized peritonitis. An open and laparoscopic appendectomy was performed in 7 of 10 patients (70%) and 3 of 10 patients (30%), respectively. All patients received ceftriaxone plus metronidazole or ertapenem for 5 to 7 days. There were no reported treatment failures or recurrence of symptoms. The diagnosis of acute appendicitis in kidney transplant recipients requires a high index of suspicion. Kidney transplant recipients with acute appendicitis had good outcomes with a therapeutic approach similar to that used in the general population.
Ikram, A.; Shah, S.I.H.; Naseem, S.; Absar, S.A.; Safi-Ullah; Ambreen, T.
To determine the availability and implementation of various hospital infection control measures at tertiary care hospitals. Study Design: Survey. Place and Duration of Study: National Institute of Science and Technology, Islamabad, from June through August 2008. Methodology: Seven tertiary care very busy hospitals were selected; one from Islamabad, 5 from Rawalpindi, and one from Lahore. A detailed proforma was designed addressing all the issues pertaining to hospital infection control measures. Air sampling was done and growth yielded was identified by standard methods. Results: Analyses revealed that all of the hospitals had an Infection Control Committee. Microbiological diagnostic facilities were adequate at all the hospitals and overall microorganism yield was very high. Antibiotic policy was claimed by most, not available on ground. Majority of the operation theatres were without proper air flow system and autoclaves were not being regularly monitored. There was no proper disposal for sharps and needles. Incineration was not the usual mode for infectious waste. Conclusion: The results of the present study imply availability of proper hospital infection control policies with need of strict implementation of such measures. (author)
Full Text Available Background: Birth preparedness and complication readiness (BP/CR is a strategy to promote the timely use of skilled maternal and neonatal care and is based on the theory that preparing for childbirth and being ready for complications reduce delay in obtaining care. Study Objective: The objective of this study was to evaluate the incidence and predictors of birth preparedness, knowledge on danger signs, and emergency readiness among pregnant women attending outpatient clinic of a tertiary care hospital. Patients and Methods: Six hundred pregnant women attending the outpatient department of a tertiary care hospital for the first time in an urban setting were interviewed using a tool adapted from the “Monitoring BP/CR-tools and indicators for maternal and new born health” of the “JHPIEGO.” The outcomes of the study were birth preparedness, knowledge of severe illness, and emergency readiness. Results: Six hundred pregnant women were in the study. Mean age of respondents was 25.2 (±4 years. The mean gestation at enrolment was 18.7 ± 8 weeks. Among the women who participated in the survey, 20% were illiterate, 70% were homemakers and nearly 70% had a monthly family income >Rs. 15,197 (n = 405. Three hundred and sixteen mothers (52% were primigravida. As defined in the study, 71.5% were birth prepared. However, 59 women (9.8% did not identify a place of delivery, 102 (17% had not started saving money, and 99 mothers (16.5% were not aware of purchasing materials needed for delivery. The predictors of birth preparedness are multiparity (odds ratio [OR]: 2.2, 95% confidence interval [CI]: 1.4–3.1, registration in the antenatal clinic in the first trimester (OR: 3.7, 95% CI: 2.2–6.1, educational status of women (OR: 1.9, 95% CI: 1.2–3.0, and pregnancy supervison by a doctor (OR: 5, 95% CI: 2.8–6.6. One hundred and sixty-four women (27% made no arrangements in the event of an emergency, 376 women (63% were not aware of their blood group
However, educators seemed to be unprepared and have insufficient knowledge about how to include spirituality in teaching. This review aimed to systematically review previous literature from 2000 to 2013 regarding the content knowledge and teaching strategies used to teach spirituality and spiritual care in health ...
Sonia R. B D'Souza
Full Text Available Background: Advances in neonatal care have resulted in improved survival of neonates admitted to the intensive care of the Neonatal Intensive Care Unit (NICU. However, the NCU may be an inappropriate milieu, with presence of overwhelming stimuli, most potent being the continuous presence of noise in the ambience of the NICU. Aim and Objectives: To determine and describe the ambient noise levels in the acute NICU of a tertiary referral hospital. Material and Methods: The ambient noise, in this study was the background sound existing in the environment of the acute NICU of a tertiary referral hospital in South India. The ambient noise levels were analyzed by an audiologist and acoustical engineer using a standardized and calibrated Sound Level Meter (SLM i.e., the Hand Held Analyzer type 2250, Brüel and Kjær, Denmark on a weighted frequency A and reported as dB (A. Results: The ambient noise levels were timed measurements yielded by the SLM in terms of L eq, L as well as L exceeded the standard A 10 Aeqmax levels (Leq< 45 dB, L ≤ 50 dB, and Lmax ≤ 65 10 dB.The L eq ranged from 59.4 to 62.12 dB A. A Ventilators with alarms caused the maximum amount of ambient noise yielding a L Sound Pressure Level AF (SPL of 82.14 dB A. Conclusion: The study has found high levels of ambient noise in the acute NICU. Though there are several measures to reduce the ambient noise levels in the NICU, it is essential to raise awareness among health care personnel regarding the observed ambient noise levels and its effects on neonates admitted to the NICU.
Suvirya, Swastika; Singh, Rohit; Senthamizh, Prasad; Sharma, Vishal
(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. 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. 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. 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.
Sonowal, Supriya; Desai, Chetna; Kapadia, Jigar D; Desai, Mira K
To evaluate the knowledge, attitude and practice of consumers in India about disposal of unused medicines. A questionnaire comprising 11 questions evaluating the Knowledge (2), Attitude (3) and Practice (6) of unused medicines was prepared and pre validated before administering to 200 consumers of medicines attending the outpatient department of Civil Hospital Ahmedabad, a tertiary care teaching hospital in Western India. Requisite permissions from Institutional Ethics Committee and informed consent were obtained prior to recruiting them for the study. Responses were recorded, in Microsoft Excel ® spreadsheet and evaluated for percentage response. Majority of the respondents (136, 68%) stored unused medicines at home. Analgesics (26.5%) were the most common unused medicine stored. Safe disposal of medicine was considered necessary by majority respondents (160, 80%) for different reasons like prevention of illegal/unintended use (84, 42%), prevention of environmental pollution (32, 16%) or possible ADR caused by old drugs (54, 27%). Only 78 (39%) respondents were aware of appropriate methods of disposal. Disposal in household trash (61, 30.5%) was the most common method used. Majority of respondents felt the need for a facility or programme to collect unused medicines (152, 76%) and an increased awareness among consumers regarding hazards and methods of disposal of unused medicines (154, 77%). Majority of consumers are aware about the need for safe disposal of unused medicines. But the right attitude for and practice of safe disposal of medicines is lacking. A need for increased awareness regarding safe disposal of medicines is acknowledged by majority of consumers.
Tahira, Q.U.A.; Lodhi, S.; Haider, S.T.; Abaidullah, S.
Objective: To assess the knowledge, attitude and practice regarding medical law and ethics among doctors of a medical unit in a tertiary care teaching hospital in Lahore. Study Design: Descriptive cross sectional study. Methodology: A three part self - administered structured questionnaire designed to test the knowledge and practices regarding medical law and ethics was distributed among doctors in a medical unit in Mayo Hospital, Lahore during September - October, 2012. Results: The 52 respondent doctors included in the study comprised of 20 (38.5%) house officers, 22 (42.3%) postgraduate residents and 10 (19.2%) consultants. In keeping with the Pakistan Medical and Den-tal Council code of ethics, the correct responses of house officers, postgraduate residents and consultants regarding knowledge of medical law and ethics were respectively 50%, 27.3% and 10% for patient's autonomy, 40%, 36.4% and 10% for adhering to patient's wishes, 10%, 63.6% and 50% for breaching confidentiality, 35%, 36.4% and 0% for informed consent, 10%, 22.7% and 10% for doing best regardless of patient's opinion, 5%, 31.8% and 10% for informing patient's relatives, 15%, 4.5% and 0% for treating violent patients. The practical application part of the questionnaire was a general reflection of the knowledge and attitudes. Conclusion: Most of the doctors were poorly acquainted with PMDC code of ethics. (author)
Hada, Mahesh Singh; Chakravarty, Abhijit; Mukherjee, Partha
Escalating health care expenses pose a new challenge to the health care environment of becoming more cost-effective. There is an urgent need for more accurate data on the costs of health care procedures. Demographic changes, changing morbidity profile, and the rising impact of noncommunicable diseases are emphasizing the role of nuclear medicine (NM) in the future health care environment. However, the impact of emerging disease load and stagnant resource availability needs to be balanced by a strategic drive towards optimal utilization of available healthcare resources. The aim was to ascertain the cost of diagnostic procedures conducted at the NM Department of a tertiary health care facility by employing activity based costing (ABC) method. A descriptive cross-sectional study was carried out over a period of 1 year. ABC methodology was utilized for ascertaining unit cost of different diagnostic procedures and such costs were compared with prevalent market rates for estimating cost effectiveness of the department being studied. The cost per unit procedure for various procedures varied from Rs. 869 (USD 14.48) for a thyroid scan to Rs. 11230 (USD 187.16) for a meta-iodo-benzyl-guanidine (MIBG) scan, the most cost-effective investigations being the stress thallium, technetium-99 m myocardial perfusion imaging (MPI) and MIBG scan. The costs obtained from this study were observed to be competitive when compared to prevalent market rates. ABC methodology provides precise costing inputs and should be used for all future costing studies in NM Departments
Hada, Mahesh Singh; Chakravarty, Abhijit; Mukherjee, Partha
Escalating health care expenses pose a new challenge to the health care environment of becoming more cost-effective. There is an urgent need for more accurate data on the costs of health care procedures. Demographic changes, changing morbidity profile, and the rising impact of noncommunicable diseases are emphasizing the role of nuclear medicine (NM) in the future health care environment. However, the impact of emerging disease load and stagnant resource availability needs to be balanced by a strategic drive towards optimal utilization of available healthcare resources. The aim was to ascertain the cost of diagnostic procedures conducted at the NM Department of a tertiary health care facility by employing activity based costing (ABC) method. A descriptive cross-sectional study was carried out over a period of 1 year. ABC methodology was utilized for ascertaining unit cost of different diagnostic procedures and such costs were compared with prevalent market rates for estimating cost effectiveness of the department being studied. The cost per unit procedure for various procedures varied from Rs. 869 (USD 14.48) for a thyroid scan to Rs. 11230 (USD 187.16) for a meta-iodo-benzyl-guanidine (MIBG) scan, the most cost-effective investigations being the stress thallium, technetium-99 m myocardial perfusion imaging (MPI) and MIBG scan. The costs obtained from this study were observed to be competitive when compared to prevalent market rates. ABC methodology provides precise costing inputs and should be used for all future costing studies in NM Departments.
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.
Full Text Available English has become an inevitable means of communication. Due to globalization and rapid growth in business communication, the need to learn the English language has also gained momentum. Employers are looking for employees who are skilled in the language skills. In India, English has become an important means of communication and learning in the education and professional setup. Though English is being taught in schools and colleges, Indian students miserably fail to produce a good quality lengthy composition. In this respect, this paper aims to focus on the need to teach memo-writing skills to tertiary students. To this end, a group of second year Indian BCA students was taken as samples for the study. The students were given a pre-test on memo writing. They lacked the essential skills in writing a memo. In order to improve their memo writing skills the students had to undergo four tasks. At the end of the tasks, they were able to write a good memo. The corporate world demands accurate business writings and our students have to be trained to meet the demands of the business world. This paper studies the growth of business English, the components of effective business writing and the need to teach business writing to tertiary students, which will enable them to be successful in the business world.
Lai, Kwok-Wing; Smith, Lee
In 2014, we investigated how socio-demographic factors such as gender, teaching disciplines, teaching experience and academic seniority were related to the perception and use of digital mobile technologies in learning and teaching of a group of university teachers from one research-intensive university in New Zealand. Three hundred and eight…
Agha, Adnan; Mordy, Ayedh; Anwar, Eram; Saleh, Noha; Rashid, Imran; Saeed, Mona
Burnout Syndrome is a mental condition caused by chronic exposure to work related stress and is identified by the presence of any of the three distinct elements of emotional exhaustion, depersonalization and lack of personal accomplishment. Middle grade doctors are the backbone of any tertiary care hospital / medical institution, partaking in unscheduled and inpatient care. The aim of this study was to assess the presence of burnout syndrome in the middle grade doctors in a tertiary care hospital in Saudi Arabia. The study was conducted at the Armed Forces Hospital Southern Region, Khamis Mushyt, from August to October 2012 in departments with at least fifty inpatient admissions per month and with at least five middle grade (Resident, Registrar and Senior Registrar) doctors. The departments were Obstetrics and Gynecology, Internal Medicine, Pediatrics, Emergency, General Surgery and Nephrology. This was a cross sectional descriptive and analytical study using the Maslach Burnout Inventory-Health Services Survey and a self-reported stressor-identifying questionnaire to ascertain possible precursors of, or contributing factors to, Burnout Syndrome. A total of 96 proformas/questionnaires were collected anonymously to maintain confidentiality and burnout syndrome was identified in as high as 88.5% of the respondents with high emotional exhaustion in 68.8%, high depersonalization in 63.6% and low personal accomplishment in 38.5%. The authors concluded that burnout syndrome is high among the middle-grade doctors in this medical facility and that urgent steps are needed to address this problem to ensure that these physicians remain physically and mentally healthy.
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.
Lal, Lincy Subha; Zhuang, Amy; Hung, Frank; Feng, Chun; Arbuckle, Rebecca; Fisch, Michael J
We evaluated potential drug interactions in patients treated with antidepressants at a tertiary care cancer center to determine if it affects resource utilization. We identified a cohort of patients with continuous care at the study institution by tagging patients who received at least three prescriptions for antidepressants within a continuous 6-month period. Data collected included demographics, cancer type and comorbidities, resource utilization (hospital and emergency room visits), and potential major drug interactions. Descriptive statistics and logistic regression were utilized in the analysis. The study population, which included 297 patients, was 70% female and 71% Caucasian; the mean age was 53 years (SD, 12 years), with a mean follow-up period (duration of therapy) of 403 days. Overall, 145 (49%) of the patients had a drug combination that could result in a potential major drug interaction with antidepressants. There were 118 (40%) patients with a potential major drug interaction that could lead to serotonin syndrome symptoms and 59 (20%) patients with a potential major drug interaction with anticoagulants. Potential major drug interactions were associated with an increased number of hospital and ER visits (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.39-4.03). This finding was consistent for the two subanalysis groups as well, serotonin syndrome-inducing drugs (OR, 2.28; 95% CI, 1.33-3.92) and anticoagulants (OR, 3.66; 95% CI, 1.85-7.22). Potential drug interactions are frequent in patients receiving antidepressants in a tertiary care cancer center and are associated with an increase in resource utilization.
Chaudhry, Imtiaz A; Shamsi, Farrukh A; Elzaridi, Elsanusi; Al-Rashed, Waleed; Al-Amri, Abdulrahman; Al-Anezi, Fahad; Arat, Yonca O; Holck, David E
To describe risk factors predisposing patients to orbital cellulitis and potential complications in patients treated at a tertiary eye care referral center in the Middle East. Noncomparative, interventional, retrospective case series. Patients diagnosed with orbital cellulitis. A 15-year clinical review of patients with a diagnosis of orbital cellulitis referred to King Khaled Eye Specialist Hospital, an accredited (Joint Council on Accreditation of Healthcare Organizations, Washington, DC) tertiary care center in Riyadh, Saudi Arabia, was performed. Only those patients who had clinical signs and symptoms or radiologic evidence suggestive of orbital cellulitis were included in the study. Patient demographics, factors predisposing to orbital cellulitis, and resulting complications. A total of 218 patients (136 male, 82 female) fulfilling the diagnostic criteria for orbital cellulitis were identified. The average age of these patients was 25.7 years (range, 1 month-85 years). On imaging studies, there was evidence of inflammatory or infective changes to orbital structures; orbital abscesses were identified in 116 patients (53%). Sinus disease was the most common predisposing cause in 86 patients (39.4%), followed by trauma in 43 patients (19.7%). All patients received systemic antibiotic treatment before the identification of any responsible organisms. Of the 116 patients with orbital abscess, 101 patients (87%) required drainage. The results of cultures in patients in whom an orbital abscess was drained were positive for 91 patients (90%). The most common microorganisms isolated from the drained abscesses were Staphylococci and Streptococci species. Blood cultures were positive in only 4 patients from whom blood was drawn for cultures. Visual acuity improved in 34 eyes (16.1%) and worsened in 13 eyes (6.2%), including 9 (4.3%) eyes that sustained complete loss of vision, which was attributed to the delay in correct diagnosis and timely intervention (average 28 days
Kim, Miai; Reifel, Stuart
Child care teachers' experiences and their gendered understandings of their work were explored in this study. Two female child care teachers were interviewed individually and asked to describe their work as women's work. Analysis showed that teachers essentialized child care teaching, recognized the paradoxes of being a child care teacher,…
Nwabueze, S A; Adogu, P O U; Ilika, A L; Asuzu, M C; Adinma, E D
Continuous quality improvement is linked to the use of timely and useful feedback from clients in Human Immuno-deficiency Virus (HIV) care. HIV experts and care professionals agree that consumer involvement, such as patient satisfaction survey, is an essential part of HIV care and policy making today. The introduction ofAnti-Retroviral Treatment (ART) services in Nigeria has significantly impacted positively on the overall well being of People Living with HIV and Acquired Immune Deficiency Syndrome (PLWHA). However, there is little understanding of their satisfaction and perception of quality of care provided. Consequently, this study was carried out to assess patients' satisfaction with ambulatory HIV/AIDS care in a tertiary health facility in Anambra State. The study design is cross-sectional. A total of 150 patients from Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi were selected using systematic sampling technique from the daily AntiRetroviral (ARV) clinic register obtained from the medical records department of the centre. Data were collected using a structured interviewer-administered questionnaire and analyzed using SPSS version 13. The mean age of the respondents was 38.3 +/- 9.1. Majority (50.7%) of the patients was married, and most of them (74.7%) were semi-skilled workers. There was a statistically significant difference in the numbers of those who spent >240 naira for transportation to the clinic, compared to those who spent 30 minutes are significantly larger than the number that spent 750 naira than those who spend <750 naira on non-HIV related laboratory (20 versus 9) tests. PLWHAs in this facility were least satisfied with access to care, while they expressed greatest satisfaction with good patient care and quality of service by staff. The overall satisfaction score of the subjects was 4.04 +/- 0.33. HIV patients' overall satisfaction with the services provided to them was quite high. Therefore, there is need to sustain the current
Serrano-Gemes, G; Rich-Ruiz, M
To measure the intensity of interprofessional collaboration (IPC) in nurses of an intensive care unit (ICU) at a tertiary hospital, to check differences between the dimensions of the Intensity of Interprofessional Collaboration Questionnaire, and to identify the influence of personal variables. A cross-sectional descriptive study was conducted with 63 intensive care nurses selected by simple random sampling. Explanatory variables: age, sex, years of experience in nursing, years of experience in critical care, workday type and work shift type; variable of outcome: IPC. The IPC was measured by: Intensity of Interprofessional Collaboration Questionnaire. Descriptive and bivariate statistical analysis (IPC and its dimensions with explanatory variables). 73.8% were women, with a mean age of 46.54 (±6.076) years. The average years experience in nursing and critical care was 23.03 (±6.24) and 14.25 (±8.532), respectively. 77% had a full time and 95.1% had a rotating shift. 62.3% obtained average IPC values. Statistically significant differences were found (Pde Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.
Park, Dong Won; Moon, Jae Young; Ku, Eun Yong; Kim, Sun Jong; Koo, Young-Mo; Kim, Ock-Joo; Lee, Soon Haeng; Jo, Min-Woo; Lim, Chae-Man; Armstrong, John David; Koh, Younsuck
This research aimed to investigate the changes in ethical issues in everyday clinical practice recognized by critical care nurses during two observation periods. We conducted a retrospective analysis of data obtained by prospective questionnaire surveys of nurses in the intensive care units (ICU) of a tertiary university-affiliated hospital in Seoul, Korea. Data were collected prospectively during two different periods, February 2002-January 2003 (Period 1) and August 2011-July 2012 (Period 2). Significantly fewer cases with ethical issues were reported in Period 2 than in Period 1 (89 cases [2.1%] of 4,291 ICU admissions vs. 51 [0.5%] of 9,302 ICU admissions, respectively; P issues in both Periods occurred in MICU. The major source of ethical issues in Periods 1 and 2 was behavior-related. Among behaviorrelated issues, inappropriate healthcare professional behavior was predominant in both periods and mainly involved resident physicians. Ethical issue numbers regarding end-oflife (EOL) care significantly decreased in the proportion with respect to ethical issues during Period 2 (P = 0.044). In conclusion, the decreased incidence of cases with identified ethical issues in Period 2 might be associated with ethical enhancement related with EOL and improvements in the ICU care environment of the studied hospital. However, behaviorrelated issues involving resident physicians represent a considerable proportion of ethical issues encountered by critical care nurses. A systemic approach to solve behavior-related issues of resident physicians seems to be required to enhance an ethical environment in the studied ICU.
Obiete, Innocent Anthony; Nwazor, Joseph Chukwudi; Ifeoma, Vin-Mbah Fidelia
In recent time, graduates from the nation's tertiary institution of learning most especially the business education graduates have been plagued by the inability to get jobs in corporate industries and companies in Nigeria. Many authors and researchers have related this problem to the quality of training received by these graduates while in school…
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.
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.
Full Text Available Ceftriaxone is a third-generation cephalosporin antibiotic, which has broad-spectrum activity against Gram-positive and Gram-negative bacteria. It is a frequently used antibiotic in children worldwide. Studies revealed a number of adverse reactions related to this third generation antibiotic. A survey was done where data related with adverse drug reactions (ADRs were collected for three months from the Department of Pediatrics of a tertiary care hospital, Kolkata, West Bengal, India and then evaluated. In the study, fifteen ADRs were detected. Ceftriaxone itself or its combinations correlated with more than thirty three percent (33.4% adverse reaction cases in this study. Most common adverse drug reactions in the present study population were different types of rashes like urticaria and maculopapular eruptions.
Shobha G Pai
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.
Full Text Available 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 analyzed by SPSS software,version 16.Results In this study, 63/9% of cases were female and 36/1% were male. 24 cases (66/7% had osmotic diarrhea and 11 (30/6% had secretory diarrhea. In this study there was no significant statistical correlation between type of diarrhea and sex, gestational Age, severity of dehydration, birth weight and nutrition. The majority of patients with osmotic (58/3% and secretory diarrhea (63/6%, had weight percentile below 3%, which showed a significant statistical difference (p value
Kumburu, Happiness Houka; Sonda, Tolbert; Mmbaga, Blandina Theophil
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...... patients admitted in the medical and surgical departments. The bacterial species were determined by conventional methods and disk diffusion was used to determine the antimicrobial susceptibility pattern of the bacteria isolates. Results A total of 249 (42.2%) specimens were culture-positive yielding...... to the commonly used antimicrobial agents. Furthermore, the bacterial spectrum differs from those often observed in high-income countries. This highlights the imperative of regular generation of data on aetiological agents and their antimicrobial susceptibility patterns especially in infectious disease endemic...
Rehman, J.U.; Shah, I.
Rheumatic Hearth Disease (RHD) is still prevalent in our country and a great source of morbidity. This study was done with an objective to determine relative frequency of different valvular lesions of RHD presenting in a tertiary care hospital. Methods: This cross sectional study was conducted at the Cardiology Department of Hayatabad Medical Complex, Peshawar. A total of 171 cases of RHD were included through consecutive sampling technique. Results: There were 64.33% females. Mean age was 25.6 ± 6.95 years ranging from 15 to 40 years. The different percentage of valvular lesions in RHD were MR (59.06%), MS (46.78%), AR (43.85%) and mixed lesions (38.59%). Conclusion: Rheumatic heart disease is a very common disease in our community and mitral regurgitation is a predominant lesion at presentation. Females are usually affected more than males. (author)
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.
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.
Hashem, Atef A; O'Connell, Brian; Nunn, June; O'Connell, Anne; Garvey, Therese; O'Sullivan, Michael
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. 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). 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. 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.
Hussain, S.; Sabir, M.U.
Objectives: To determine the incidence and pattern of various congenital heart disease in a neonatal unit of a tertiary care hospital. Methods: The prospective study was carried out in the neonatal unit of Combined Military Hospital, Rawalpindi, from September 2008 to August 2011. All 5800 neonates admitted with gestational age of >28 weeks irrespective of birthweight were included in the study. Neonatologist/Paediatrician carried out the neonatal examination during the first 12 hours of life. Neonates suspected of having congenital heart disease were further evaluated by pulse oxymetry, X-ray chest and echocardiography to ascertain final diagnosis and type of lesion. Data was collected on a predesigned proforma containing information regarding gender, mode of delivery, gestational age, weight at birth, family history, and associated malformations. SPSS 16 was used for statistical analysis. Results: Of the 5800 neonates, 87 (1.5%) were found to have congenital heart disease with an incidence of 15/1000. There was a male preponderance. Most common lesion was ventricular septal defect 27(31.3%), followed by atrial septal defect 20 (22.9%), patent ductus arteriosus 13 (14.94%), tetralogy of fallot 06 (6.89%), transposition of great arteries 04 (4.59%), Pulmonary stenosis 05 (5.79%) and 03(3.44%) had atrioventricular canal defects. Conclusion: Congenital heart disease is a common congenital anomaly. Its incidence varies from centre to centre due to different factors like nature of the sample, method of detection and early examination by a neonatologist/paediatrician. In this study a higher incidence is reported because it was carried out in a tertiary care unit, which is a referral hospital and all the neonates admitted in the unit were included in the study. (author)
Full Text Available Objective: To compare, on the basis of clinical, radiological and epidemiological aspects, all cases of tuberculosis (TB diagnosed in the tertiary healthcare services to those diagnosed at the primary healthcare providers in the municipality of Vitória-ES. Methods: Cross- sectional, retrospective study, with analysis of the SINAN’s database, to identify all cases among residents of the municipality of Vitória-ES and diagnosed with TB in 2006 and 2007. Patients were divided into two groups: cases diagnosed in Primary Health Care (PHC and those diagnosed in Tertiary Health Care (THC. For statistical analysis, it was used the software STATA CORP 9.0. Results: 338 patients were identified; 207 (61.24% of these were diagnosed in PHC and 131 (38.76% in THC. The pulmonary form was predominant in both groups. However, the extrapulmonary form presented higher frequency in the THC group. When analyzing the results of sputum smear, the positivity was found in 114 (55.07% patients of the PHC and in 57 (43.51% of THC. Regarding the positive cultures, 119 (57.48% patients diagnosed in PHC and only 38 (29% in THC tested positive. Conclusion: There is evidence of high proportion of patients with TB communicated as “new cases” in THC in the city and it was observed a predominance of the pulmonary form in both groups - PHC and THC, although the extrapulmonary form was more frequent in the latter. doi:10.5020/18061230.2013.p251
Nett, Randall J; Cummings, Kristin J; Cannon, Brenna; Cox-Ganser, Jean; Nathan, Steven D
In April 2016, a Virginia dentist who had recently received a diagnosis of idiopathic pulmonary fibrosis (IPF) and was undergoing treatment at a specialty clinic at a Virginia tertiary care center contacted CDC to report concerns that IPF had been diagnosed in multiple Virginia dentists who had sought treatment at the same specialty clinic. IPF is a chronic, progressive lung disease of unknown cause and associated with a poor prognosis (1). Although IPF has been associated with certain occupations (2), no published data exist regarding IPF in dentists. The medical records for all 894 patients treated for IPF at the Virginia tertiary care center during September 1996-June 2017 were reviewed for evidence that the patient had worked as a dentist, dental hygienist, or dental technician; among these patients, eight (0.9%) were identified as dentists and one (0.1%) as a dental technician, and each had sought treatment during 2000-2015. Seven of these nine patients had died. A questionnaire was administered to one of the living patients, who reported polishing dental appliances and preparing amalgams and impressions without respiratory protection. Substances used during these tasks contained silica, polyvinyl siloxane, alginate, and other compounds with known or potential respiratory toxicity. Although no clear etiologies for this cluster exist, occupational exposures possibly contributed. This cluster of IPF cases reinforces the need to understand further the unique occupational exposures of dental personnel and the association between these exposures and the risk for developing IPF so that appropriate strategies can be developed for the prevention of potentially harmful exposures.
Chittur Y Ranjini
Full Text Available Purpose: To identify the prevalence and microbial profile of infectious keratitis in a tertiary eye care hospital, and to test for the in vitro antimicrobial resistance of the bacterial isolates. Methods: A total of 312 patients presenting to a tertiary eye care hospital with infected corneal ulcer were enrolled in this study. Their socio-demographic data and risk factors were recorded. Corneal scrapings collected from the edge of the ulcer were processed for direct gram stain and KOH mount. Culture was recovered on blood agar, chocolate agar, MacConkey agar and Sabouraud′s dextrose (SDA agar in multiple C shaped streaks. After overnight incubation, bacterial culture was followed by standard biochemical tests and antimicrobial sensitivity according to the clinical and laboratory standards institute (CLSI guidelines. Inoculated SDA was inspected daily for up to 10 days and the growth was identified by its colony morphology, pigment production and lacto-phenol cotton blue mount examination. Results: Of 312 patients, a microbial etiology was established in 117 cases (37.5%. Of these, 72 (61.5% were male. The age range of 41-60 years was the most affected group. Of 117 positive cases, 52 (44.5% were bacterial, 58 (49.5% were fungal and 7 (6% patients showed mixed bacterial and fungal infection. The most common isolated fungus was Fusarium which was detected in 36 (31% cases, followed by Aspergillus spp in 13 (11% subjects. Staphylococcus aureus was the most common isolated bacteria. All Gram positive cocci were susceptible to vancomycin followed by gatifloxacin, whereas all Gram negative bacilli were susceptible to gatifloxacin. Conclusion: Routine microbiological examination of patients with corneal ulcer is necessary in order to analyze and compare the changing trends of the etiology and their susceptibility patterns.
Full Text Available Objective: This study was conducted to review the etiological factors and diseases associated with pediatric noncystic fibrosis bronchiectasis in a tertiary care center in Saudi Arabia. Materials and Methods: A retrospective review of all patients with confirmed noncystic fibrosis (Non-CF bronchiectasis by chest X-ray and/or CT chest in a pulmonary clinic during the period 1993-2005 at a tertiary care center in Riyadh. Results: A total of 151 cases were diagnosed as Non-CF bronchiectasis. Seventy-five (49.7% were male, 76 (50.3% were female; 148 (98% are alive and 3 (2% died. The southwestern regions constituted 72 (50% of the cases. There was a period of (5 ± 3.2 years between the start of symptoms and diagnosis of bronchiectasis. More than two-thirds of the patients had cough, tachypnea, wheezing, sputum production and failure to thrive. Ninety-one (60% had associated diseases: Pulmonary diseases in 48 (32%, immunodeficiency in 27 (18%, central nervous system anomalies in 10 (7%, cardiac in 10 (7% and asthma in 103 (68% of the patients. Left lower lobe was commonly involved in 114 (76% patients. Sixty-eight (67% were found to have sinusitis. More than two-thirds of patients had two or more associated diseases. Forty-nine (32% developed gastroesophageal reflux. Hemophilus influenza was cultured in 56 (37%, strept pneumoniae in 25 (17% and pseudomonas aeruginosa in 24 (16% of the patients. Eighty percent of the patients who had pulmonary function test had abnormal changes. Disease progression was related to development of symptoms before 5 years of age, persistent atelectasis and right lower lobe involvement ( P < 0.05. Conclusion: Non-CF bronchiectasis should be included in the differential diagnosis of recurrent chest infection in Saudi Arabia. Early diagnosis and identification of associated diseases is needed to prevent progression of the disease.
Hashem, Atef A
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.
Aslam, M; Siddiqui, A A; Sandeep, G; Madhu, S V
To find out the prevalence of obesity and glucose intolerance among nurses working in tertiary care hospital. Study was conducted in 496 apparently healthy females comprising two groups. Group B had 290 nurses and control group A had 206 age matched female subjects of general population. Detailed performa was filled which included anthropometry, systemic examination and other details. Fasting plasma glucose was done followed by oral glucose tolerance test (OGTT). Subjects with body mass index ≥23 kg/m 2 were categorized as 'overweight' and ≥25 kg/m 2 as 'obese' as per criteria for Asian Indians. Women with waist circumference of ≥80 cm were categorized as 'centrally obese'. Mean age of subjects in groups A and B was 40.45 ± 8.64 years and 40.50 ± 6.96 years respectively. Significantly higher number of nurses (80%) were overweight or obese compared to controls (59.71%,P = < .001). Similarly, central obesity was significantly higher in nurses (82.07%) compared to controls (67.96%,P = <.001). The prevalence of glucose intolerance (prediabetes and newly detected diabetes) was significantly higher in controls compared to nurses (45.63% vs 29.66%, P < .001). Every four out of five nurses working in tertiary care hospital have overweight/obesity and central obesity. Despite this they have lower rates of glucose intolerance. Copyright © 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved.
S. Gayathriedevi Sellathamby
Full Text Available BACKGROUND This study is carried out to estimate incidence of medical termination of pregnancies in a tertiary care centre, to analyse the causes of medical termination of pregnancies, to analyse the success of the methods of abortion and adoption family planning procedures in a tertiary care centre (Government Rajaji Hospital, Madurai. This may provide the baseline measures for safe abortion practices and to increase the awareness among men and women of reproductive age, the availability of safe abortion services at locality. The aim of the study is to know the incidence of medical termination of pregnancies in a tertiary level hospital, to study the causes for seeking MTP, to analyse the success of the methods of abortion and adoption of family planning methods. MATERIALS AND METHODS This study was carried out in Government Rajaji Hospital, Madurai, during the period of 12 months from September 2011- August 2012. Of 3516 patients attending the family planning OP, 496 women seek MTP. Among them, every 5 th women were selected and thus 100 cases were included in this study. Social parameters like age, education, residence, marital status, family pattern, number of living children, sex of the living children, obstetric parameters like parity, trimester of abortion, methods of abortion, causes for MTP, adoption of family planning methods, basic investigation like Hb%, BT, CT, urine albumin, RFT, blood sugar, blood grouping and typing and VCTC were included. RESULTS Induced abortions were common in women in 20-29-year age group, more in third gravid, Hindus, from rural areas, living in nuclear family, married and educated. Most of the women seek 1 st trimester abortion with underlying social cause. Majority had surgical abortion. Majority adopted transabdominal tubectomy as the concurrent family planning method. Second trimester abortions common in unmarried, uneducated women. CONCLUSION The variables analysed in this study bring into light the
Full Text Available INTRODUCTION Needle Stick Injury, a preventable problem, is a serious concern for all health care providers and workers and poses a significant risk of occupational transmission of blood borne pathogens such as HIV, HBV, HCV and some others. Relevant literature is scanty from India and none could be located from coastal Andhra Pradesh. The present study aims at determining the occurrence of Needle Stick Injuries in various categories of health workers in a tertiary care teaching hospital in coastal Andhra Pradesh, factors associated with these Needle Stick Injuries, circumstances under which they occur and the responses of the health care workers following the injury. The study also aims at assessing the awareness levels of the health care workers regarding diseases transmitted through Needle Stick Injuries. MATERIALS AND METHODS After getting the permission from the authorities of KIMS&RF and clearance from IEC of KIMS&RF, an institution based crosssectional study on health care providers involved in diagnosis and treatment of patients and the cleaning staff using predesigned and pretested questionnaire was done after seeking their consent. The data collected included basic demographics of the study subjects, professional status and work experience, history of Needle Stick Injury during the last three years while on their job and the relevant details, perceptions regarding Needle Stick Injuries, knowledge on diseases associated with it and information regarding training on Universal Work Precautions. The data was entered in Microsoft Excel worksheet and analysed statistically using Epi Info version 6 software. RESULTS Of the 353 study subjects (97 males and 256 females who answered the questionnaire, 53% reported to have experienced Needle Stick Injuries and 94% of study subjects believed it to be an important problem. About 43 % met with Needle Stick Injury more than once in the last 3 years. Only 30% reported about the injury and 31% did
Macqueen, Susy; Woodward-Kron, Robyn; Flynn, Eleanor; Reid, Katharine; Elliott, Kristine; Slade, Diana
Communication in emergency departments (EDs), often between several health professionals and patients and relatives, is a major cause of patient complaint and error; however, communication-skills teaching for medical students largely focuses on individual clinician-patient interactions. We developed and implemented an evidence-informed online resource, Communication for Health in Emergency Contexts (CHEC; http://www.chec.meu.medicine.unimelb.edu.au/resources) to raise medical students' awareness of the challenges of communication in the ED, and to provide students with communication strategies for addressing these challenges. The foundation of the CHEC resource was the findings and data from a large research project conducted at five emergency departments in Australia over the period 2006-2009. From this, we developed ED scenarios and teaching vignettes using authentic communication data. The project included a nationwide medical curriculum scoping phase, involving interviews with medical students and educators, on ED communication curriculum needs in order to inform the educational activities. The CHEC resource provides students with the opportunity to follow real-life scenarios through all stages of the ED journey, whereas insights from ED medical and nursing staff provide learning opportunities about interprofessional communication for medical students. Evaluation suggests that students find the resource useful, and that the resource has been successfully embedded in medical and junior doctor training on communication and quality and safety. The CHEC resource enhances the capacity of busy clinical educators to raise students' awareness of the communication needs of emergency health care by focusing on communication in high-stress, time-pressured settings using a web format. The CHEC resource provides students with the opportunity to follow real-life scenarios through all stages of the ED journey. © 2015 John Wiley & Sons Ltd.
Sawatzky, Jo-Ann V; Enns, Carol L; Ashcroft, Terri J; Davis, Penny L; Harder, B Nicole
Nursing education plays a central role in the ability to practice effectively. It follows that an optimally educated nursing workforce begets optimal patient care. A framework for excellence in nursing education could guide the development of novice educators, establish the basis for evaluating teaching excellence, and provide the impetus for research in this area. However, a review of the social sciences and nursing literature as well as a search for existing models for teaching excellence revealed an apparent dearth of evidence specific to excellence in nursing education. Therefore, we developed the Caring Framework for Excellence in Nursing Education. This framework evolved from a review of the generic constructs that exemplify teaching excellence: excellence in teaching practice, teaching scholarship, and teaching leadership. Nursing is grounded in the ethic of caring. Hence, caring establishes the foundation for this uniquely nursing framework. Because a teaching philosophy is intimately intertwined with one's nursing philosophy and the ethic of caring, it is also fundamental to the caring framework. Ideally, this framework will contribute to excellence in nursing education and as a consequence excellence in nursing practice and optimal patient care.
Leelavathi D Acharya
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.
Joshi, P; Nair, S; Chaturvedi, P; Nair, D; Agarwal, J P; D'Cruz, A K
Advanced oral cancers are a challenge for treatment, as they require complex procedures for excision and reconstruction. Despite being occurring at a visible site and can be detected easily, many patients present in advanced stages with large tumors. Timely intervention is important in improving survival and quality of life in these patients. The aim of the present study was to find out the causes of delay in seeking specialist care in advanced oral cancer patients. A prospective questionnaire based study was done on 201 consecutive advanced oral squamous cancer patients who underwent surgery at our hospital. All patients had either cancer of gingivobuccal complex (GBC) or tongue and had tumors of size more than 4 cm (T3/T4) and were treatment naοve at presentation. Even though most patients observed abnormal lesions in their mouth, majority delayed the decision to visit a physician early. A significant percentage of patients (50%) also reported a delayed diagnosis by the primary care physician before being referred to a tertiary care center for definitive treatment. The average total duration from symptoms to treatment was 7 months. The main reasons of this delay in receiving treatment were due to patients themselves (primary delay) or due to time taken by the primary physician to diagnose the condition (secondary delay). Oral self-examination can be helpful in detecting oral cancers early.
Full Text Available Background:Patient concerns represent opportunities for improvement in orthopaedic care. Thisstudy’s objectiveis to identify the nature and prevalence of unsolicited patient complaints regarding orthopaedic care ata tertiary referral hospital. The primary null hypothesis that there are no demographic factors associatedwith complaint types was tested. Secondarily we determined if the overall complaint number and typesdifferedby year.Methods:Complaints to the hospital ombudsperson by orthopaedic patients between January 1997 and June 2013 werereviewed. All 1118 complaints were categorized: access and availability, humaneness and disrespect, communication,expectations of care and treatment, distrust, billing and research.Results:Patients between 40 and 60 years of age filed the most complaints in all categories except distrust(more common in patients over age 80 and research. Women were slightly more likely to address access andavailability, humaneness, disrespect, and billing compared to men. The overall number of complaints peakedin 1999. The most common issue was access and availability followed by communication, and humaneness/disrespect.Conclusion:Half of concerns voiced by patients addressed interpersonal issues. The largest category was related toaccess and availability. Quality improvement efforts can address technology to improve access and availability as wellas empathy and communication strategies.
Shera, A. Samad; Basit, Abdul; Team, PROMPT
Pakistan is a developing country with limited resources and diverse socio-economic standards. Pakistan has high prevalence of diabetes and its complications, which is a great challenge to the existing health care system. National action plans for control of diabetes have been developed and initiatives have been taken but not at an ideal pace. First National Practice Guidelines for Pakistan were published in 1999. It was very helpful in standardizing the management of Type-2 diabetes. In view of important developments in the field of diabetes during the recent years, it was felt that 1999 National Clinical Practice Guidelines edited, should be revised. Also with rapidly increasing number of diabetic patients and the escalating burden on health economy, it is essential to develop a primary to secondary / tertiary care referral system. These guidelines are developed after an extensive research and cover many aspects of diabetes management. This special communication is an extract of a PROMPT document that has already been published as a Supplement in Pakistan Journal of Medical Sciences in 2017. We hope that these guidelines will help in improving the diabetes care in Pakistan. PMID:29142579
Peltier, Wendy L; Gani, Faiz; Blissitt, Jennifer; Walczak, Katherine; Opper, Kristi; Derse, Arthur R; Johnston, Fabian M
Although previous research on advance care planning (ACP) has associated ACP with improved quality of care at the end of life, the appropriate use of ACP remains limited. To evaluate the impact of a pilot program using the "Honoring Choices Wisconsin" (HCW) model for ACP in a tertiary care setting, and to understand barriers to system-wide implementation. Retrospective review of prospectively collected data. Patients who received medical or surgical oncology care at Froedtert and the Medical College of Wisconsin. Patient demographics, disease characteristics, patient satisfaction, and clinical outcomes. Data from 69 patients who died following the implementation of the HCW program were reviewed; 24 patients were enrolled in the HCW program while 45 were not. Patients enrolled in HCW were proportionally less likely to be admitted to the ICU (12.5% vs. 17.8%) and were more likely to be "do not resuscitate" (87.5% vs. 80.0%), as well as have a completed ACP (83.3% vs. 79.1%). Furthermore, admission to a hospice was also higher among patients who were enrolled in the HCW program (79.2% vs. 25.6%), with patients enrolled in HCW more likely to die in hospice (70.8% vs. 53.3%). The HCW program was favorably viewed by patients, patient caregivers, and healthcare providers. Implementation of a facilitator-based ACP care model was associated with fewer ICU admissions, and a higher use of hospice care. System-level changes are required to overcome barriers to ACP that limit patients from receiving end-of-life care in accordance with their preferences.
Evans, Jessica; Kobewka, Daniel; Thavorn, Kednapa; D'Egidio, Gianni; Rosenberg, Erin; Kyeremanteng, Kwadwo
To use theoretical modelling exercises to determine the effect of reduced intensive care unit (ICU) length of stay (LOS) on total hospital costs at a Canadian centre. We conducted a retrospective cost analysis from the perspective of one tertiary teaching hospital in Canada. Cost, demographic, clinical, and LOS data were retrieved through case-costing, patient registry, and hospital abstract systems of The Ottawa Hospital Data Warehouse for all new in-patient ward (30,483) and ICU (2,239) encounters between April 2012 and March 2013. Aggregate mean daily variable direct (VD) costs for ICU vs ward encounters were summarized by admission day number, LOS, and cost centre. The mean daily VD cost per ICU patient was $2,472 (CAD), accounting for 67.0% of total daily ICU costs per patient and $717 for patients admitted to the ward. Variable direct cost is greatest on the first day of ICU admission ($3,708), and then decreases by 39.8% to plateau by the fifth day of admission. Reducing LOS among patients with ICU stays ≥ four days could potentially result in an annual hospital cost saving of $852,146 which represents 0.3% of total in-patient hospital costs and 1.2% of ICU costs. Reducing ICU LOS has limited cost-saving potential given that ICU costs are greatest early in the course of admission, and this study does not support the notion of reducing ICU LOS as a sole cost-saving strategy.
Critical illness has a major impact on the nutritional status of both children and adults. A retrospective study was conducted to evaluate the incidence of hospital malnutrition at a pediatric tertiary intensive care unit (PICU). Serum concentrations of IL-6 in subgroups of well-nourished and malnou...
Fatima, Iram; Humayun, Ayesha; Anwar, Muhammad Imran; Iftikhar, Adil; Aslam, Muhammad; Shafiq, Muhammad
Objectives Service quality is one of the important gears to appraise services and determine the gray areas that need improvement. In countries with a resource-poor health system, the first step of measuring quality is yet to be taken. This study seeks to inform policy makers in developing contextual service quality models by identifying service quality gaps in tertiary care teaching hospitals using patients’ perspective. Methods A cross-sectional study was performed using multistage cluster sampling, and a modified version of the SERVQUAL (SERV-service, QUAL-quality) instrument was administered to determine patient’s expectations and perceptions. A total of 817 completed questionnaires were obtained from patients and/or their attendants using convenience sampling. Results Data analysis revealed statistically significant negative quality gaps between expectations and perceptions of tangibility, reliability, empathy, assurance, responsiveness, and communication. The difference in mean expectation and perception for responsiveness across the sexes was significant (p quality were independent of sex. Educational status showed significant difference in expectation and perception in responsiveness (p service quality: p service departments showed no relationship with any of the perceived or expected dimension of service quality of hospitals. Conclusions Tertiary care hospitals failed to meet patients’ expectations in all major areas of service quality, posing a question of how hospitals implement and evaluate their quality assurance policy. PMID:28804582
Steinert, Yvonne; Basi, Mandeep; Nugus, Peter
Clinical teaching lies at the heart of medical education. However, few studies have explored the embedded nature of teaching and clinical care. The goal of this study was to examine the process of clinical teaching as it naturally, and spontaneously, unfolds in a broad range of authentic contexts with medical students and residents. This focused ethnographic study consisted of 160 hours of participant observation and field interviews with three internal medicine teams. Thematic analysis guided data organization and interpretation. Three overlapping themes emerged: the interconnectedness between clinical work and pedagogy; a multiplicity of teachers; and the influence of space and artifacts on teaching and learning. Clinical teaching, which was deeply embedded in clinical care, was influenced by the acuity of patient problems, learner needs, and the context in which teaching unfolded; it also occurred on a spectrum that included planned, opportunistic, formal, and informal teaching (and learning). Study findings suggest that clinical teaching, which is marked by an intersection between service and teaching, can be viewed as an example of work-based teaching. They also yield suggestions for the enhancement of clinical teaching in inpatient settings, faculty development, and educational policies that recognize clinical teaching and learning.
S Qureshi; C Agrawal; M Madan; A Pandey; H Chauhan
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) f...
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
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
Ajay K Verma
Full Text Available Background: Noninvasive mechanical ventilation (NIMV is the delivery of positive pressure ventilation through an interface to upper airways without using the invasive airway. Use of NIMV is becoming common with the increasing recognition of its benefits. Objectives: This study was done to evaluate the feasibility and outcome of NIMV in tertiary care centres. Materials and Methods: An observational, retrospective study conducted over a period of 18 months in two tertiary level hospitals of north India on 184 consecutive patients who were treated by NIMV, regardless of the indication. NIMV was given in accordance with the arterial blood gas (ABG parameters defining respiratory failure (Type 1/Type 2. Results: The most common indication of NIMV in our hospitals was acute exacerbation of chronic obstructive pulmonary disease (AE-COPD 80.43%, and 90.54% AE-COPD patients were improved by NIMV. Application of NIMV resulted in significant improvement of pH and blood gases in COPD patients, while non-COPD patients showed significant improvement in partial pressure of oxygen (PaO 2 alone. The mean duration of NIMV was 8.35 ± 5.98 days, and patients of interstitial lung disease (ILD were on NIMV for the maximum duration (17 ± 8.48 days. None of the patients of acute respiratory distress syndrome were cured by NIMV; 13.04% patients on NIMV required intubation and mechanical ventilation. Conclusion: This study demonstrates and encourages the use of NIMV as the first-line ventilatory treatment in AE-COPD patients with respiratory failure. It also supports NIMV usage in other causes of respiratory failure as a promising step toward prevention of mechanical ventilation.
Verma, Ajay K; Mishra, Mayank; Kant, Surya; Kumar, Anand; Verma, Sushil K; Chaudhri, Sudhir; Prabhuram, J
Noninvasive mechanical ventilation (NIMV) is the delivery of positive pressure ventilation through an interface to upper airways without using the invasive airway. Use of NIMV is becoming common with the increasing recognition of its benefits. This study was done to evaluate the feasibility and outcome of NIMV in tertiary care centres. An observational, retrospective study conducted over a period of 18 months in two tertiary level hospitals of north India on 184 consecutive patients who were treated by NIMV, regardless of the indication. NIMV was given in accordance with the arterial blood gas (ABG) parameters defining respiratory failure (Type 1/Type 2). The most common indication of NIMV in our hospitals was acute exacerbation of chronic obstructive pulmonary disease (AE-COPD 80.43%), and 90.54% AE-COPD patients were improved by NIMV. Application of NIMV resulted in significant improvement of pH and blood gases in COPD patients, while non-COPD patients showed significant improvement in partial pressure of oxygen (PaO2) alone. The mean duration of NIMV was 8.35 ± 5.98 days, and patients of interstitial lung disease (ILD) were on NIMV for the maximum duration (17 ± 8.48 days). None of the patients of acute respiratory distress syndrome were cured by NIMV; 13.04% patients on NIMV required intubation and mechanical ventilation. This study demonstrates and encourages the use of NIMV as the first-line ventilatory treatment in AE-COPD patients with respiratory failure. It also supports NIMV usage in other causes of respiratory failure as a promising step toward prevention of mechanical ventilation.
Phalke, Vaishali D; Phalke, Deepak B; Syed, M M Aarif; Mishra, Anjeney; Sikchi, Saudamini; Kalakoti, Piyush
Prescription is a written order from physician to pharmacist which contains name of drug, its dose and its method of dispensing and advice over consuming it. The frequency of drug prescription errors is high. Prescribing error contributes significantly towards adverse drug events. The present study was undertaken to understand the current prescription writing practices and to detect the common errors in them at a tertiary health care centre situated in a rural area of Western Maharashtra, India. A cross sectional study was conducted at a tertiary level hospital located at a rural area of Maharashtra state, India during October 2009-March 2010. 499 prescriptions coming to medical store during period of one month were considered for data analysis. Important information regarding the patient, doctor, drug and the general description of the prescription were obtained. All the prescriptions were on the hospital pad. A significant number of the prescriptions (n=88, 17.6%) were written in illegible handwriting and not easily readable. The name, age and sex of the patient were mentioned is majority of the prescriptions. All the prescriptions (100%) failed to demonstrate the presence of address, height and weight of the patient. Only the brand name of the drugs was mentioned in all the prescriptions with none of them having the generic name. The strength, quantity and route of administration of the drug were found on 73.1%, 65.3% and 75.2% prescriptions. There are widespread errors in prescription writing by the doctors. Educational intervention programs and use of computer can substantially contribute in the lowering of such errors. A short course on prescription writing before the medical student enters the clinical field and strict monitoring by the administrative authorities may also help alleviate the problem.
Vaishali D Phalke
Full Text Available BackgroundPrescription is a written order from physician to pharmacistwhich contains name of drug, its dose and its method ofdispensing and advice over consuming it. The frequency ofdrug prescription errors is high. Prescribing errorcontributes significantly towards adverse drug events. Thepresent study was undertaken to understand the currentprescription writing practices and to detect the commonerrors in them at a tertiary health care centre situated in arural area of Western Maharashtra, India.MethodA cross sectional study was conducted at a tertiary levelhospital located at a rural area of Maharashtra state, Indiaduring October 2009-March 2010. 499 prescriptions comingto medical store during period of one month wereconsidered for data analysis. Important informationregarding the patient, doctor, drug and the generaldescription of the prescription were obtained.ResultsAll the prescriptions were on the hospital pad. A significantnumber of the prescriptions (n=88, 17.6% were written inillegible handwriting and not easily readable. The name, ageand sex of the patient were mentioned is majority of theprescriptions. All the prescriptions (100% failed todemonstrate the presence of address, height and weight ofthe patient. Only the brand name of the drugs wasmentioned in all the prescriptions with none of them havingthe generic name. The strength, quantity and route ofadministration of the drug were found on 73.1%, 65.3% and75.2% prescriptions.ConclusionThere are widespread errors in prescription writing by thedoctors. Educational intervention programs and use ofcomputer can substantially contribute in the lowering ofsuch errors. A short course on prescription writing beforethe medical student enters the clinical field and strictmonitoring by the administrative authorities may also helpalleviate the problem.Word count: 2980Tables: 2
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
Full Text Available BACKGROUND : Poisoning with various substances is an important cause of death and disability worldwide . The types of poisons that are encountered in the emergency medicine departments encompass a wide range of substances . Apparently , geographic location , socio - demographic factors , ease of availability of poisons and many other cryptic factors contribute to the wide spectrum of substances that cause poisoning . Pesticides , drugs and chemicals are reported to be the most commo nly used poisons in India . Management of poisoning is quite challenging for the health care professionals globally . Factors such as the uncertainty in the identification of allegedly consumed poison , varied clinical features and the need for timely access to specific information for treatment , complicates poisoning management . This study was therefore conducted to explore the clinical features , management and outcomes of poisoning cases reporting to a tertiary care centre in south India . OBJECTIVE : To ident ify the spectrum of poisons and evaluate their clinical manifestations , medical management and clinical outcomes . METHODOLOGY : All cases of poisoning that were reported at a tertiary care hospital in South India for a period of 18 months from January 1 , 20 13 to June 30 , 2014 were included in this study . A data abstraction sheet was designed to document demographic details ( age and gender , poison consumed , duration of stay in the hospital , clinical features , treatment administered , need for life support and patient outcomes . RESULTS : A total of 145 poisoning cases were reported during the study period . Among them , 58 . 5% were males and 41 . 3% were females . Majority of victims were in the age group of 21 - 30 years . Intentional poisoning was observed in 86 . 2% , whereas the rest were accidental poisonings . Organophosphorus ( OP poisoning was the most common poisoning encountered in this study . It accounted for 25 . 5% of the total
Full Text Available Increasingly, Lesbian, Gay, Bisexual, and Transgender (LGBT health care is becoming an important quality assurance feature of primary, secondary and tertiary healthcare in Britain. While acknowledging these very positive developments, teaching LGBT curricula content is contingent upon having educators understand the complexity of LGBT lives. The study adopted a qualitative mixed method approach. The study investigated how and in what ways barriers and facilitators of providing LGBT medical, health and social care curricula content figure in the accreditation policies and within undergraduate and postgraduate medical and healthcare teaching. This paper illustrates opposing views about curricula inclusion. The evidence presented suggests that LGBT content teaching is often challenged at various points in its delivery. In this respect, we will focus on a number of resistances that sometimes prevents teachers from engaging with and providing the complexities of LGBT curricula content. These include the lack of collegiate, colleague and student cooperation. By investing some time on these often neglected areas of resistance, the difficulties and good practice met by educators will be explored. This focus will make visible how to support medical, health and social care students become aware and confident in tackling contemporaneous health issues for LGBT patients.
Eleje, George U; Onwusulu, Daniel N; Ezeama, Chukwuemeka O; Afiadigwe, Evaristus A; Eke, Ahizechukwu C; Ikechebelu, Joseph I; Ugboaja, Joseph O; Okwuosa, Ayodele O
To determine women's perceptions and expectations of focused prenatal care visits. The present questionnaire-based, cross-sectional survey was performed among pregnant women in their third trimester attending two tertiary health centers in southern Nigeria between January and March 2012. Obstetric data, histories, and information on preferences for prenatal visits were obtained using questionnaires. A total of 353 questionnaires were appropriately completed. Among 277 participants who stated a preference for the number of prenatal care visits, 241 (87.0%) reported a preference of more than four. Among 203 parous women, 132 (65.0%) had no previous negative obstetric experience. Only previous stillbirth (odds ratio [OR] 2.67, 95% confidence interval [CI] 1.05-6.77; P = 0.039) among multiparous women, and HIV/AIDS (OR 0.27, 95% CI 0.06-1.17; P = 0.048) among all women were significantly associated with a preference for more prenatal visits. Previous negative obstetric experiences did not generally affect preference for prenatal visits. However, pregnant women expressed dissatisfaction with a reduced number of visits. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
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.
Sabzghabaee, Ali Mohammad; Yaraghi, Ahmad; Khalilidehkordi, Elham; Mirhosseini, Seyyed Mohammad Mahdy; Beheshtian, Elham; Eizadi-Mood, Nastaran
Introduction. This study was conducted to evaluate and document the frequency and causes of agitation, the symptoms accompanying this condition in intoxications, relationship between agitation score on admission and different variables, and the outcome of therapy in a tertiary care referral poisoning center in Iran. Methods. In this prospective observational study which was done in 2012, 3010 patients were screened for agitation at the time of admission using the Richmond Agitation Sedation Scale. Demographic data including age, gender, and the drug ingested were also recorded. The patients' outcome was categorized as recovery without complications, recovery with complications (hyperthermia, renal failure, and other causes), and death. Results. Agitation was observed in 56 patients (males, n = 41), mostly aged 19-40 years (n = 38) and more frequently in illegal substance (stimulants, opioids and also alcohol) abusers. Agitation score was not significantly related to the age, gender, and previous history of psychiatric disorders. Forty nine patients had recovery without any complication. The need for mechanical ventilation was the most frequent complication. None of the patients died. Conclusion. Drug abuse seems to be a must-to-consider etiology for patients presenting with acute agitation and its morbidity and mortality could be low in agitated poisoning cases if prompt supportive care is performed.
Full Text Available Background: Hearing impairment has a devastating, detrimental and an invariably adverse impact on the development of the newborns and the psychological well-being of their families. It also adversely affects development of the central auditory nervous system, and can affect speech perception that interferes with growth in social, emotional, behavioural and cognitive spheres, academic achievement, vocational options, employment opportunities and economic selfsufficiency. Objectives: To find out incidence of hearing impairment in high risk neonates in Neonatal Intensive Care Unit (NICU, prevalence of hearing impairment with and without high risk factors in newborns and to correlate the risk factors with hearing impairment. Material and Methods: A cohort study was carried out at a tertiary care hospital of Surat, Gujarat, India consisting of 190 normal newborns and 163 newborns with high risk factors. These newborns underwent a systematized Transient Otoacoustic Emissions Examination (TOAE and Brain Stem Evoked Audiometry (BERA examination according to designed protocol and were followed up with repeated ear examinations. Data were recorded and analyzed statistically. Results: The incidence of hearing impairment in NICU, newborns were 3.6% and the prevalence of hearing impairment was 13%. Hearing impairment was statistically significant in newborns with high risk factors such as low birth weight, preterms 5 days when compared to normal newborns. Conclusion: Presence of risk factors in newborns predisposes them to hearing impairment more as compared to normal newborns and the more the number of risk factors they are exposed to, the more will be the chances of hearing impairment.
Mythri, H; Kashinath, Kr
Patients in Intensive Care Units (ICUs) are a significant subgroup of all hospitalized patients, accounting for about a quarter of all hospital infections. The aim was to study, the current status of nosocomial infection, rate of infection and distribution of infection among patients admitted in Medical Intensive Care Unit (MICU) of a District Hospital. Data were collected retrospectively from 130 patient's records presented with symptoms of nosocomial infection in MICU of a Tertiary Health Center, Tumkur from August 2012 to May 2013. Descriptive statistics using percentage was calculated. Incidence of nosocomial infections in MICU patients was 17.7% (23/130). Of which 34.8% (8/130) was urinary tract infection (UTI) being the most frequent; followed by pneumonia 21.7% (5/130), 17.4% (4/130) surgical site infection, 13.0% (3/130) gastroenteritis, 13.0% (3/130) blood stream infection and meningitis. The nosocomial infection was seen more in the 40-60 year of age. The male were more prone to nosocomial infections than the female. The most frequent nosocomial infections (urinary, respiratory, and surgical site) were common in geriatric patients in the MICU setting and are associated with the use of invasive device. Large-scale studies are needed to be carried out in Indian population to plan long-term strategies for prevention and management of nosocomial infections.
Mancini, Alessio; Verdini, Daniele; La Vigna, Giorgio; Recanatini, Claudia; Lombardi, Francesca Elena; Barocci, Simone
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%).
Arinzechukwu Nkemdirim Okere
Full Text Available Objective: The primary objective of this case study was to evaluate the impact of a medication reconciliation service (MRS provided by student pharmacists in an emergency department (ED. Methods: Eligible patients were assigned to two groups, MRS or non-MRS. Patients in the MRS group were seen by student pharmacists while the non-MRS group followed usual care. As part of the services provided by the student pharmacists, medication reconciliation was provided under the supervision of a clinical pharmacist. At the conclusion of their ED visit, patients were asked to complete a survey addressing knowledge of medications, confidence in medication taking and patient satisfaction. To evaluate the impact of provision of MRS by student pharmacists on readmission rates in the ED, the electronic health records of the institution were queried for subsequent inpatient hospitalizations and ED visits. Results: Based on the study, patients in MRS group were more likely to be satisfied with the education provided to them in the ED (p=0.016 and had greater confidence in taking their medications (p=0.03. Sixty days post ED visit MRS group readmissions were significantly lower compared to non-MRS group (P= 0.047. Conclusions: Students' participation in the provision of medication reconciliation led to reduction of readmission in the tertiary care ED, improved patient satisfaction and confidence in medication use. Type: Case Study
Michael Swanoski, PharmD
Full Text Available Objective: The primary objective of this case study was to evaluate the impact of a medication reconciliation service (MRS provided by student pharmacists in an emergency department (ED.Methods: Eligible patients were assigned to two groups, MRS or non-MRS. Patients in the MRS group were seen by student pharmacists while the non-MRS group followed usual care. As part of the services provided by the student pharmacists, medication reconciliation was provided under the supervision of a clinical pharmacist. At the conclusion of their ED visit, patients were asked to complete a survey addressing knowledge of medications, confidence in medication taking and patient satisfaction. To evaluate the impact of provision of MRS by student pharmacists on readmission rates in the ED, the electronic health records of the institution were queried for subsequent inpatient hospitalizations and ED visits.Results: Based on the study, patients in MRS group were more likely to be satisfied with the education provided to them in the ED (p=0.016 and had greater confidence in taking their medications (p=0.03. Sixty days post ED visit MRS group readmissions were significantly lower compared to non-MRS group (P= 0.047.Conclusions: Students’ participation in the provision of medication reconciliation led to reduction of readmission in the tertiary care ED, improved patient satisfaction and confidence in medication use.
Noman, F.; Usmani, B.; Imtiaz, A.; Mahmood, F.
Objective: To find out common risk factors in patients from whose samples Multi-Drug Resistant pathogens were isolated. Study Design Prospective observational study. Setting: Microbiology department of Liaquat National Hospital Karachi, a 750-bedded tertiary care Hospital. Material and Method All multi-drug resistant pathogens (resistant to representative antibiotics of at least three different classes of antimicrobial agents including carbapenems) isolated from samples like blood, bronchial wash, sputum, pus, etc, received from different units of hospital at Microbiology laboratory Liaquat National Hospital from December 2006 through February 2007 were included in this study. Patient information was collected from their personal file and through concerned treating physicians. Results and Conclusion A total of 228 MDR pathogens were isolated from different samples in 3 months, these included: Acinetobacter spp 184 (81 %) and Pseudomonas aeruginosa 44 (19%). Majority were from lower respiratory tract specimen, followed by blood. Most (86%) patients were in intensive care unit or high dependency unit. Mechanical ventilation was predominant finding in patients with Acinetobacter spp while surgical procedures were more frequently associated with Pseudomonas aeruginosa. Only 3% of Acinetobacter spp and 7 % of Pseudomonas aeruginosa were isolated during first 48 hours of hospital stay. (author)
Chin, Joyce; Young, Alvin L; Hui, Mamie; Jhanji, Vishal
To review clinical presentation, investigation results and treatment outcomes of patients with Acanthamoeba keratitis (AK) at a tertiary eye care center in Hong Kong. A retrospective case review was performed for cases of Acanthamoeba keratitis diagnosed at the Prince of Wales Hospital, Hong Kong over a 10-year period. Fifteen eyes of 13 patients were treated for AK over the study period. 12 out of 13 patients (92.3%) were contact lens wearers. All patients presented with blurred vision and pain, while 9 patients (69.2%) presented with redness of the affected eye. The most common ocular sign was diffuse corneal haze or ground glass appearance of the cornea (69.2%) followed by anterior chamber inflammation (53.8%), ring infiltrate (38.4%), epithelial defect (38.4%), perineural infiltrates (30.7%) and satellite lesions (15.3%). Acanthamoeba was detected on corneal scrapings in 4 eyes and on confocal microscopy in 4 eyes. The mean duration of treatment was 140 ± 50.8 days. Surgical intervention was required in two cases due to uncontrolled eye infection and progressive corneal thinning. All patients had improvement in visual acuity after treatment. Patients with AK exhibited a wide spectrum of clinical characteristics. Improper care and usage of contact lenses is a major risk factor for Acanthamoeba keratitis. Diagnosis of AK remained a challenge. Timely diagnosis and appropriate treatment with amoebicidal drugs can improve the outcomes of Acanthamoeba keratitis. Copyright © 2014 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.
Haider, Nighat; Shaikh, Abdul Sattar; Wazir, Rehana; Atiq, Mehnaz
Myocarditis is an inflammatory disorder of myocardium associated with high mortality and morbidity. It is often difficult to diagnose because it can either be asymptomatic or mimic other illnesses. This study is conducted to evaluate clinicodemographic features and outcome of acute myocarditis in children admitted at a tertiary care hospital. Medical records of all children aged 1month to 16years who were admitted between 2005 and 2013 at Aga Khan University Hospital, Karachi and discharged with a diagnosis of myocarditis were reviewed retrospectively. Clinical and demographic features, management and outcome were recorded. Records of a total of 62 patients with the diagnosis of myocarditis were reviewed retrospectively between 2005 and 2013. Median age of patients was 12.5months with 28 (45%) females and 34 (55%) males. The main presenting complaint observed was irritability (73%) and least common symptom was abdominal pain (23%) while the most frequently occurring examination finding was tachycardia (90%). Length of the hospital stay was 8±4.7days with 21 (34%) admissions in the ward and 41 (66%) in intensive care unit. The most frequent presentation in our study was irritability, followed by difficulty in breathing while the least common symptom was abdominal pain. Tachycardia was the commonest clinical sign observed so it is important to look for heart rate and rhythm in a sick child with irritability. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Sadaf, N.; Haq, G.; Din, S.S.U.
Objective: To determine maternal and foetal outcome in patients of Haemolysis, Elevated Liver enzyme and Low Platelet Cont syndrome. Methods: The descriptive case series was conducted at the Gynae Unit II of Civil Hospital, Karachi, over a period of 12 months in two episodes; first from December 28, 2006, to February 28, 2007, and then from September 1, 2007, to June 30, 2008. It comprised 40 consecutive women with pre-ecampsia and eclampsia along with altered platelet count who met the syndrome criteria. A pre-designed proforma was administered for data collection. Maternal and foetal outcomes were noted. SPSS 10 was used for statistical analysis. Result: Among the 40 mothers, cesarean section was the most common outcome (n=24; 60%). Pulmonary oedema was found in 2 (5%) cases, acute renal failure in 10 (25%), disseminated intravascular coagulation in 6 (15%), and abruptio placenta in 5 (12.5%). Intrauterine growth restriction as a foetal outcome was observed in 18 (45%) cases. Pre-term birth was the result in 20 (50%) cases, and perinatal mortality was high (n=23; 57.5%). Conclusion: Management and delivery of HELLP syndrome patients should be performed at tertiary care centres, where highly trained obstetrician, neonatal intensive care unit personnel and Multi-disciplinary facilities are available. Correct diagnosis and timely intervention can decrease the risk of maternal and perinatal mortality. (author)
Background. The objective of this study was to investigate levels of foot care knowledge among patients attending the diabetes clinic at Pretoria Academic Hospital by comparing the knowledge of patients with 'at risk' feet (ARF) to those with 'normal/not at risk' feet (NARF) and so assess whether the education effort by the ...
Tariq, Muhammad; Saleem, Taimur; Ullah, Hamid; Mehraj, Vikram; Samdani, Abdul Jawwad; Kazmi, Syeda Hena; Ayaz, Syed Imran; Riaz, Mehmood; Patel, Mohammed Junaid; Akhtar, Jaweed; Beg, Mohammed Asim
To compare the clinical outcomes of a loading dose regimen of quinine with a uniform dose regimen in patients with severe falciparum malaria. A retrospective chart review of 315 patients admitted with severe falciparum malaria and treated with quinine at a tertiary care teaching hospital of Karachi, Pakistan during 1999-2006 was conducted. Group A with 103 patients (32.7%) was given an initial loading dose of quinine while group B with 212 patients (67.3%) did not receive the loading dose. The two groups were compared in terms of reduction of parasite load, resolution of fever, recovery of consciousness and incidence of adverse effects. Outcome parameters were measured on the third day of therapy. More individuals in group A (62.1%) were afebrile as compared to group B (54.7%) at day 3 of therapy. Patients in group B showed greater reduction in parasitaemia (47.2% at baseline to 4.7% on day 3) as compared to group A (56.3 % at baseline to 9.7% on day 3). Following therapy, fewer patients in group B had altered consciousness (7.1% at baseline to 4.7% on day 3) as compared to patients in group A (7.8% at baseline to 5.8% on day 3). However, these associations were not statistically significant. The incidence of thrombocytopenia was higher in Group A (5.8%) as compared to Group B (0.9%). Although quinine loading dose may be more effective than uniform dose in rapid fever clearance; it also appears to be associated with higher toxicity. Uniform dose of quinine may be prescribed in severe falciparum malaria in view of its better safety profile.
Full Text Available Background. Medical emergency teams (METs or rapid response teams (RRTs facilitate early intervention for clinically deteriorating hospitalized patients. In healthcare systems where financial resources and intensivist availability are limited, the establishment of such teams can prove challenging. Objectives. A low-cost, ward-based response system was implemented on a medical clinical teaching unit in a Montreal tertiary care hospital. A prospective before/after study was undertaken to examine the system’s impact on time to intervention, code blue rates, and ICU transfer rates. Results. Ninety-five calls were placed for 82 patients. Median time from patient decompensation to intervention was 5 min (IQR 1–10, compared to 3.4 hours (IQR 0.6–12.4 before system implementation (p<0.001. Total number of ICU admissions from the CTU was reduced from 4.8/1000 patient days (±2.2 before intervention to 3.3/1000 patient days (±1.4 after intervention (IRR: 0.82, p=0.04 (CI 95%: 0.69–0.99. CTU code blue rates decreased from 2.2/1000 patient days (±1.6 before intervention to 1.2/1000 patient days (±1.3 after intervention (IRR: 0.51, p=0.02 (CI 95%: 0.30–0.89. Conclusion. Our local ward-based response system achieved a significant reduction in the time of patient decompensation to initial intervention, in CTU code blue rates, and in CTU to ICU transfers without necessitating additional usage of financial or human resources.
Full Text Available Parents play a pivotal role in upbringing a child and shaping their future. However, children of alcoholics (COAs suffer due to their parent′s dependence pattern. The various domains affected encompass cognitive, behavioural, psychological, emotional and social spheres. This study was designed to assess the impact of alcohol dependence in the parent on the development and behavior of their children, so that further steps could be taken to minimize the negative influences. Aims: To study the impact of parental alcohol dependence on the development and behaviour outcome of children in various domains, alongwith the effect of the family environment. Materials and Methods: The study was a cross-sectional observational study conducted at a tertiary care teaching hospital on 25 children between 6 and 18 years of age, whose atleast one parent was diagnosed as alcohol dependant. The other parent was assessed using a general health questionnaire-28. Child behaviour checklist and family evaluation scale (FES were then applied. Statistical Analysis Used: The analysis was done according the manuals provided with the respective scales to calculate the score. Results: Both male and female COAs had high externalizing and internalizing scores. The girls have higher internalizing scores while the boys of such parents have higher externalizing scores. The FES showed dysfunction in all the three dimensions, namely the relationship, personal growth and the system maintenance. Conclusions: Our study corroborates the findings of the studies done in the past on COAs. The COAs face various affective, anxiety, somatic, attention deficit/hyperactivity, oppositional defiant conduct problems.
Lo, Clement; Ilic, Dragan; Teede, Helena; Fulcher, Greg; Gallagher, Martin; Kerr, Peter G; Murphy, Kerry; Polkinghorne, Kevan; Russell, Grant; Usherwood, Timothy; Walker, Rowan; Zoungas, Sophia
Health-care for co-morbid diabetes and chronic kidney disease (CKD) is often sub-optimal. To improve health-care, we explored the perspectives of general practitioners (GPs) and tertiary health-care professionals concerning key factors influencing health-care of diabetes and CKD. A total of 65 health professionals were purposively sampled from Australia's 2 largest cities to participate in focus groups and semi-structured interviews. Four focus groups were conducted with GPs who referred to 4 tertiary health services in Australia's 2 largest cities, with 6 focus groups conducted with tertiary health-care professionals from the 4 tertiary health services. An additional 8 semi-structured interviews were performed with specialist physicians who were heads of diabetes and renal units. All discussions were facilitated by the same researcher, with discussions digitally recorded and transcribed verbatim. All qualitative data was thematically analysed independently by 2 researchers. Both GPs and tertiary health-care professionals emphasised the importance of primary care and that optimal health-care was an inter-play between patient self-management and primary health-care, with specialist tertiary health-care support. Patient self-management, access to specialty care, coordination of care and a preventive approach were identified as key factors that influence healthcare and require improvement. Both groups suggested that an integrated specialist diabetes-kidney service could improve care. Unit heads emphasised the importance of quality improvement activities. GPs and tertiary health-care professionals emphasised the importance of patient self-management and primary care involvement in the health-care of diabetes and CKD. Supporting GPs with an accessible, multidisciplinary diabetes-renal health service underpinned by strong communication pathways, a preventive approach and quality improvement activities, may improve health-care and patient outcomes in co-morbid diabetes
Amol Chandrakant Deshmukh
Full Text Available BACKGROUND Hypertension, a common clinical problem is considered as an ‘iceberg disease’ because its unknown morbidity far exceeds the known morbidity. In terms of attributable deaths, it is one of the leading behavioural and physiological risk factors amounting to 13% of global deaths. Drug selection is based on efficacy in lowering BP (blood pressure and in reducing Cardiovascular (CV endpoints like stroke, myocardial infarction and heart failure. This study was carried out to evaluate the pattern, extent, rationality and frequency of the use of antihypertensive drugs in the treatment of hypertension. The aim of the study is to analyse drug utilisation in the treatment of hypertension in a tertiary care hospital. MATERIALS AND METHODS This study was conducted during January 2014 to December 2015 in Medicine OPD (Outpatient Department in a tertiary care hospital. The sample size was selected as per the WHO recommendations on conducting Drug Utilisation Studies (DUS. Statistical Analysis- The collected data was numerically coded and entered in Microsoft Excel 2007 and analysed by SPSS version 16. Settings and Design- Prospective, cross-sectional, observational study. RESULTS Out of 612 patients, 262 (42.81% were in the age group of 60 and above. Considering gender distribution, 328 (53.59% were males and 284 (46.41% were females. Of these, 274 (44.78% were prescribed monotherapy, 256 (41.83% were prescribed two-drug therapy, 72 (11.76% were prescribed three-drug therapy and 10 (1.63% were prescribed four-drug therapy. Among 274 (44.78% patients prescribed with monotherapy, 112 (40.87% were prescribed with CCB (calcium channel blocker, 76 (27.73% were given BB (B-blocker, 45 (16.42% were prescribed ACEI (angiotensin converting enzyme inhibitor, 35 (12.77% were prescribed with ARB (angiotensin receptor blocker and 6 (2.18% were prescribed with Diuretics (D. Of the total antihypertensive drugs prescribed, 68.30% were prescribed by generic name
Koshy, Jacob; John, M Joseph; Thomas, Satish; Kaur, Gurvinder; Batra, Nitin; Xavier, Wilson J
Screening for ocular manifestations of leukemia, although not a routine practice, is important as they may antedate systemic disease or form an isolated focus of its relapse. This study evaluates the spectrum of ocular manifestations in acute and chronic leukemias presenting to a tertiary care center in India. Subjects of leukemia presenting to a tertiary care center in India. A prospective, cross-sectional study looking at the spectrum of ocular manifestations in all inpatients of acute or chronic leukemia. The collected data were analyzed using the Statistical Package for Social Sciences for Windows software, version 16 (SPSS Inc., Chicago, Illinois, USA). The study subjects (n = 96) comprised 61 males and 35 females whose age ranged from 18 months to 91 years (mean = 39.73, ±22.1). There were 79 adults and 17 children, 53 new and 43 existing patients, 68 acute and 28 chronic, 61 myeloid and 35 lymphoid patients. Ocular lesions were found in 42 patients (43.8%). The ocular manifestations of leukemia were significantly (P = 0.01467) more frequent in acute 35/68 (51.9%) than chronic 7/28 (25%) leukemias. Primary or direct leukemic infiltration was seen in 8 (8.3%) subjects while secondary or indirect involvement due to anemia, thrombocytopenia, hyperviscosity, total body irradiation, and immunosuppression were seen in 42 (43.8%) subjects. Ocular changes were present in 37/79 (46.8%) adults and 5/17 (29.4%) children (P = 0.09460). Twenty-eight males (28/61) 45.9% and 14/35 (40%) females had ocular manifestations (P = 0.2874). The ocular manifestations were significantly (P = 0.01158) more frequent in myeloid leukemias 32/61 (52.9%) than lymphoid leukemias 10/35 (28.6%). Leukemic ophthalmic lesions were found in 42/96 (43.8%) patients. Ocular involvement is more often seen in adults, acute and myeloid leukemias. All the primary leukemic manifestations were seen in males. A periodic ophthalmic examination should be mandatory for all leukemic patients, as ocular
Full Text Available BACKGROUND Needlestick Injury (NSI is a major occupational health and safety issue among Healthcare Workers (HCWs. In India, incidence of NSI is high, but surveillance is poor with scarce authentic data. The aim of the study is to determine the occurrence of NSI, its associated factors and assessment of knowledge and practice of preventive measures and post exposure prophylaxis among HCWs in a tertiary care hospital in Kerala. MATERIALS AND METHODS A cross-sectional study was conducted among 515 HCWs who included doctors, house surgeons, final year medical students, nurses, student nurses and lab technicians of a government sector tertiary care hospital in Kerala. All HCWs of the institution present during the study time were included and only those unwilling to participate excluded. Ethical clearance and administrative permission was obtained along with informed consent from subjects after ensuring confidentiality. Content validated, structured questionnaire consisting of questions regarding demographic data, incidence and prevalence of needlestick injury, circumstances leading to it, response of subjects to NSI and knowledge of study subjects on post exposure prophylaxis was administered to the study subjects. The technique of data collection was self-reporting by the study subjects. Data collected was analysed using statistical software Epi Info 7. RESULTS Overall, 55.7% HCWs had sustained at least one NSI in this hospital, while 35% of them had a NSI during the current year. NSIs were sustained during blood withdrawal (34%, injections (20.5%, suturing (20.2% and cannula insertion (12%. Recapping the needle (26% was the most frequent cause followed by collision with others (24%, manipulation of needle in patient (23% and during/in transit to disposal (10%. Majority (84% did not report the incident, 8.4% underwent post exposure follow up, 82% of the HCWs were fully hepatitis B vaccinated, 44% had received training, 62% used gloves, 49
Dadhwal, Vatsla; Sharma, Aparna; Khoiwal, Kavita; Deka, Dipika; Sarkar, Plaboni; Vanamail, P
There is conflicting data on the effect of HIV infection as well as antiretroviral therapy (ART) on pregnancy outcome. The objectives of this study were to compare pregnancy outcomes in women with and without HIV infection, and to evaluate the effect of HAART on pregnancy in HIV-infected women. This is a prospective case record analysis of 212 HIV-infected women delivering between 2002 and 2015, in a tertiary health care center in India. The pregnancy outcome in HIV-infected women was compared to 238 HIV-uninfected controls. Women received ART for prevention of mother to child transmission as per protocol which varied during the period of study. Effect of use of ART on preterm birth (PTB) and intrauterine growth restriction (IUGR) was analyzed. HIV-infected women were more likely to have PTB, IUGR, and anemia (9.4%, 9.9%, 5.2%) compared to uninfected women (7.6%, 5%, 3.8%), this did not reach statistical significance (P-value = >0.05). The incidence of PIH, diabetes mellitus and intrahepatic cholestasis of pregnancy was similar in both groups. Mean birth weight was significantly lower in neonates of HIV-infected women (2593.60±499g) than HIV-uninfected women (2919±459g) [P-value=0.001]. neonatal intensive care unit admissions were also significantly higher in infants born to HIV-infected women (P-value=0.002). HIV-infected women on ART had decreased incidence of PTB and IUGR. Good antenatal care and multidisciplinary team approach can optimize pregnancy outcomes in HIV-infected women.
Agarwal, Rachna; Chhillar, Neelam; Tripathi, Chandra B
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.
Full Text Available ABSTRACT Objective To determine rates of retention, antiretroviral therapy (ART use, and viral suppression in an adult cohort from a public tertiary referral hospital in the city of Buenos Aires, Argentina. Methods HIV-positive ART-naïve patients ≥ 18 years old starting care 2011-2013 contributed data until the end of 2014. Three outcomes were assessed in 2014: retention in care, ART use, and viral suppression. Patient characteristics associated with each outcome were assessed through logistic regression. Results A total of 1 031 patients were included. By the end of 2014, 1.5% had died and 14.8% were transferred to a different center. Of the remaining 859 patients, 563 (65.5% were retained in 2014. Among those retained, 459 (81.5% were on ART in 2014. Of those 459 on ART, 270 (58.8% were virologically suppressed. Younger age was associated with lower retention (OR (odds ratio: 0.67; 95% CI (confidence interval: 0.44-0.92 for ≥ 35 vs. < 35 years, but unrelated with ART use or viral suppression. Low CD4 count at first visit was associated with ART use (OR: 35.72 for CD4 < 200, 7.13 for CD4 200-499 vs. ≥ 500, P < 0.001 and with virologic suppression (OR: 2.17 for CD4 < 200, 2.46 for CD4 200-499 vs. ≥ 500, P: 0.023. Conclusions Our hospital in Buenos Aires is still below the recommended 90-90-90 targets of the Joint United Nations Programme on HIV/AIDS (UNAIDS for ART use and viral suppression. We found a major gap in retention in care. Identifying younger age as being associated with worse retention will help in the design of targeted interventions.
Avelino, Melissa Gomes Ameloti
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.
Jibril O. Abdulmalik
Full Text Available There is limited availability of mental health services in Nigeria, and indeed most of Africa. Available services are also often under-utilized because of widespread ignorance and supernatural beliefs about the etiology of mental illnesses. The consequence, therefore, is a long and tedious pathway to care for the mentally ill, especially children and adolescents. This was a study of all new patients, aged 18 years and below, presenting over a 6 month period in 2009 (January – June at the outpatient clinic of a tertiary psychiatric facility in northern Nigeria. A socio-demographic questionnaire was utilized, along with a record of the clinician’s assessment of diagnosis for 242 patients. Subjects who had been withdrawn from school, or any previously engaged-in activity for longer than 4 weeks on account of the illness, were recorded as having disability from the illness. The children were aged 1-18 years (mean=12.3; SD=5.2 with males accounting for 51.7% (125 while 14.5% of the females (n=117 were married. Two thirds (64.5% of the patients had been ill for longer than 6 months prior to presentation. One hundred and forty four subjects (59.5% had received no care at all, while 36.4% had received treatment from traditional/religious healers prior to presentation. The most disabling conditions were ADHD (80%, mental retardation (77.8%, epilepsy (64.1% and psychotic disorders (50%. There is urgent need for extending mental health services into the community in order to improve access to care and increase awareness about effective and affordable treatments.
Daniel Chukwunyere Nnadi
Full Text Available Background: Palliative care is the proactive care which seeks to maximize quality of life for people and families facing life-threatening illnesses. Objectives: To ascertain the existing knowledge of palliative care among medical interns and determine the effect of a structured educational intervention on improvement of their knowledge levels. Subjects and Methods: This is a quasi-experimental, interventional study with a one group pre- and post-test design involving medical interns rotating through the various departments of the Usmanu Danfodiyo University Teaching Hospital, Sokoto. The study population was chosen by convenience sampling method. The interns completed a pre- and a post-test assessment following a structured educational intervention for the evaluation of knowledge of palliative care. Knowledge was evaluated by a self-administered structured questionnaire. Results: A total number of 49 medical interns were recruited, among whom were 41 males and 8 females. Their ages ranged from 21 to 36 years with a mean of 27.7 (standard deviation 2.14 years. In the pretest, 11/49 (22.5% of the respondents had poor knowledge level of palliative care; however, in the postintervention, only 2/49 (4.1% of the respondents had poor knowledge. Similarly, good knowledge levels appreciated from 9/49 (18.4% to 14/49 (28.6% while very good knowledge increased from 10/49 (20.4% to 19/49 (38.8%. This effect was statistically significant (Chi-square test 11.655 df = 3, P = 0.009. Conclusion: There is poor knowledge of palliative care among the interns due to ignorance. Following an educational intervention, the knowledge levels appreciated significantly. Palliative care should be part of the medical curriculum.
Full Text Available Background and Objectives. Critically ill obstetric patients are a particularly unique cohort for the intensivist. The objective of this study was to review the indications for admission, demographics, clinical characteristics, and outcomes of obstetric patients admitted to intensive care unit of a medical college hospital in southern India and to identify conditions associated with maternal mortality. Design. Retrospective analysis of pregnant/postpartum (up to 6 weeks admissions over a 1-year result. We studied 55 patients constituting 11.6% of mixed ICU admissions during the study period. Results. The mean APACHE (acute physiology and chronic health evaluation II score of patients at admission was 11.8. Most of the patients (76% were admitted in the antepartum period. The commonest indications for ICU admission were obstetric haemorrhage (51% and hypertensive disorders of pregnancy (18%. 85% of patients required mechanical ventilation and 78% required inotropic support. Conclusions. Maternal mortality was 13%, and the majority of the deaths were due to disseminated intravascular coagulation and multiorgan failure, following an obstetric haemorrhage. A dedicated obstetric ICU in tertiary hospitals can ensure that there is no delay in patient management and intensive care can be instituted at the earliest.
Healy, Jennifer; Chappell, Phylliss; Lee, Shuko; Ross, Jeanette; Sanchez-Reilly, Sandra
Dying is a natural process, yet physicians are often uncomfortable caring for dying patients. Learners have limited exposure to curriculum on caring for dying patients and often navigate these encounters without appropriate skills and confidence. We developed and implemented the Double Parallel Curriculum in Palliative Care (DP-PC): End-of-Life (EOL) module. The DP-PC focuses on teaching third-year medical students (MS3) to not only take care of patients in their last hours of life but give learners the confidence to teach patient's families what to expect as they hold vigil at their loved one's bedside. To develop and implement an educational intervention that improves learners' knowledge and confidence in EOL patient and family care. To expand learner confidence to a dual level (learners become teachers) with a simplified and culturally sensitive electronic bedside teaching tool designed to guide learners and patients/families conversations. Curriculum was completed during MS3 ambulatory rotation and included pre-/posttests, an online case-based module, faculty demonstration, and learner role-play using the bedside teaching tool. A total of 247 participants took the pretest, 222 participants took the posttest, and 222 participants matched the pre-/posttest surveys. Students' knowledge of EOL care and the confidence to teach other learners and families about EOL care significantly improved after completing the curriculum. The DP-PC is a technology-savvy educational intervention that improves learner confidence and knowledge toward caring for dying patients and their families. Easy access, technology-based teaching tools may enhance bedside teaching of health-care learners and improve the care of patients and their families at the end of life.
Whereat, Sarah E; McLean, Anthony S
The place of Intensive Care Medicine education within Medical Schools in Australia and New Zealand was investigated by survey in 2009. All intensive care units in Australia and New Zealand were invited to take part in the survey. The survey included commitment to intensive care medicine training, teaching methods, curriculum content, assessment, and hours of student contact. All university teaching hospitals were identified and results analyzed. None. From recognized tertiary referral teaching hospitals, the response was 60%. A mandatory teaching program was offered by 56%, with a further 22% offering an optional program. The medical school curricula were primarily a mix of problem-based learning and traditional, lecture-based courses. Intensive care experience was usually undertaken in the latter years of the course. Contact hours allocated under the curriculum was less than 1 wk in the great majority. Assessment of students, where it existed, was undemanding. Intensive care medicine, although growing in stature within medical schools, still appears to occupy only a small place in the overall curriculum. A survey was undertaken to determine the extent of intensive care medicine training undertaken in medical student courses in Australia and New Zealand. A small majority of university hospitals had mandatory programs, with nearly a quarter having neither a mandatory or optional program. This is a higher proportion than identified in previous international surveys, but the results indicate considerable deficits requiring ongoing development within the undergraduate program.
Full Text Available Background: Diabetic foot syndrome is one of the most common and devastating preventable complications of diabetes resulting in major economic consequences for the patients, their families, and the society. Aims & Objectives: The present study was carried out to assess knowledge, attitude and practices of Diabetic Foot Wound Care among the patients suffering from Diabetic Foot and to correlate them with the socio-demographic parameters. Material & Methods: It was a Hospital based cross-sectional study involving clinically diagnosed adult (>18 years patients of Diabetic Foot visiting the Surgery and Medicine OPDs at Teerthankar Mahaveer Medical College & Research Centre, Moradabad, India. Results: Significant association KAP (Knowledge, Attitude and Practices score was seen with age of the patient, education, addiction, family history of Diabetes Mellitus, prior receipt of information regarding Diabetic foot-care practices, compliance towards the treatment and the type of foot wear used. Conclusions: The results highlight areas especially Health education, use of safe footwear and life style adjustments, where efforts to improve knowledge and practice may contribute to the prevention of development of Foot ulcers and amputation.
Tiwari, A; Kishore, J; Tiwari, A
Cervical cancer is one of the major causes of deaths due to cancer among women in India. Pap smear is one of the best methods to detect early changes in cervix. However, there is lack of data on awareness level of women about Pap smear and various risk factors for cervical cancer. To study the awareness about various risk factors for cervical cancer, health-seeking behavior and hygienic practices among women and to assess the distress experienced by these women before the Pap smear examination. This cross-sectional study was carried out on women coming for a Pap smear examination in a tertiary teaching hospital in New Delhi. A pretested interview schedule was used to get information after obtaining their informed consent. Fifty-seven percent stated that they did not consult a doctor when they noticed the symptoms the first time. Sixty-one percent did not know what a cervical cancer is and a same percentage of women did not know what a Pap smear examination was. Older age group, Muslim and literate women had higher number of abnormal Pap smear results. Women who reported being stressed in their lives had higher number of abnormal smears as compared to women who claimed to lead a stress free life. Poor hygienic practices among these women from urban areas were also associated with abnormal Pap smear results. The study concluded that factors such as poor awareness, shyness, poor hygiene, and old age could be responsible for abnormal Pap smears and this needs special attention in cancer prevention activities of the government.
Hasnain, Hina; Ali, Huma; Zafar, Farya; Sial, Ali Akbar; Alam, Shazia; Beg, Anwar Ejaz; Bushra, Rabia; Rizvi, Mehwish; Khan, Maqsood Ahmed; Shareef, Huma; Naqvi, Ghazala R; Tariq, Anum
Drug-drug interactions (DDIs) are extremely significant concern, particularly in sensitive population including pediatric and geriatric. Propensity for the development of DDIs is high in patients admitted at intensive care units (ICU). This study was conducted to evaluate the DDIs incidence, facts and measures in ICU. From a total of 150 cases studied for ICU patients, with the mean age of 56.37±12.45 years, 55.33% were male and the rest were female 44.66%. The demographic information like age, gender and main diagnosis details of study participants that were extracted from the patients' clinical record. A statistically significant association between the drug interaction and the number of drugs prescribed per prescription was observed (pICU attributed high risk of adverse reactions due to use of multiple interventions to treat severity of disease condition. Such studies may be used to develop an effective tool for the diagnosis and management of DDIs.
Hamid, Muhammad Haroon; Zafar, Aizza; Maqbool, Sajid
To determine the frequency, causative organisms and susceptibility pattern of nosocomial bloodstream infections in children. Observational study. Paediatric Intensive Care Unit of the Children's Hospital, Lahore, from January to December 2004. All children admitted to the unit during the study period were daily evaluated for features suggestive of nosocomial infection. In addition to other investigations, blood cultures were done in all suspected cases for the confirmation of nosocomial bloodstream infection (BSI). Nosocomial infection was defined according to the criteria set by Centre for Disease Control and Prevention. Demographic, microbiological and other variables were carefully studied to analyze frequency, incidence rate, spectrum of isolates and susceptibility pattern. Children with and without nosocomial BSI were compared with regard to age, duration of stay in hospital, need and duration of ventilation and the outcome. Of the total 406 admissions, 134 children were suspected to have nosocomial infection on at least 214 occasions (episodes). Blood cultures yielded growth of pathological organisms in 62 of these episodes, giving the frequency of nosocomial BSI as 15.2 per 100 admissions (62/406 episodes). Children with nosocomial bloodstream infection were found to have younger mean age (2.1 vs. 4.1 years), longer average duration of stay (13.1 vs. 6.6 days), more frequent need for ventilation (64% vs. 34%) and longer duration of ventilation (9.7 vs. 4.8 days). Majority of isolates (77%) were gram-negative bacteria; Klebsiella being the most common isolate (n= 23). Aztreonam, Ceftiazidime, Ceforuxime and Ciprofloxacin showed high resistance pattern (33-50%). Isolates showed good sensitivity to Vancomycin (100%), Imipenem (80%), Meropenem (100%) and Co-amoxiclav (88%). The frequency of nosocomial BSI in the observed setting was quite high, having marked impact on the duration of stay and outcome. Emergence of resistant pathogens is alarming.
Full Text Available Nephrectomy is not an uncommon surgery in day-to-day practice of urology. Trauma is the most common cause of emergency nephrectomy. On the other hand, elective nephrectomy is done for both benign and malignant diseases of the kidney. This study has been performed to know the different causes of nephrectomy in a rural, tertiary care center of India. In our series, we have studied all the elective nephrectomies done in our hospital during a period of eight years. We have analyzed 88 cases of nephrectomies regarding their age, sex, laterality of disease, and histopathologic report of the nephrectomy specimens. Out of 88 cases, 61 were males and 27 were females. In our series, 62.5% cases of nephrectomies were done for benign causes and 37.5% cases for malignant causes. Among the benign causes, neglected pelviureteric junction obstruction was the leading cause, followed by calculus disease resulting in obstruction. On the other hand, renal cell carcinoma was the most common malignant pathology requiring nephrectomy.
Full Text Available OBJECTIVES: The study was carried out for creating a profile in cases of hemoglobinopathies coming to our Hospital and comparing the results with other Indian studies. SETTING: The study was carried out at a premier tertiary care center in Orissa. A total of 820 referred cases of Anemia were examined between March 2010 to July 2015. METHODS: Hematological indices and hemoglobin HPLC with quantification of the bands was done in all cases. Hematological indices were measured on SYSMEX Cell Counter (XT - 1800i and Hemoglobin HPLC was performed on BIORAD D10. RESULTS: Out of 820 referred cases 453 was found to be normal and 367 had one or other form of haemoglobinopathy. The data shows the prevalence of Sickle cell Trait to be 18.6%, β Thalassemia - Trait 10.8% & Sickle cell disease 8.7% in the study population. CONCLUSIONS: The prevalence of hemoglobinopathy is found to be very high. It is present in a proportion of 1:2.25 in patients coming for anemia for investigation or clinically suspected cases of hemoglobino pathies. Hence, all the cases of anemia should undergo HPLC screening in this part of the country. There should be an initiative towards population screening, genetic counseling and prenatal diagnosis to counter the magnitude of problem
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.
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.
Shivalli, Siddharudha; Sanklapur, Vasudha
The nurse's role in healthcare waste management is crucial. (1) To appraise nurses quantitatively and qualitatively regarding healthcare waste management; (2) to elicit the determinants of knowledge and attitudes of healthcare waste management. A cross-sectional study was undertaken at a tertiary care hospital of Mangalore, India. Self-administered pretested questionnaire and "nonparticipatory observation" were used for quantitative and qualitative appraisals. Percentage knowledge score was calculated based on their total knowledge score. Nurses' knowledge was categorized as excellent (>70%), good (50-70%), and poor (70% score). Most (86%) expressed the need of refresher training. No study variable displayed significant association (P > 0.05) with knowledge. Apt segregation practices were followed except in casualty. Patients and entourages misinterpreted the colored containers. Nurses' knowledge and healthcare waste management practices were not satisfactory. There is a need of refresher trainings at optimum intervals to ensure sustainability and further improvement. Educating patients and their entourages and display of segregation information board in local language are recommended.
Kundak, Ahmet Afşin; Dilli, Dilek; Karagöl, Belma; Karadağ, Nilgün; Zenciroğlu, Ayşegül; Okumuş, Nurullah; Doğan, Vehbi; Uzunalıç, Nuran
To analyze non benign neonatal arrhythmias (NA) observed in a tertiary neonatal intensive care unit (NICU). From June 2006 through July 2011, newborns admitted to the NICU for NA or diagnosed as NA after hospitalization were evaluated retrospectively. The newborns with non benign NA were included in the study. During the study period, the incidence of non-benign NA was 0.7 % (n = 55/7880). The mean age at diagnosis was 16.7 ± 1.8 d ranging from 1 d to 90 d. The most common type was supraventricular arrhythmia (SVT) with an incidence of 0.3 %. Univariate analyses showed that there were significant differences between the survived and died infants according types of congenital heart disease (CHD), electrolyte imbalance, and arrhythmias. The mortality rates were higher among infants with obstructive type left-to right shunt and common mixing type CHD. The most dangerous type of electrolyte imbalance was hyperkalemia. Many arrhythmias could not be noticed at neonatal period even in NICU, implying that it is increasingly important for the physician to be aware of the etiology, development, and natural history of these arrhythmias.
Sabir, Sumera; Ahmad Anjum, Aftab; Ijaz, Tayyaba; Asad Ali, Muhammad; Ur Rehman Khan, Muti; Nawaz, Muhammad
The study was conducted to isolate and determine the antibiotic resistance in E. coli from urinary tract infections in a tertiary care hospital, Lahore. Urine samples (n=500) were collected from patients with signs and symptoms of Urinary tract infections. Bacteria were isolated and identified by conventional biochemical profile. Antibiotic resistance pattern of E. coli against different antibiotic was determined by Kirby-Baur method. Bacterial etiological agent was isolated from 402 samples with highest prevalence of E. coli (321, 80%) followed by Staphylococcus aureus (9.4%), Proteus species (5.4%) and Pseudomonas species (5.2%). The E. coli were highly resistant to penicillin (100%), amoxicillin (100%) and cefotaxime (89.7%), followed by intermediate level of resistance to ceftazidime (73.8%), cephradine (73.8%), tetracycline (69.4%), doxycycline (66.6%), augmentin (62.6%), gentamycin (59.8%), cefuroxime (58.2%), ciprofloxacin (54.2%), cefaclor (50%), aztreonam (44.8%), ceftriaxone (43.3%), imipenem (43.3%), and low level of resistance to streptomycin (30%), kanamycin (19.9%), tazocin (14%), amikacin (12.7%) and lowest to norfloxacin (11.2%). Out of 321 E. coli isolates, 261 (81%) were declared as multiple drug resistant and 5 (1.5%) were extensive drug resistant. It is concluded that most of the urinary tract infections in human are caused by multiple drug resistant E. coli.
Full Text Available Background: Sikkim is declared as a goitre endemic state with an estimated prevalence of 54%. The spectrums of diseases include simple goitre, thyroiditis, adenoma, carcinoma, multinodular goitre and Graves′ disease. The present study aims to determine the pattern of thyroid swelling in a hospital setup at Sikkim. Materials and Methods: This study is a retrospective analysis of records of all patients presenting with thyroid swelling in a tertiary care hospital at Gangtok, Sikkim during the period of 4 years between 1 st January 2008 and 31 st December 2011. Patients were diagnosed by clinical examination, FNAC, USG, CT scan and hormone estimation. Histopatholgical confirmation was done in surgical cases. Clinic opathological and demographic data of 166 such patients were obtained and analyzed for the present study. Results: The most common goitrous disease was simple goitre (69.27% followed by thyroiditis (10.24%, toxic goitre (7.83% and malignancy (12.65%. Papillary variant was the commonest carcinoma. Overall female:male ratio was 4.9:1. The prevalence goitrous lesion was highest in the middle age group between 30-39 years, while the extremes of age (below 10 years and above 70 years were rarely involved. Conclusions: The prevalence of goitre in Sikkim is still very high despite iodisation programs by the Government. There is urgent need for more data on autoimmunity and goitrogens status to explain the high prevalence of goitre in this population.
Bloch-Infanger, Constantine; Bättig, Veronika; Kremo, Jürg; Widmer, Andreas F; Egli, Adrian; Bingisser, Roland; Battegay, Manuel; Erb, Stefan
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.
Chander, Jagdish; Kaistha, Neelam; Gupta, Varsha; Mehta, Manjula; Singla, Nidhi; Deep, Antariksh; Sarkar, B L
Cholera is endemic in Chandigarh and its surrounding areas. This retrospective study was undertaken over a period of nine years (January 1999-December 2007) from a tertiary care hospital in north India to understand the changing epidemiology aspects and antibiotic resistance patterns in Vibrio cholerae isolates. A total of 277 isolates of V. cholerae were included in the study. V. cholerae was identified by standard microbiological procedures. Antibiotic sensitivity testing was performed by disc diffusion method and isolates phage typed. All the isolates were identified as V. cholerae O1 biotype El Tor serotype Ogawa; phage 27 was the predominant type. Men were more commonly affected with maximum number in the age group 0-5 yr. Majority of the isolates were resistant to furazolidone but sensitive to gentamicin and cefotaxime. Resistance pattern to amoxycillin was variable. Three isolates were found to be resistant to ciprofloxacin. All the patients presented during June-October coinciding with the monsoon season and a majority were from suburbs. The emergence of resistance amongst V. cholerae especially towards ciprofloxacin may significantly influence the control strategies in future outbreaks. Phage 27 remained the predominant type in all the years. Continuous surveillance with regard to drug resistance, early detection and a strong regional commitment may help contain the disease.
Geeta S. Pardeshi
Full Text Available Setting. Government tertiary health care center in India. Objective. To understand the perceptions of medical residents about their risk of developing TB in the workplace. Design. Cross-sectional study in which a semistructured questionnaire which included an open-ended question to assess their main concerns regarding TB in workplace was used to collect data. Results. Out of 305 resident doctors approached, 263 (94% completed a structured questionnaire and 200 of these responded to an open-ended question. Daily exposure to TB was reported by 141 (64% residents, 13 (5% reported a prior history of TB, and 175 (69% respondents were aware of TB infection control guidelines. A majority reported concerns about acquiring TB (78% and drug-resistant TB (88%. The key themes identified were concerns about developing drug-resistant TB (n=100; 50%; disease and its clinical consequences (n=39; 20%; social and professional consequences (n=37; 19%; exposure to TB patients (n=32; 16%; poor infection control measures (n=27; 14%; and high workload and its health consequences (n=16; 8%. Conclusion. Though many resident doctors were aware of TB infection control guidelines, only few expressed concern about lack of TB infection control measures. Doctors need to be convinced of the importance of these measures which should be implemented urgently.
Pramanik, Subhodip; Ghosh, Sujoy; Mukhopadhyay, Pradip; Bhattacharjee, Rana; Mukherjee, Bidisha; Mondal, Samim Ali; Ghosh, Ipsita; Bari, Ranajit; Chowdhury, Subhankar
Type 2 diabetes mellitus and thyroid dysfunction (TD) are two major public health endocrine problem, but the prevalence of TD and iodine status in patients with T2 DM in India is less studied. The study objective was to explore the prevalence of TD and to evaluate iodine health in type 2 diabetes patients attending a tertiary care center in Eastern India. Consecutive 100 patients with diabetes attending outpatient department were evaluated clinically and biochemically (thyrotropin [TSH], free thyroxine, anti-TPO antibody, and urinary iodine). We excluded pregnant women or patients taking drugs that can alter thyroid function. Subclinical hypothyroid and overt hypothyroidism were diagnosed as per standard definitions. Out of 100 patients were analyzed, 51 (51%) were male. Mean (±standard deviation) age was 45.4 ± 11.2 years, body mass index 24.1 ± 4.28 kg/m 2 , and duration of diabetes 7.76 ± 5.77 years. The prevalence of subclinical hypothyroidism and overt hypothyroidism was 23/100 (23%) and 3/100 (3%), respectively. Thyroid autoantibody was positive in 13 (13.1%) patients. All patients were iodine sufficient. A trend toward increased neuropathy ( r = 0.45) and nephropathy ( r = -0.29) was associated with rising TSH. Almost one in four people living with diabetes are suffering from TD. Thus, routine screening should be implemented. Salt iodination program is a huge success in this part of the country.
Full Text Available Objective: Type 2 diabetes mellitus and thyroid dysfunction (TD are two major public health endocrine problem, but the prevalence of TD and iodine status in patients with T2 DM in India is less studied. The study objective was to explore the prevalence of TD and to evaluate iodine health in type 2 diabetes patients attending a tertiary care center in Eastern India. Methods: Consecutive 100 patients with diabetes attending outpatient department were evaluated clinically and biochemically (thyrotropin [TSH], free thyroxine, anti-TPO antibody, and urinary iodine. We excluded pregnant women or patients taking drugs that can alter thyroid function. Subclinical hypothyroid and overt hypothyroidism were diagnosed as per standard definitions. Results: Out of 100 patients were analyzed, 51 (51% were male. Mean (±standard deviation age was 45.4 ± 11.2 years, body mass index 24.1 ± 4.28 kg/m2, and duration of diabetes 7.76 ± 5.77 years. The prevalence of subclinical hypothyroidism and overt hypothyroidism was 23/100 (23% and 3/100 (3%, respectively. Thyroid autoantibody was positive in 13 (13.1% patients. All patients were iodine sufficient. A trend toward increased neuropathy (r = 0.45 and nephropathy (r = −0.29 was associated with rising TSH. Conclusion: Almost one in four people living with diabetes are suffering from TD. Thus, routine screening should be implemented. Salt iodination program is a huge success in this part of the country.
Full Text Available BACKGROUND Thoracic diseases are common and include a wide spectrum of lesions involving distinct compartments, i.e. lung parenchyma, pleura, chest wall and mediastinum. ‘Chest masses’ is a vast topic and includes all the lung, mediastinal, chest wall and pleural tumour whether benign or malignant. Compared to other noninvasive techniques, Computed Tomography (CT can better delineate the local extent of lung tumours as well as visualise the mediastinal nodes. MATERIALS AND METHODS Study was conducted in a tertiary care hospital, VSSMCH, Sambalpur, Burla. All 50 patients who had chest findings were included in the present study. Relevant lab investigations and CT was done to determine the size, morphology, margin, density, calcification and various other characters. RESULTS All the patients were in the age of 15-65 years. The incidence of benign lesion was maximum below the age of 35 years. All the malignant lesions were above the age of 45 years. Lung lesions constituted 52% of the cases, while mediastinal masses constituted 48% of the cases. Out of the lung lesions, 53.84% of the lesions turned out to be malignant, whereas 46.14% of the lesions were benign. CONCLUSION Majority of the lung lesions were malignant and tuberculosis was the commonest among the benign lesions. Among the mediastinal lesions, germ cell tumour was found to be the commonest lesion.
Full Text Available BACKGROUND Hearing impairment is present in at least one-third of the population above 65 years of age. This loss of hearing leads to difficulty in social or professional interactions, social isolation depression individually. Besides in the working population above, it results in loss of efficiency and financial burden. This study has been undertaken to study the pattern of hearing in the above 50 years males who attended the E.N.T. OP in our tertiary care hospital for various ear-related complaints. MATERIALS AND METHODS This cross-sectional study was carried out in the E.N.T. Department, Government Mohan Kumaramangalam Medical College between 6th August 2012 and 30 th May 2015. 486 male patients with complaints related to ear were included. Those patients who had otitis media or had undergone ear surgery were excluded. RESULTS Hearing impairment was detected in 62% of the study population, although only 10% reported to the clinic due to complaints of hearing loss by family. Noise-induced hearing loss was detected in 27.5% of the patients. CONCLUSION Routine audiological evaluation especially in adults in the over 50 age group should be a priority. There should be more emphasis on adopting strategies to prevent noise-induced hearing loss and on rehabilitating the above 50 hearing impaired in our society.
Full Text Available Aim: To study the effects of omalizumab in chronic spontaneous urticaria in Indian patients. Setting and Design: The study was conducted in a tertiary care centre and it was retrospective and descriptive in nature. Material and Methods: We analysed the data of patients who were administered omalizumab between June 2014 and June 2015 for the management of refractory chronic spontaneous urticaria at our centre. Omalizumab was used in those patients who did not respond to updosing of antihistaminics and cyclosporine. Omalizumab was used in dose of 300 mg per month for 3 doses. Results: Twenty-four patients were administered omalizumab during the study period. Average age of the patients was 36.54 years, female:male ratio was 1.4:1, mean duration of disease was 20.66 months, and autologous serum skin test was positive in 33% of studied individuals. Ninety six percent of cases showed response to treatment in our study. Remission was seen in 25% of patients, 50% showed satisfactory response, and 20.83% showed partial response. Average UAS7 scoring before starting omalizumab in preceding week was 24.4. Average UAS7, 2 weeks after starting omalizumab was 4 in responsive patients. Conclusion: Omalizumab is safe and effective treatment for the management of chronic spontaneous urticaria. It can be used in Indian setting after failure to other third-line therapies such as addition of montelukast and cyclosporine due to high cost of treatment.
Dogar, I.A.; Azeem, M.W.; Kiran, M.; Hussain, I.; Mehmood, K.; Hina, I.
Objective: To examine the prevalence of depression and anxiety in patients with cancer in an outpatient department of a tertiary care hospital in Pakistan. Methodology: This study was conducted between May 2006 and January 2007. The sample consisted of 60 diagnosed cancer patients (30 males/30 females). DSM- IV criteria and Hospital Anxiety and Depression Scale (HADS) were used to diagnose and assess anxiety and depression. Results: Fifty two percent (31 patients, 10 males/21 females) of the subjects reported having symptoms of anxiety, depression or both according to DSM IV Criteria, (anxiety =14, males six / females eight, depression = 6, males two / females four , and depression + anxiety both = 11, males two / females nine). A total of 70% (21/30) of the entire female sample met the criteria for depression, anxiety or both. A total of 33% (10/30) of the entire male sample met the criteria for depression, anxiety or both. Conclusion: This study shows high prevalence rates of depression and anxiety in cancer patients in Pakistan. The oncologists and internists treating cancer patients should screen their patients for symptoms of depression and anxiety. (author)
Sagheer, M.A.; Khan, M.F.; Sharif, S.
Objective: To observe the prevalence of anxiety and depression in chronic low back pain population at a tertiary care centre. Methods: The prospective cross-sectional study was conducted using convenience sampling at the Department of Neurosurgery, at Liaquat National Hospital, Karachi, Pakistan, from January to June 2010. The prevalence of anxiety and depression in chronic low back pain patients was studied according to specified age and gender groups using Hospital Anxiety and Depression Scale. Results: Of the 140 patients in the study, 66 (47.14%) were females and 74 (52.85%) were males. The average age of the patients was 43.02+-13.34 years. The average duration of symptoms was 4.29+-3.3 years. Abnormal level of anxiety and depression were found in 77 (55%) and 68 (48.57%) patients respectively. Out of them 54 (38.5%) and 51 (36.4%) were borderline abnormal for anxiety and depression respectively, while 23 (16.4%) and 17 (12.1%) were abnormal for anxiety and depression respectively. Among the males, there were 20 (14.28%) and 23 (16.42%) patients with abnormal levels of the corresponding numbers among the females were 57 (40.71%) and 45 (32.14%). There was a significant association in anxiety (p 0.05). Conclusion: Individuals with chronic low back pain were at high risk to experience anxiety and depression. This risk was higher for females. (author)
Clarke, Dave F; Roberts, Wendy; Daraksan, Mina; Dupuis, Annie; McCabe, Jane; Wood, Halyey; Snead, O Carter; Weiss, Shelly K
It is well documented that children with autistic spectrum disorder (ASD) have an increased prevalence of seizures; however, studies have not been done to evaluate the prevalence of ASD in children with epilepsy. This comorbidity is important to define as early diagnosis and intervention in some children with ASD has been shown to improve outcome. Children with epilepsy seen in a tertiary care epilepsy clinic were evaluated using validated autism screening questionnaires (ASQ). In addition, questions about sleep-related disorders, behavior, seizure characteristics, antiepileptic agents, and body mass index (BMI) were requested. An attempt was then made to determine if there was a correlation between the factors identified and ASD. Of the 107 questionnaires returned, 97 ASQ's were properly completed and used in this study. Approximately 32% of children fit the ASQ criteria for having ASD. Most children had not been previously diagnosed. Worst behavior and daytime sleepiness was seen in those at greater risk (p children at risk of having ASD. Though confirmatory diagnostic evaluations are needed, this questionnaire-based study suggests that children with epilepsy are at greater risk of having ASD, and illustrates the need for more clinical vigilance. Behavioral difficulties and daytime sleepiness identified in these children could potentially affect their ability to learn. It is of interest that the age of seizure onset identified in those at greater risk corresponds with the approximate age of regression identified in some children with ASD.
Seth, Pankaj; Kaur, Harpreet; Kaur, Maneet
Diabetic ketoacidosis, a well-known and major acute metabolic complication classically occurs in young patients with type 1 diabetes. However, it may occur in patients with type 2 Diabetes Mellitus too. Aim of this study was to look into the clinical profile, precipitating factors and clinical outcome in the patients presenting with Diabetic ketoacidosis in the Emergency of a Tertiary care hospital. The study was a prospective study conducted over a period of two years in Kasturba Medical College, Manipal Karnataka, India. Clinical profile of 60 diabetic patients admitted in the Emergency with the diagnosis of Diabetic ketoacidosis were analysed. Out of 60 patients, 12 were of Type 1 and 48 were Type 2 Diabetes Mellitus. Mean duration of diabetes was 8.65 years. Only 14 (23.3%) patients were taking regular treatment for Diabetes Mellitus whereas 32 (53.33%) patients were on irregular treatment and eight (13.33%) were not on any treatment at all. Among 12 Type 1 Diabetic patients, six patients were freshly diagnosed to be diabetic when they presented with Diabetic ketoacidosis complication. Nausea and vomiting (63.33%) were the most common symptoms of these patients. Infections (73.33%) were the most common precipitating factor for Diabetic ketoacidosis. Mean fluid requirement on first day of therapy was 3.51 liters. Mortality of 10% was seen. Diabetic ketoacidosis is a fatal acute metabolic complication of Diabetes Mellitus with heterogeneous clinical presentation. Early diagnosis and treatment can avoid morbidity & mortality.
Berchicci, Luigi; Miserocchi, Elisabetta; Di Nicola, Maura; La Spina, Carlo; Bandello, Francesco; Modorati, Giulio
To evaluate demographic characteristics, clinical features, systemic disease associations, visual outcomes, and treatment modalities of patients with episcleritis and scleritis in an Italian tertiary care referral center. Data from 25 patients with episcleritis and from 85 patients with scleritis followed from 2003 to 2012 were retrospectively evaluated. The main outcome measures were demographics, ocular disease characteristics, presence of systemic associated disease, treatment regimen, and follow-up period. Episcleritis and scleritis were found bilaterally in 24% and 31% of patients, respectively (pepiscleritis was diffuse in 15 and focal in 10 patients, while the scleritis was diffuse in 49, nodular in 28, necrotizing in 6, and posterior in 2 patients. Anterior uveitis (4% vs 31%; pepiscleritis and patients with scleritis, respectively. An associated systemic disease was found in 20% and 52% of patients with episcleritis and patients with scleritis (pepiscleritis, 76% required topical corticosteroid treatment to achieve disease resolution, 16% oral nonsteroidal anti-inflammatory drugs (NSAIDs), and 8% antivirals; 39% of patients with scleritis required systemic NSAIDs, 12% oral corticosteroids, 34% immunosuppressive drugs, and 15% antibiotics or antivirals. The importance of differentiating scleritis from episcleritis is remarkable given the significant difference in the degree of ocular complications and associated systemic diseases between these ocular conditions. Prompt diagnosis, systemic assessment, and treatment are fundamental in all patients with scleral inflammation.
Shah, Ayushi Jayesh; Singh, Vijaykumar; Patil, Subita P; Gadkari, Mithila R; Ramchandani, Varun; Doshi, Karan Janak
Compliance to antihypertensive therapy reduces the risk of complications. It is important to understand the factors affecting compliance in patients so that the goal of successful treatment is not jeopardized. To determine the proportion of participants' compliant to treatment and various factors associated with compliance of antihypertensive treatment. A cross-sectional study of 330 hypertensive patients on treatment attending the outpatient department of a tertiary care hospital in Mumbai. It was conducted over 8 weeks using a validated, pretested questionnaire including information on the individual's sociodemographic profile, compliance to antihypertensive therapy and lifestyle advice assessed using a 4-point Likert scale. Data were entered into MS Excel 2007 and analyzed using SPSS 20. Participants' mean age was 55.2 ± 12.6 years. 39.4% were compliant to their treatment. Common reasons for frequently skipping the dose - forgetfulness (41.2%) and discontinued the medication when feeling well (30.3%). Factors positively associated with compliance were gender and illiteracy. The proportion of noncompliance among smokers and alcoholics was statistically significant. Forgetfulness and subjective feeling of wellness were the prevalent reasons for noncompliance. Controlling habits such as smoking and alcohol may prove as key factors for compliance.
Kateel, Ramya; Augustine, Alfred J; Prabhu, Shivananda; Ullal, Sheetal; Pai, Manohar; Adhikari, Prabha
To evaluate the clinical and microbiological profile of diabetic foot ulcer patients admitted to a tertiary care hospital. This study recruited 120 diabetic foot ulcer patients of all grade. Their medical records were evaluated retrospectively. We found that median age of patient was 60(52, 67.75) years. 68.3% of patients were males. Median duration of diabetes mellitus was 15(10, 20) years. Mean HbA1C and fasting glucose was 10.3±2.3 and 167.6±52.42 respectively. Neuropathy (35%) and peripheral vascular disease (23.3%) was major micro vascular and macro vascular complication associated. Different locations of ulcers were toe (23.3%), sole (20%), dorsum (18.3%), shin (16.6%), heel (13.3%), and ankle (8.3%). Bacterial infection was seen in 81.66% patients out of which 23.3% had poly microbial infection. Diabetic foot ulcer patient had poor blood glucose control with elevated HbA1C and fasting blood glucose level. Neuropathy and peripheral vascular disease, hypertension were major complications. Staphylococcus aureus, Pseudomonas aeruginosa were common infecting bacteria. Copyright © 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved.
Apexa S. Raithatha
Full Text Available Introduction. Musculoskeletal disorders (MSD are common among nurses and can affect patient outcomes. There is a dearth of literature on MSD among Indian nurses. The study objective was to measure prevalence of MSD and their association with perceived work demands and sociodemographic variables among female nurses at a tertiary care hospital in rural India. Methods. A cross-sectional study was undertaken in 2013 through interviewer administered questionnaires which comprised three parts: sociodemographic data, modified Nordic questionnaire, and perceived physical and psychological work demands. Results. 296 nurses with a mean age of 30.4 years participated. Prevalence of any MSD in the last seven days was 60.5% with low back pain being the most common and elbow pain the least common. Occurrence of any MSD was associated with age, number of children, working hours at home, BMI, and total work experience. High perceived physical demands score was associated with lower back (OR: 3.06 and knee pain (OR: 7.73. Conclusion. Prevalence of MSD was high and occurrence of lower back and knee MSD was associated with perceived physical demands. This information should be used as a benchmark and guiding tool for designing work place interventions to improve working conditions and health of nurses.
Dsouza, Caren; Rao, Vinay V; Kumar, Arun; Diaz, Erel
To study the pattern and burden of trauma cases which presented to a tertiary care centre in an upcoming Dakshina Kannada District of Karnataka, India. This was an epidemiological study. Data was collected by purposive sampling technique. Study period lasted from Jan 2013 to Aug 2013. Collected data was analyzed. The annual incidence of trauma at our centre was 15.96% (1140 cases). Most of the injuries were reported in 21-30 years age group. The male to female ratio was approximately 2.3:1. Limb injury (66.92%) constituted the commonest form of injury. Among the various injuries, fall was the commonest cause of injury (60.78%), followed by RTA (16.75%) and assault (11.6%). A majority of the cases were admitted during night time (61.24%). There has been an alarming increase in the number of trauma cases in the past decade. The target age group being the most productive one; it affects the economy directly . There is a need of urgent protective measures which are required for the benefit of the community.
Full Text Available BACKGROUND Haemolytic anaemia is a well-recognised clinical problem. This study looks into the clinical profile of haemolytic anaemia and also attempts to find out the common underlying causative disease. It also tries to group the patients according to the clinical manifestations and underlying causes. MATERIALS AND METHODS This is a hospital-based observational study conducted in a tertiary care centre in Northern Kerala. Forty-four adult patients with clinical manifestations and laboratory evidence of haemolytic anaemia were identified and studied for a period of one year. RESULTS Maximum number of cases were seen in the age group of 20-40 years. The overall male-female ratio was 1.1:1. The most common presenting symptoms were features of anaemia like breathlessness, easy fatigability, headache and tiredness. Family history of anaemia was present in 34.1%. The most common signs observed were pallor and jaundice. The most common causes were autoimmune haemolytic anaemia and sickle cell anaemia. CONCLUSION Haemolytic anaemia mostly affects individuals in their 3rd and 4th decade. There is no significant difference in gender distribution of haemolytic anaemia. Haemolytic anaemia most commonly presents with symptoms of anaemia and jaundice. Commonest causes of haemolytic anaemia are autoimmune haemolytic anaemia and sickle cell anaemia.
Ayushi Jayesh Shah
Full Text Available Background: Compliance to antihypertensive therapy reduces the risk of complications. It is important to understand the factors affecting compliance in patients so that the goal of successful treatment is not jeopardized. Objectives: To determine the proportion of participants' compliant to treatment and various factors associated with compliance of antihypertensive treatment. Settings and Design: A cross-sectional study of 330 hypertensive patients on treatment attending the outpatient department of a tertiary care hospital in Mumbai. Subjects and Methods: It was conducted over 8 weeks using a validated, pretested questionnaire including information on the individual's sociodemographic profile, compliance to antihypertensive therapy and lifestyle advice assessed using a 4-point Likert scale. Statistical Analysis: Data were entered into MS Excel 2007 and analyzed using SPSS 20. Results: Participants' mean age was 55.2 ± 12.6 years. 39.4% were compliant to their treatment. Common reasons for frequently skipping the dose – forgetfulness (41.2% and discontinued the medication when feeling well (30.3%. Factors positively associated with compliance were gender and illiteracy. The proportion of noncompliance among smokers and alcoholics was statistically significant. Conclusion: Forgetfulness and subjective feeling of wellness were the prevalent reasons for noncompliance. Controlling habits such as smoking and alcohol may prove as key factors for compliance.
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.
Almas, Aysha; Ghouse, Ayaz; Iftikhar, Ahmed Raza; Khursheed, Munawwar
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.
William, Timothy; Menon, Jayaram; Rajahram, Giri; Chan, Leslie; Ma, Gordon; Donaldson, Samantha; Khoo, Serena; Frederick, Charlie; Jelip, Jenarun; Anstey, Nicholas M; Yeo, Tsin Wen
The simian parasite Plasmodium knowlesi causes severe human malaria; the optimal treatment remains unknown. We describe the clinical features, disease spectrum, and response to antimalarial chemotherapy, including artemether-lumefantrine and artesunate, in patients with P. knowlesi malaria diagnosed by PCR during December 2007-November 2009 at a tertiary care hospital in Sabah, Malaysia. Fifty-six patients had PCR-confirmed P. knowlesi monoinfection and clinical records available for review. Twenty-two (39%) had severe malaria; of these, 6 (27%) died. Thirteen (59%) had respiratory distress; 12 (55%), acute renal failure; and 12, shock. None experienced coma. Patients with uncomplicated disease received chloroquine, quinine, or artemether-lumefantrine, and those with severe disease received intravenous quinine or artesunate. Parasite clearance times were 1-2 days shorter with either artemether-lumefantrine or artesunate treatment. P. knowlesi is a major cause of severe and fatal malaria in Sabah. Artemisinin derivatives rapidly clear parasitemia and are efficacious in treating uncomplicated and severe knowlesi malaria.
Miranda, Gerardo E; Torres, Ruben Y
To describe the etiologies and frequency of traumatic peripheral nerve injury (TPNI) seen in the electrodiagnostic laboratory of a tertiary care hospital in Puerto Rico. The charts of patients who underwent an electrodiagnostic study for a TPNI were revised. The main outcome measure was the frequency of each injury by anatomic location, specific nerve or nerves affected, injury mechanism, and injury severity. One hundred forty-six charts were included, and in them were listed a total of 163 nerve injuries; 109 (74.7%) cases were men and 37 (25.3%) were women. The mean age was 33.6 years. The facial nerve, the brachial plexus, and the ulnar nerve were more frequently injured than any other nerve or nerve bundle. The ulnar, sciatic, median, and radial nerves and the lumbosacral plexus were more commonly injured as a result of gunshot wounds than of any other mechanism of injury. The brachial plexus was most frequently injured in motor vehicle accidents and the facial nerve injuries most commonly had an iatrogenic cause. In terms of injury severity, 84.2% were incomplete and 15.8% were complete. TPNIs are common in young individuals and potentially can lead to significant disability. Further studies are needed to assess the socioeconomic impact of these injuries on our population.
Torres, Ruben Y; Miranda, Gerardo E
Describe the etiology and frequency of traumatic peripheral nerve injuries (TPNI) in the electrodiagnostic laboratory of a tertiary care hospital. The charts of patients who underwent an electrodiagnostic study for a TPNI were revised. The main outcome measure was the frequency of each injury by anatomic location, involved nerve, mechanism, and severity. 146 charts were included for a total of 163 injured nerves; 109 (74.7%) males and 37 (25.3%) females. The mean age was 33.6 years. The facial nerve and the brachial plexus followed by the ulnar nerve were more frequently involved. The ulnar, sciatic, median, radial nerve, and the lumbosacral plexus were more commonly injured by gunshot wounds, the brachial plexus by motor vehicle accidents, and the facial nerve by iatrogenic causes. The majority of the injuries were incomplete or partial (84.2% were incomplete and 15.8% complete injuries). TPNIs can lead to significant disability, but further investigation is needed to better understand their socio-economic impact.
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)
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.)
Rosenberg, Tom; Heitner, Shmuel; Scolnik, Dennis; Levin Ben-Adiva, Einav; Rimon, Ayelet; Glatstein, Miguel
The aims of the study were to determine the evolution of benign acute childhood myositis in children and to assess the relationship between creatine phosphokinase (CPK) values and myoglobinuria. A retrospective study of patients with benign acute childhood myositis seen in 2 tertiary care university-affiliated pediatric hospitals during overlapping 4-year periods. Demographic data, historical details, clinical, and laboratory results were extracted from the charts of children younger than 16 years with a CPK greater than 3 times normal. Complications, treatments, and outcomes were recorded. Fifty-four children were included, 43 (80%) were male, and mean age was 7.3 years (median [range], 6 [3-16] years), none showed abnormal neurological findings, manifested hematuria, or developed renal failure. Mean CPK level at presentation was 1872 IU/L (range, 511-8086 IU/L). None developed renal failure, and there were no adverse outcomes on follow-up. Acute childhood myositis is a predominantly benign disease. Neurological examination is usually normal and rhabdomyolysis is rare. Although severe pathological comorbid conditions must be excluded, a complete history and examination, coupled with simple blood and urine tests, can help minimize unnecessary diagnostic investigations.
Awan, Safia; Shafqat, Saad; Kamal, Ayeesha Kamran; Sonawalla, Aziz; Siddiqui, Sarwar; Siddiqui, Fowzia; Wasay, Mohammad
The burden of neurological diseases in developing countries is rising although little is known about the epidemiology and clinical pattern of neurological disorders. The objective of this study was to understand the burden of disease faced by neurologists a in tertiary care setting. A prospective observational study was conducted of all presentations to neurology clinics at Aga Khan University Hospital Karachi over a period of 2 years. A total of 16,371 out-patients with neurological diseases were seen during the study period. The mean age of the study participants were 46.2 ± 18.3 years and 8508 (52%) were male. Headache disorders were present in 3058 (18.6%) of patients followed by vascular diseases 2842 (17.4%), nerve and root lesions 2311 (14.1%) and epilepsies 2055 (12.5%). Parkinson's disease was more prevalent in male participants 564 (70.8%) as compared to female 257 (62.1%) (p = 0.002). Migraines and vertigo disease were more diagnosed in females as compared to males. Epilepsies were seen more in younger age groups. Parkinson's disease was seen in 50.9% of participants between the ages of 45 and 65 years, and the frequency increased with age.
Munir, M. A.; Saqib, M. A. N.; Qureshi, H.; Alam, S. E.; Arif, A.; Khan, Z. U.; Saeed, Q.; Iqbal, R.
Objectives: To assess the gaps in the diagnosis and management of dengue fever cases. Methods: 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. Results: 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%). Conclusions: 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. (author)
Full Text Available BACKGROUND Diseases of heart valves constitute a major cause of cardiovascular morbidity and mortality worldwide. In developing countries, Rheumatic Heart Disease (RHD continues to be the predominant form of valvular heart disease. The current study was undertaken at a Tertiary Care Institute with an objective of establishing distribution and different patterns of valvular heart diseases by echocardiography. MATERIALS AND METHODS 17,625 consecutive first time Echocardiograms performed between January 2016 and December 2016 were analysed. Echo was performed by consultant cardiologists using Philips HD11XE and Aloka SSD4000 machine following ASE guidelines. Applying exclusion criteria of trivial and functional regurgitant lesions yielded a total of 632 cases of organic valvular heart diseases. RESULTS In our study 632 patients were diagnosed with valvular heart disease, out of which 428 patients (67.7% were diagnosed with Rheumatic Heart Disease. Mitral valve was the most commonly affected followed by aortic and tricuspid valves. The least commonly affected valve was pulmonary valve. In Rheumatic heart disease, most common isolated lesion reported was MS with MR, most commonly reported in females between 21 - 40 years’ age group. CONCLUSION In non-RHD group, mitral valve prolapse (21.3% was the commonest lesion reported followed by calcific degenerative aortic valve (6.17% and congenital bicuspid aortic valve (3.4%; 118 patients were reported with multivalvular lesion. MS + MR + AR was the commonest multivalvular lesion found in 65 patients (55.08%.
Muhammad Imran Hasan Khan
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.
Rao, Chaitra C; Rangappa, Pradeep; Rao, Karthik; Jacob, Ipe
Urosepsis is one of the common causes of admission to the Intensive Care Unit (ICU). It has traditionally been treated with antibiotics, but surgical management with Double J [DJ] ureteral stents is gaining popularity. This study compares patients with complicated urosepsis who underwent surgical source control by ureteral stenting with those managed medically. The study enrolled patients admitted to a tertiary adult ICU with a diagnosis of urosepsis over a period of 2 years. The primary outcomes were renal replacement therapy (RRT) requirement and ICU mortality. The secondary outcomes were ICU and hospital length of stay, ventilator-free days, and inotrope free days. Patients were divided those with obstructive and nonobstructive urinary tract infection (UTI). A total of 58 patients met the criteria, of who 32 had obstructive UTI and were included in Group A, with the remaining 26 with nonobstructive UTI comprised Group B. In Group A, 27 patients underwent source control with ureteral DJ stenting, three patients recovered with medical management, and two who were advised source control did not consent to the procedure. Seventeen patients in Group A and seven patients in Group B required RRT ( P = 0.044). There was no significant difference in ICU mortality, hospital mortality, and 28 days survival between the two groups. With early source control, obstructive UTI outcomes were comparable to nonobstructive UTI. However, despite undergoing ureteric stenting, more patients with obstructive UTI required RRT than those with nonobstructive UTI.
Tan, Rou Wei; Mohamed Shah, Noraida
Background Antihistamines are widely prescribed to children but should be used with caution in young children. Objective To determine the paediatric prescribing pattern of antihistamines with a focus on the off-label prescribing and factors that influence such prescribing. Setting Paediatric wards of a tertiary care hospital setting in Malaysia. Methods The pharmacy-based computer system and medical records were used to collect the required data. Labelling status of each antihistamine was determined based on the information provided in the product leaflets. Main outcome measure Antihistamines prescribed off-label and factors associated with such prescribing. Results Of the 176 hospitalised children aged antihistamine in the year 2012, 60.8 % received it in an off-label manner. Of 292 antihistamine prescription items, 55.5 % were prescribed off-label. Loratadine (35.3 %) was the most frequently prescribed antihistamine and chlorpheniramine maleate (34.0 %) was the most common antihistamine prescribed off-label. The main reason for the off-label prescribing of antihistamines was prescribing at higher than the recommended dose (30.2 %). Binary logistic regression showed that children aged antihistamines. Conclusion Prescribing antihistamines for children in an off-label manner was prevalent at the studied locations and warrants further investigation on the consequences of such prescribing.
Binoy Kumar Mohanty
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.
Babar, N.; Usman, J.; Munir, T.; Gill, M. M.; Anjum, R.; Gilani, M.; Latif, M.
Objective: To determine the frequency of Vancomycin Resistant Enterococcus (VRE) in a tertiary care hospital of Rawalpindi, Pakistan. Study Design: Observational, cross-sectional study. Place and Duration of Study: Department of Microbiology, Army Medical College, Rawalpindi, from May 2011 to May 2012. Methodology: Vancomycin resistant Enterococcus isolated from the clinical specimens including blood, pus, double lumen tip, ascitic fluid, tracheal aspirate, non-directed bronchial lavage (NBL), cerebrospinal fluid (CSF), high vaginal swab (HVS) and catheter tips were cultured on blood agar and MacConkey agar, while the urine samples were grown on cystine lactose electrolyte deficient agar. Later the antimicrobial susceptibility testing of the isolates was carried out using the modified Kirby-Bauer disc diffusion method on Mueller Hinton agar. Results: A total of 190 enterococci were isolated. Of these, 22 (11.57%) were found to be resistant to vancomycin. The antimicrobial sensitivity pattern revealed maximum resistance against ampicillin (86.36%) followed by erythromycin (81.81%) and gentamicin (68.18%) while all the isolates were 100% susceptible to chloramphenicol and linezolid. Conclusion: The frequency of VRE was 11.57% with the highest susceptibility to linezolid and chloramphenicol. (author)
Mohamad, Nur Afiqah; Ramachandran, Vasudevan; Ismail, Patimah; Mohd Isa, Hazlita; Chan, Yoke Mun; Ngah, Nor Fariza; Md Bakri, Norshakimah; Ching, Siew Mooi; Hoo, Fan Kee; Wan Sulaiman, Wan Aliaa
To describe the prevalence and changes in treatment patterns of ranibizumab and photodynamic therapy (PDT) among retinal disease patients who attended the Ophthalmology Clinic in the tertiary care Hospital Selayang from 2010 to 2014. Study subjects were recruited retrospectively using the Electronic Medical Record (EMR) database software in Hospital Selayang. Demographic data, medical history, diagnostic procedure, treatments and diagnosis of patients were recorded. The five-year analysis included 821 patients with a mean age of 65.9±11.73y. Overall, there were a higher number of males (63.1%) and a higher number of Chinese (47.4%) patients. Among the 821 patients, 62.9% received ranibizumab injection followed by 19.2% PDT therapy and 17.9% had ranibizumab combined with PDT therapy. Age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV) were the most common retinal eye diseases reported, recording prevalence of 25.0% and 45.6%, respectively. The trend in ranibizumab treatment was reported to increase while PDT showed a decrease in trend from year 2010 to 2014. In terms of treatment, following multiple logistic regression, AMD was associated with the subjects being more likely to have received ranibizumab monotherapy ( P Malaysia is consistent with management of patients from other countries whereby ranibizumab is the most common treatment given to patients with AMD, while PCV patients most commonly receive PDT and ranibizumab combined with PDT therapy.
Maldonado, Natalia; Castro, Bibiana; Berrio, Indira; Manjarrés, Miguel; Robledo, Carlos; Robledo, Jaime
Carbapenems resistance is a growing phenomenon and a threat to public health because of the reduced therapeutic options for resistant infections. A retrospective case-control study was conducted in 2 tertiary-care hospitals in Medellín, Colombia. Fifty patients infected with ertapenem-resistant enterobacteriaceae were compared with a control group consisting of 100 patients with infections caused by ertapenem susceptible enterobacteriaceae. A multivariate logistic regression model was used to identify factors that best explain ertapenem-resistant enterobacteriaceae infections. The factors associated with ertapenem-resistant enterobacteriaceae infections were prior exposure to carbapenems (adjusted OR 3.43; 95% IC 1.08-10.87) and prior exposure to cefepime (adjusted OR 6.46; 95% IC 1.08-38.38). Prior exposure to antibiotics is the factor that best explains the ertapenem-resistant enterobacteriaceae infection in this population, highlighting the importance of antimicrobial stewardship programs in hospitals. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.
Cai, Guozhi; Cook, Guy
Recent literature on language teaching has questioned the established view that a language is most effectively taught monolingually, arguing instead that the student's own language has an important role to play, and this view is now widely accepted. While this literature draws attention to the extremism of some monolingual approaches, and…
Nguyen, Nhung; Williams, John; Nguyen, Tuan
In the light of the education reform driven by Vietnam's government, information communication technologies (ICTs) are becoming integrated into education, while concurrently, teaching approaches are shifting from teacher-centred to student-centred in Vietnam's universities. The innovation is top-down and is being applied on a large scale. Emerging…
Anand Bimari Janagond
Full Text Available Background: Health-care workers (HCWs are at increased risk of acquiring tuberculosis (TB than the general population. While national-level data on the burden of TB in general population is available from reliable sources, nationally representative data on latent tuberculosis infection (LTBI burden in HCWs in the high burden countries is lacking. Methods: A prospective study was carried out to assess the risk of TB infection among HCWs who directly engage in medical duties. HCWs were recruited between January 2014 and December 2015. A structured questionnaire was used for risk assessment of TB infection among HCWs, including sociodemographic characteristics (e.g., age, gender, period of professional work, and employed position, knowledge of TB prevention and control, and history of professional work. A single-step tuberculin skin test (TST using 5 international units (IU; 0.1 ml of tuberculin (purified protein derivative from Mycobacterium bovis Bacillus Calmette–Guérin [BCG]. TB infection was determined using a TST induration ≥10 mm as a cutoff point for TST positivity. TST-positive participants were further subjected to detailed clinical evaluation and chest radiography to rule out active TB. The associations between TB infection and the sociodemographic characteristics, duration of possible exposure to TB while on medical duties, BCG vaccination, and knowledge about TB were estimated using Chi-square test. A two-sided P < 0.05 indicated statistical significance. Results: A total of 206 eligible HCWs signed the informed consent and completed the questionnaires between January 2014 and December 2015. The age of the participants ranged from 18 to 71 years, with a mean age of 27.13 years. TST induration size (mean 6.37 mm the TST results suggested that 36.8% (76/206 were infected with TB using a TST induration ≥10 mm as a cut-off point. All 76 TST-positive HCWs showed no evidence of active TB in clinical evaluation and chest radiography
Al Nuhait, Mohammed; Al Harbi, Khaled; Al Jarboa, Amjad; Bustami, Rami; Alharbi, Shmaylan; Masud, Nazish; Albekairy, Abdulkareem; Almodaimegh, Hind
The term sickness presenteeism (SP) has been described as the act of going to work despite having a state of health that may be regarded as poor enough to justify sick leave. SP has been observed to be prevalent among three-quarters of health care providers (HCPs). Working while sick not only puts patients at risk but also decreases productivity and increases the probability of medical errors. Moreover, SP has been identified as a risk factor for many negative health outcomes among the HCPs themselves, such as depression, burnout, and serious cardiac events. The aim of this study was to identify the reasons for and prevalence of SP and perceptions of the impact of this practice on patient safety among HCPs. A cross-sectional study was conducted, including 279 purposively selected healthcare professionals (doctors, nurses, dentists, pharmacists and other health care professionals) working at the Ministry of National Guard Health Affairs-King Abdulaziz Medical City (MNGHA-KAMC). While nearly all of the participants (91%) believed that working while sick exposed patients to risk, the rate of SP during the past year was reported as 74%, and one fourth of respondents reported working while sick 3-4 times during the past year. More than half of the participants were not aware of the existence of a departmental policy regarding sick leave. The most common reasons reported for working while sick were not wanting to burden co-workers (71%), feelings of duty toward patients (67%), and avoiding an increased future workload caused by absence (59%). A lack of awareness regarding the existing rules and polices related to sick leave was reported by more than half of the participants. Several predisposing and enabling factors were reported as determinants influencing SP, e.g., observation of the practice of SP by peers and feelings of sympathy towards coworkers, including not wanting to overburden them, were reported to be determinants informing the decision of whether to work
Full Text Available Background: High-risk infant follow-up (HRIF program is necessary for early detection, timely intervention, and promotion of health outcomes in vulnerable infants, ethically. The present study was carried out to assess the clinical outcomes of the HRIF Program in Alzahra hospital as a tertiary care centre, in Iran. Materials and Methods: In this cohort study, 5840 neonates were born at Alzahra hospital, from June 1, 2011 to 30th February 2012. Among those who were admitted to neonatal intensive care unit (NICU, 253 infants were recruited by census according to HRIs criteria. After doing necessary measurements and family education, information was recorded in HRI health certificate and then entered in the access database for analysis. Results: From 253 eligible HRIs registered, 241 (95% infants attended the follow-up clinic after discharge. A total of180 cases were recalled for further visits, 110 of which attended the clinic. Anthropometric indices had an increasing trend in the first 6 months of life. There was no significant relation between ages and stages questionnaire (ASQ results and infant birth weight, height, and head circumference. The ratios of intraventricular hemorrhage (IVH and retinopathy of prematurity (ROP were 8.7% and 3.1%, respectively. The incidence of congenital hypothyroidism was 2:341 in HRIs. Conclusions: Although some outcomes, such as ROP, improved in our study compared to similar studies, the findings indicate an impairment of the current follow-up processes and highlight the necessity to modify the current HRIF program. Ethically, we insist on integrating HRIF program in child health services to promote early childhood development.
Mirnia, Kayvan; Akrami, Forouzan; Jodeiry, Behzad; Heidarzadeh, Mohammad; Safavinia, Sima
High-risk infant follow-up (HRIF) program is necessary for early detection, timely intervention, and promotion of health outcomes in vulnerable infants, ethically. The present study was carried out to assess the clinical outcomes of the HRIF Program in Alzahra hospital as a tertiary care centre, in Iran. In this cohort study, 5840 neonates were born at Alzahra hospital, from June 1, 2011 to 30 th February 2012. Among those who were admitted to neonatal intensive care unit (NICU), 253 infants were recruited by census according to HRIs criteria. After doing necessary measurements and family education, information was recorded in HRI health certificate and then entered in the access database for analysis. From 253 eligible HRIs registered, 241 (95%) infants attended the follow-up clinic after discharge. A total of180 cases were recalled for further visits, 110 of which attended the clinic. Anthropometric indices had an increasing trend in the first 6 months of life. There was no significant relation between ages and stages questionnaire (ASQ) results and infant birth weight, height, and head circumference. The ratios of intraventricular hemorrhage (IVH) and retinopathy of prematurity (ROP) were 8.7% and 3.1%, respectively. The incidence of congenital hypothyroidism was 2:341 in HRIs. Although some outcomes, such as ROP, improved in our study compared to similar studies, the findings indicate an impairment of the current follow-up processes and highlight the necessity to modify the current HRIF program. Ethically, we insist on integrating HRIF program in child health services to promote early childhood development.
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.
Ahmed, Kazi Rumana; Jebunessa, Fatema; Hossain, Sharmin; Chowdhury, Hasina Akhter
Diabetes mellitus is likely to have a major effect on vision, and adequate knowledge of its ocular manifestations is of substantial importance to diabetic patients. The study aimed to assess the ocular knowledge and practices among Type 2 diabetic patients of Bangladesh. This cross-sectional study included 122 diabetic patients from the outpatient department (OPD) of the apex diabetic healthcare hospital of the country under the sponsorship of the Diabetic Association of Bangladesh (BIRDEM). A questionnaire was used for collecting data on knowledge on and practices relating to diabetes mellitus with particular emphasis on ocular issues. A predefined score was used for categorizing levels of knowledge and practices as poor, average, and good. Of the 122 respondents, 63%, 55%, 40%, 44%, and 30% reported, blindness, retinopathy, cataracts, glaucoma, and double vision respectively, as complications of diabetes mellitus. About 50% were aware of the need for eye screening for people with the complications. Only 8% monitored their blood glucose levels daily, 15% monitored weekly, and 10% reported checking their blood pressure daily and 43% took their medications as prescribed. The level of diabetic knowledge was poor, moderate and good, respectively, among 24%, 56%, and 20% of the respondents, whereas the practice standards showed that 47%, 31%, and 22% had poor, average, and good levels respectively. The knowledge score was significantly associated with the practice score (r = 0.460, p = 0.001). The results indicate that the ocular knowledge and practices among diabetic patients attending a tertiary-care hospital in Bangladesh is average. Health and eye-care practitioners need to expand diabetic health education and promotion among diabetic patients.
Full Text Available Purpose:To obtain data on the characteristics of low-vision patients seen at a tertiary eye care hospital in India. Methods:Records of 410 patients were retrospectively reviewed at the Centre for Sight Enhancement, L.V.Prasad Eye Institute, Hyderabad, India. Patients underwent a comprehensive clinical low-vision examination. Data obtained included age, gender, consangunity, visual acuity, visual fields, ocular conditions causing low vision and types of low-vision devices and methods prescribed. Results:Two hundred and ninety seven (72% of 450 patients were male. One-fifth were in the 11-20 years age group (21%. Visual acuity in the better eye was <6/18 - 6/60 in almost half these patients (49.3%. One hundred and twenty two patients (29.9% referred with a visual acuity of ≥ 6/18, either had difficulty in reading normal print or had restricted visual fields. The main causes for low vision were: retinitis pigmentosa (19%, diabetic retinopathy (13%, Macular diseases (17.7%, and degenerative myopia (9%. Visual rehabilitation was achieved using accurate correction of ametropia (174 patients, approach magnification (74 patients and telescopes (45 patients for recognising faces, watching television and board work. Spectacle magnifiers (187 patients, hand/stand magnifiers (9 patients, closed-circuit television (3 patients, overhead illumination lamp (143 patients and reading stand (24 patients were prescribed for reading tasks. Light control devices (146 patients were used for glare control, and cane (128 patients and flashlight (50 patients for mobility. Patients were trained in activities to improve their daily living skills, (54 patients; counselled in environmental modification (144 patients and ancillary care (63 patients for educational and vocational needs. Conclusion:Data obtained from this study elucidates the characteristics of low-vision patients. This information is likely to help in the development of appropriate low vision services.
Suriya, Chutikarn; Kasatpibal, Nongyao; Kunaviktikul, Wipada; Kayee, Toranee
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. To determine the diagnostic indicators of peptic ulcer perforation. 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). 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). Five diagnostic indicators for peptic ulcer perforation monitoring were suggested from this study. Improving diagnostic indicators for medical care may improve the outcome of patients that have perforated peptic ulcer.
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.
Tripp, Dean A; Nickel, J Curtis; Krsmanovic, Adrijana
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......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...... of psychosocial variables on patient SI. Results: Compared to 6% in healthy controls, 23% of patients endorsed SI in the past two weeks. Correlations between SI, depression, and catastrophizing across controls and cases show that for controls, SI is associated with greater pain (0.31; pdepression only...
Tripp, Dean A; Nickel, J Curtis; Krsmanovic, Adrijana; Pontari, Michel; Moldwin, Robert; Mayer, Robert; Carr, Lesley K; Yang, Claire C; Nordling, Jorgen
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). The patients are women managed at tertiary care centres (n=190). Controls were recruited from the community (n=117). Both groups completed questionnaires on demographics, pain (McGill Pain Questionnaire), IC/BPS symptoms, and psychological variables. Univariate and multivariate hierarchical regression modelling was conducted to examine the strength of associations and unique effects of psychosocial variables on patient SI. Compared to 6% in healthy controls, 23% of patients endorsed SI in the past two weeks. Correlations between SI, depression, and catastrophizing across controls and cases show that for controls, SI is associated with greater pain (0.31; ptreatment of disease symptoms, but also early detection/treatment of associated psychosocial problems.
Anis-ur-Rehman; Qureshi, Azhar Munir; Najeeb, Shehzad; Siddiqui, Tahir Saeed; Idris, Muhammad; Ahmad, Tausif
Perinatal as well as neonatal mortality record in our country is one of the highest in the world. Home deliveries, lack of adequate facilities, poverty and lack of education are sonme of the important known causes. The present study was planned to determine neonatal mortality in Hazara. Hospital records of neonatal admissions at Ayub Teaching Hospital (ATH) Abbottabad from 1st January 2007-31st December 2007 were analysed retrospectively. Percent neonatal mortality was calculated from the record, along with the causes of neonatal mortality. A total of 1705 neonates were admitted in the study period at the department of neonatology Ayub Teaching Hospital Abbottabad. Out of 1,705 neonates 947 (56%) were males while 857 (44%) were females with a male to female ratio of 1.24:1 . Majority, 1,411 out of 1,705 (83%), of the neonates was admitted during the 1st week of their life, mean age 6 days. Asphyxia, sepsis and prematurity were the three most common causes of neonatal admissions contributing 27%, 26% and 24% respectively. Overall mortality was 11%. Neonatal mortality is an important contributing factor to infant mortality in Hazara Division. Majority of patients was admitted in the first week of life which indicates that good antenatal and natal care can reduce the mortality and morbidity of our neonates. Improvement in the prenatal, natal and nursery care as a whole can reduce the neonatal mortality in preterm as well as full term neonates.
Hamid, M.H.; Maqbool, S.
To determine the frequency, causative organisms and susceptibility pattern of nosocomial bloodstream infections in children. All children admitted to the unit during the study period were daily evaluated for features suggestive of nosocomial infection. In addition to other investigations, blood cultures were done in all suspected cases for the confirmation of nosocomial bloodstream infection (BSI). Nosocomial infection was defined according to the criteria set by Centre for Disease Control and Prevention. Demographic, microbiological and other variables were carefully studied to analyze frequency, incidence rate, spectrum of isolates and susceptibility pattern. Children with and without nosocomial BSI were compared with regard to age, duration of stay in hospital, need and duration of ventilation and the outcome. Of the total 406 admissions, 134 children were suspected to have nosocomial infection on at least 214 occasions (episodes). Blood cultures yielded growth of pathological organisms in 62 of these episodes, giving the frequency of nosocomial BSI as 15.2 per 100 admissions (62/406 episodes). Children with nosocomial bloodstream infection were found to have younger mean age (2.1 vs. 4.1 years), longer average duration of stay (13.1 vs. 6.6 days), more frequent need for ventilation (64% vs. 34%) and longer duration of ventilation (9.7 vs. 4.8 days). Majority of isolates (77%) were gram-negative bacteria; Klebsiella being the most common isolate (n= 23). Aztreonam, Ceftiazidime, Ceforuxime and Ciprofloxacin showed high resistance pattern (33-50%). Isolates showed good sensitivity to Vancomycin (100%), Imipenem (80%), Meropenem (100%) and Co-amoxiclav (88%). The frequency of nosocomial BSI in the observed setting was quite high, having marked impact on the duration of stay and outcome. Emergence of resistant pathogens is alarming. (author)
Mishra, Nitin; Nagpal, Sajanjiv Singh; Chadda, Rakesh K.; Sood, Mamta
Background: Patients with mental health problems in the nonwestern world seek help from a variety of sources, such as the family physicians, psychiatrists, psychologists, traditional faith-healers, or alternative medicine practitioners. Understanding the help-seeking behavior is important from the public health perspective. Materials and Methods: Two hundred new patients visiting a psychiatric outpatient service at a tertiary care hospital were interviewed on a semi-structured questionnaire f...
Ruchi Yadav; Dhiraj Kumar Srivastava; Sanjeev Yadav; Sandip Kumar; Pankaj Kumar Jain; Sachin Gupta
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 s...
Bhawna Sharma; Namrata Saxena; Vineeta Gupta
Background: The study was conducted to determine the frequency, demographic characteristics, indication and fetomaternal outcome associated with emergency obstetric hysterectomy in a tertiary care center. Methods: Thirty cases of emergency obstetric hysterectomy performed during the five-year period from April 2011 to April 2016 were analyzed in the dept. of Gynae and obs. in Shri Guru Ram Rai Institute of Medical Sciences in Dehradun. Results: During the study period there were 30 case...
.... Designing notes which 'prompt' residents to gather patient information vital to optimal care can teach residents the concepts of longitudinal care, particularly chronic disease management and preventive care...
Thippeswamy, Thippeswamy; Chikkegowda, Prathima
Non Communicable Diseases (NCDs) are the major causes of mortality and morbidity globally. Awareness about NCDs and their risk factors has an important role in prevention and management strategies of these NCDs. 1) To assess the awareness of risk factors contributing to NCDs among the patients visiting tertiary care hospital in Mysuru district; 2) To compare the difference in awareness of risk factors for NCDs among the urban and rural patients with/ without NCD visiting the tertiary care hospital. A cross- sectional study was conducted in a tertiary care centre- JSS Hospital, Mysuru, Karnataka from March 2013 - August 2013. The patients visiting Medicine OPD during the period were the study subjects. The subjects were allocated into 4 groups: Urban without any NCD, Urban with atleast one NCD, rural without NCD, rural with atleast one NCD. A pretested questionnaire regarding awareness of risk factors for NCDs was used in the study and frequency and proportions were used to analyse the data. A total of 400 subjects, 100 subjects in each group were included in the study. Out of these subjects about 65% of the urban group and 42% of the rural group subjects were aware of the NCDs and their risk factors. Least awareness was observed among the rural subjects without any NCDs (35%). The awareness of risk factors of NCDs and knowledge regarding prevention of NCDs was not satisfactory. The results highlighted the need and scope for health education and interventions to improve the awareness about NCDs and their risk factors.
Monge Galindo, L; López-Pisón, J; Samper Villagrasa, P; Peña Segura, J L
The purpose of this study is to determine the profile of the demand for paediatric neurology care in a Spanish tertiary hospital over the past 20 years. We studied epidemiological data, reasons for consultation, diagnoses and complementary tests from all patients examined by our Paediatric Neurology Unit in its 20 years of service (from May 1990 to March 2010). We also reviewed data from patients whose first visit took place within the last five years (2005-2010) and compared them to data obtained from a prior study carried out in this Unit from 1990 to 1995. To compare the first 5 years (group 1) with the last 5 years (group 2), we calculated confidence intervals, P<.05, for the frequency distribution (%) in each category. Main reasons for consultation and principal diagnoses for the 12726 patients evaluated in the 20-year period, as well as results from group 1 (2046 patients) and group 2 (4488 patients) corresponding to first and the last 5 years of activity respectively, are presented with their confidence intervals in a series of tables. Variations in the reasons for consultation, diagnoses and complementary tests over time reflect changes determined by medical, scientific and social progress, and organisational changes specific to each hospital. This explains the difficulty of comparing different patient series studied consecutively, which are even more pronounced between different hospitals. Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.
Hegazi, Moustafa; Abdelkader, Alaa; Zaki, Maysaa; El-Deek, Basem
This study was conducted to determine characteristics of Candida colonization and candidemia in the pediatric intensive care unit (PICU) of a tertiary care children's hospital. Patients between 6 months and 15 years of age consecutively admitted to the PICU of Mansoura University Children's Hospital in Mansoura, Egypt, during one year period, were evaluated for Candida colonization and candidemia. Susceptibility of Candida species isolated from blood to fluconazole and amphotericin B was determined by Etest. Sixty-six patients without prior fluconazole prophylaxis had 88 episodes of candidemia, representing 19% of all cases with blood stream infections (BSIs). Candida albicans (CA) and non-albicans Candida (NAC) species accounted for 40% and 60% of candidemia episodes respectively. C. parapsilosis, C. tropicalis, and C. glabrata accounted for 25%, 17%, and 8% of NAC candidemias respectively. Fluconazole resistance was detected in 11.4% and 18.9% of CA and NAC isolates respectively. Of the fluconazole resistant NAC isolates, four were C. krusei. Amphotericin B resistance was detected in 17% of NAC isolates. Candida colonization was detected in 78.8% of patients. Compared to CA candidemia, higher risk for NAC candidemia was associated with age older than 1 year, Candida isolation from endotracheal tube (ETT) and from central venous catheter. Mortality rate was 42.4%, attributable mortality of candidemia was 16.7%. Regression analysis showed that the most significant independent predictors of death were ETT and mechanical ventilation (MV), MV longer than 7 days, and candiduria. This study presents important epidemiological features of Candida BSIs in a non-neonatal population.
Hutton, Eileen K; Stoll, Kathrin; Taha, Natalie
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.
Kilcullen, Meegan; Ireland, Susan
Neonatology has made significant advances in the last 30 years. Despite the advances in treatments, not all neonates survive and a palliative care model is required within the neonatal context. Previous research has focused on the barriers of palliative care provision. A holistic approach to enhancing palliative care provision should include identifying both facilitators and barriers. A strengths-based approach would allow barriers to be addressed while also enhancing facilitators. The current study qualitatively explored perceptions of neonatal nurses about facilitators and barriers to delivery of palliative care and also the impact of the regional location of the unit. The study was conducted at the Townsville Hospital, which is the only regional tertiary neonatal unit in Australia. Semi-structured interviews were conducted with a purposive sample of eight neonatal nurses. Thematic analysis of the data was conducted within a phenomenological framework. Six themes emerged regarding family support and staff factors that were perceived to support the provision of palliative care of a high quality. Staff factors included leadership, clinical knowledge, and morals, values, and beliefs. Family support factors included emotional support, communication, and practices within the unit. Five themes emerged from the data that were perceived to be barriers to providing quality palliative care. Staff perceived education, lack of privacy, isolation, staff characteristics and systemic (policy, and procedure) factors to impact upon palliative care provision. The regional location of the unit also presented unique facilitators and barriers to care. This study identified and explored facilitators and barriers in the delivery of quality palliative care for neonates in a regional tertiary setting. Themes identified suggested that a strengths-approach, which engages and amplifies facilitating factors while identified barriers are addressed or minimized, would be successful in
Demissie, Berhan Solomon; Demissie, Ephrem Solomon
About 19 million children worldwide live with visual impairments resulting from different ocular morbidities. This study aimed to identify the different causes of eye diseases in children visiting a tertiary eye centre at Jimma University Hospital. We conducted a retrospective review of charts of patients of children were seen at JUDO in the year 2010, most of them repeatedly. We evaluated the reports of 341 children (53% males). Children aged 11-15 years constituted the largest group (37%). The commonest childhood ocular diseases diagnosed in 2010 were ocular surface and eyelid infections (30.5%), ocular allergies (28.1%), ocular traumas and injuries (15.5%) and refractive errors (5.8%). Avoidable eye diseases accounted for about 97% of ocular morbidities. Infectious causes of childhood ocular diseases are the major reasons of visits of children seen at the Eye Department. Most of the ocular morbidities in children during the study year were either treatable or preventable. Further study on childhood eye diseases at community level is required to design proper preventive and curative strategies for childhood eye diseases in the region.
Full Text Available BACKGROUND Hydatid Disease (HD is a zoonotic disease caused by the larvae of Echinococcosis granulosus, now become a rare clinical entity in teaching medical college hospitals. This is due to the public education about the disease, mode of spread and treatment available. The aim of the study is to review the epidemiology, clinical presentation, diagnostic methods available, organs affected and treatment available in the tertiary hospitals and outcome. MATERIALS AND METHODS Data Collection- Patients with upper right abdominal pain with radiological and ultrasound findings are included in the study. About twenty patients are taken for this study. Medical managements, surgical procedure done and outcomes are recorded, tabulated and analysed. Research Design- Prospective Study, Research Setting- KAPV Govt. Medical College and Mahatma Gandhi Memorial Govt. Hospital, Trichy, Tamilnadu. Duration- 7 yrs. (2009 to 2016 Sample Size- Twenty. Inclusion CriteriaPatients between 12 to 70 years of age of both sexes. Patient having right upper abdomen or epigastric pain with positive radiological and ultrasound findings. Patient willing to participate in the study. Exclusion Criteria- Patients more than 70 years not willing to participate in the study patients absconded in between the management. RESULTS Liver is a commonest solid organ affected by the hydatid disease. Most of the diagnosis are made accidentally when the patients are investigated for some other diseases. The commonest clinical presentation is right abdominal or epigastric pain with hepatomegaly. The average age group is 45 years. X-ray abdomen, ultrasound abdomen are the most useful investigations. Asymptomatic uncomplicated small cyst less than 5 cms are managed with medical treatment. Symptomatic large cysts are submitted for surgical intervention. CONCLUSION The main source of income in majority of rural population is agriculture and sheep and cattle grazing. WHO is working towards the
Fang, Christina H; Friedman, Remy; White, Priscilla E; Mady, Leila J; Kalyoussef, Evelyne
There are few studies that discuss the issues surrounding emergent awake tracheostomy. We aim to review the indications, anesthesia used, complications, and outcomes of patients undergoing urgent awake tracheostomy. Chart review. Medical charts of patients who underwent an emergent awake tracheostomy at our institution-affiliated tertiary care center over a 5-year period from 2009 to 2014 were reviewed. Data were collected from inpatient, outpatient, and operative records. Sixty-eight patients underwent emergent awake tracheostomy. Over half presented with hoarseness (n=37, 54.4%) and/or stridor (n=37, 54.4%). Acute upper airway obstruction secondary to malignancy was the most common indication and accounted for 58 cases (85.3%). Thirty-nine (70.1%) of the 55 patients with squamous cell carcinoma presented with advanced disease (stage III or IV). Other indications included glottic or subglottic stenosis (4.4%), failure to intubate (2.9%), and other (7.4%). Local anesthesia was used alone in 35.3% of cases and in combination with conscious sedation in 64.7% of cases. Mild bleeding occurred postoperatively in five patients (7.4%). There were no other postoperative complications. Nineteen patients were lost to follow-up. The mean follow-up of 49 patients was 7.2 weeks, ranging from 2 to 261 weeks. Long-term complications occurred in three patients and included tracheitis 7.4% and suprastomal granuloma 2.9%. Eleven patients (22%) were decannulated at a mean of 11.8 months following tracheostomy. Emergent awake tracheostomy should be considered in patients with impeding airway obstruction and is a safe and effective method to secure an airway in these patients. 4. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.
Sharma, Kalpana; Das, Devjani; Joshi, Manish; Barman, Dipjyoti; Sarma, A J
This study is intended to analyze the clinical profile and outcomes of deep neck space infection in diabetic patients in our tertiary care centre. A prospective study of 1 year duration from 30th September 2015 to 30th September 2016 at department of Otorhinolaryngology, Gauhati Medical College and Hospital, Guwahati. A total of 45 diabetic patients who presented with DNSI are included in this study. Their demographic profile, etiology, bacteriology, treatment, duration of hospital stay, complications and outcomes have been analyzed. 45 patients were recorded; 32 (71.11%) were men, and 13 (45%) were women, with a mean age of 63.27 ± 7.55 years. There were 30 patients (66.67%) who had associated systemic diseases apart from diabetes mellitus. The parapharyngeal space in 13 patients (28.89%) was the most commonly involved space. Odontogenic infections in 18 patients (40%) and upper airway infections 9 patients (20%) were the two most common causes. Klebsiella pneumonia in 29 patients (64.44%), was the commonest organism isolated through pus cultures. All the patients except one (97.78%) came with abscess and underwent surgical drainage. One patient (2.22%) with carbuncle underwent regular dressing. Six patients (13.33%) had major complications. Those patients with other underlying systemic diseases or complications tended to have a longer hospital stay and were older. No cases of death has been reported. (mortality rate, 0%). DNSI patients with diabetes have a more severe clinical course. They are likely to have complications more frequently and a longer duration of hospital stay. In clinical practices while dealing with these patients more vigilance is required. On admission empirical antibiotics should cover K. pneumonia. Early surgical drainage remains the main method of treatment. Primary prevention can be achieved by orodental hygiene, regular dental check ups and in this part of the country by avoidance of substance abuse like tobacco chewing.
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.
Ghodasra, Devon H; Eftekhari, Kian; Shah, Ankoor R; VanderBeek, Brian L
To determine the frequency of clinical management changes resulting from inpatient ophthalmic consultations for fungemia and the associated costs. Retrospective case series. Three hundred forty-eight inpatients at a tertiary care center between 2008 and 2012 with positive fungal blood culture results, 238 of whom underwent an ophthalmologic consultation. Inpatient charts of all fungemic patients were reviewed. Costs were standardized to the year 2014. The Student t test was used for all continuous variables and the Pearson chi-square test was used for categorical variables. Prevalence of ocular involvement, rate of change in clinical management, mortality rate of fungemic patients, and costs of ophthalmic consultation. Twenty-two (9.2%) of 238 consulted patients with fungemia had ocular involvement. Twenty patients had chorioretinitis and 2 had endophthalmitis. Only 9 patients (3.7%) had a change in management because of the ophthalmic consultation. One patient underwent bilateral intravitreal injections. Thirty percent of consulted patients died before discharge or were discharged to hospice. The total cost of new consults was $36 927.54 ($204.19/initial level 5 visit and $138.63/initial level 4). The cost of follow-up visits was $13 655.44 ($104.24/visit). On average, 26.4 patients were evaluated to find 1 patient needing change in management, with an average cost of $5620.33 per change in 1 patient's management. Clinical management changes resulting from ophthalmic consultation in fungemic patients were uncommon. Associated costs were high for these consults in a patient population with a high mortality rate. Together, these data suggest that the usefulness of routine ophthalmic consultations for all fungemic patients is likely to be low. Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
Kayal, Ashok Kumar; Goswami, Munindra; Das, Marami; Basumatary, Lakhshya Jyoti; Bhowmick, Suvorit Subhas; Synmon, Baiakmenlang
The discovery of antibodies against aquaporin-4 and evolving concepts of noncompressive myelopathies in the 21 st century have made a major impact on the etiological profile of these diseases, with few cases turning out to be idiopathic. To find causes of noncompressive myelopathy in a tertiary care hospital of Northeast India. 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. 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 B 12 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. Underlying etiology (demyelinating, autoimmune, infectious, vascular, metabolic disorder, or physical agent) was found in 68% patients of noncompressive myelopathy.
Rahman, A. S.; Jamal, Q.; Riaz, M.
Objective: To observe the prevalence of recognised and unrecognised depression among in-patients. Methods: The cross-sectional study was conducted from June 2012 to May 2013 at a tertiary care hospital in Karachi, and comprised patients admitted in the Medicine and Surgical departments at the time. Patients with known history of depression or on anti-depressants or on anti-psychotics, or with suicidal attempt were excluded. The prevalence of unrecognised depression was then perceived using Patient Health Qurstionnaire-9. Statistical analysis was performed using SPSS 20. Results: Of the 1180 patients, 432(36.6 percent) either had history of depression or on were on anti-depressants. The study sample, as such, comprised 748(65 percent), and of them 399(53 percent) were from the Medicine and 349(47 percent) patients were from Surgery department. Prevalence of recognised depression was 36.6 percent; 48 percent in Medical and 14 percent in Surgical patients. Unrecognised depression was 51.2 percent; 45.3 percent in Medical and 53.6 in Surgical patients. Overall prevalence was 87.9 percent; 93.4 percent in Medical and 53 percent in Surgical patients. Gender was not found to be significantly associated with depression in Medical (p= 0.367) and Surgical (p=0.606) patients. No depression was found in 48(12 percent) Medical patients and 131(37.5 percent) Surgical patients. Conclusion: More than one-third of in-patients had co-morbid depression diagnoses, mostly unrecognised by their clinicians. (author)
Guerra-Sáenz, E K; Narváez-Navarro, A G; Hernández-López, A C; Rojas-Delgado, C E; Ruíz-Cantú, G; Cordero-Pérez, P; Hernández-Guedea, M; Zapata-Chavira, H; Escobedo-Villarreal, M M; Muñoz-Espinosa, L; Pérez Rodríguez, E
This study aims to identify the causes for the incomplete donation process at a tertiary care hospital. A descriptive, retrospective study was performed; all potential donors reported to the Transplant Service within the period of 2005 to 2014 were included. Descriptive statistics were used across frequencies and proportions for categorical variables, central tendency, and dispersion for continuous variables. The total number of deaths reported at the University Hospital (HU) was 8472, of which 815 (n = 815) were reported to COETRA ("Consejo Estatal de Trasplantes"). Among organ or tissue donors, the main known cause of death was head trauma (HT) in 26% (72). Cardiac arrest (CA) as cause of death provided the largest number of donations (141, 57%); of these, 102 (41%) were male and 39 (16%) were female. In comparison, brain death (BD) provided 104 (43%); of these, 65 (27%) were male, and 39 (16%) were female. The age interval was with a higher donation rate was 45 to 49 y (BD 18, CA 22). Donation request was not performed in 359 patients because of medical contraindication 60% (215), rapid deterioration 18% (64), and incomplete donation process 8% (27). Of 452 organ requests, 207 were not accomplished, because of body integrity 28% (57), family disagreement 20% (42), and no acceptance of BE 13% (26). Opportunity areas: (1) Ensure the notification of all deaths to Transplant Department for identification of potential donors; (2) Reduce rapid deterioration and raise number of completed donation protocols; (3) Increase the donation rate. Copyright © 2016 Elsevier Inc. All rights reserved.
Full Text Available Stenotrophomonas maltophilia is an environmental bacterium and an opportunistic pathogen usually associated with healthcare-associated infections, which has recently been recognized as a globally multi-drug resistant organism. The aim of this study was genotyping and physiological characterization of Stenotrophomonas maltophilia isolated in a large, tertiary care pediatric hospital in Belgrade, Serbia, hosting the national reference cystic fibrosis (CF center for pediatric and adult patients.We characterized 42 strains of cystic fibrosis (CF and 46 strains of non-cystic fibrosis (non-CF origin isolated from 2013 to 2015 in order to investigate their genetic relatedness and phenotypic traits. Genotyping was performed using sequencing of 16S rRNA gene, Pulse Field Gel Electrophoresis (PFGE and Multi locus sequencing typing (MLST analysis. Sensitivity to five relevant antimicrobial agents was determined, namely trimethoprim/sulfamethoxazole (TMP/SMX, chloramphenicol, ciprofloxacin, levofloxacin and tetracycline. Surface characteristics, motility, biofilm formation and adhesion to mucin were tested in all strains. Statistical approach was used to determine correlations between obtained results.Most of the isolates were not genetically related. Six new sequence types were determined. Strains were uniformly sensitive to all tested antimicrobial agents. The majority of isolates (89.8% were able to form biofilm with almost equal representation in both CF and non-CF strains. Swimming motility was observed in all strains, while none of them exhibited swarming motility. Among strains able to adhere to mucin, no differences between CF and non-CF isolates were observed.High genetic diversity among isolates implies the absence of clonal spread within the hospital. Positive correlation between motility, biofilm formation and adhesion to mucin was demonstrated. Biofilm formation and motility were more pronounced among non-CF than CF isolates.
Shahid, M.; Sarfraz, A.; Shahid, N.
To assess the clinical presentations and short-term outcomes of patients with thyroiditis presenting to a tertiary care hospital in Karachi, Pakistan. Study Design: Case series. Place and Duration of Study: Department of Endocrinology, Liaquat National Hospital, Karachi, from June 2014 to February 2015. Methodology: Patients between 18 and 70 years of age with acute onset of thyroiditis confirmed on thyroid scan or clinical judgment presenting to the outpatient services were included in the study. Pregnant females, psychiatric patients and patients having other chronic illnesses were excluded from the study. Results: A total of 26 patients with thyroiditis attended the endocrine clinic. Mean age of patients was 41.2 ± 11.12 years. There were 18 (69.2%) females. Clinical presentations were fever (65.4%), tender neck (23.1%), goiter (19.2%), localized tenderness in neck and palpable lymph nodes (26.9%). Major symptoms reported were: sore throat (69.2%), weight loss (38.5%), upper respiratory tract infection, thyroid pain, tremor, sweating and fever of unknown origin in 26.9% cases. All the patients had raised Erythrocyte Sedimentation Rate (ESR). Low Thyroid Stimulating Hormone (TSH) < 0.4 mlU/L was seen in 88.5% and 57.7% had raised Free T4 > 1.8 ng/dL. Complete recovery was seen in 88.5% patients while 11.5% had early hypothyroidism. Conclusion: Fever and sore throat were the main presenting features of thyroiditis patients. ESR was raised in all patients. A majority of patients had complete recovery with appropriate management; however, few cases developed hypothyroidism. (author)
Singh, Prashant; Sharma, Piyush Kumar; Agnihotri, Abhishek; Jyotsna, Viveka P; Das, Prasenjit; Gupta, Siddhartha Datta; Makharia, Govind K; Khadgawat, Rajesh
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.
Anand, Tanu; Grover, Shekhar; Kumar, Rajesh; Kumar, Madhan; Ingle, Gopal Krishna
Healthcare workers particularly doctors are at high risk of being victims of verbal and physical violence perpetrated by patients or their relatives. There is a paucity of studies on work-related violence against doctors in India. We aimed to assess the exposure of workplace violence among doctors, its consequences among those who experienced it and its perceived risk factors. This study was done among doctors working in a tertiary care hospital in Delhi. Data were collected by using a self-administered questionnaire containing items for assessment of workplace violence against doctors, its consequences among those who were assaulted, reporting mechanisms and perceived risk factors. Of the 169 respondents, 104 (61.4%) were men. The mean (SD) age of the study group was 28.6 (4.2) years. Sixty-nine doctors (40.8%) reported being exposed to violence at their workplace in the past 12 months. However, there was no gender-wise difference in the exposure to violence (p=0.86). The point of delivery of emergency services was reported as the most common place for experiencing violence. Verbal abuse was the most common form of violence reported (n=52; 75.4%). Anger, frustration and irritability were the most common symptoms experienced by the doctors who were subjected to violence at the workplace. Only 44.2% of doctors reported the event to the authorities. 'Poor communication skills' was considered to be the most common physician factor responsible for workplace violence against doctors. A large proportion of doctors are victims of violence by their patients or relatives. Violence is being under-reported. There is a need to encourage reporting of violence and prepare healthcare facilities to tackle this emerging issue for the safety of physicians.
Full Text Available Background: The aim of the study was to review the cases of all children who had gastric volvulus from 2002 to 2007 at a tertiary care centre in India and to compare the outcome of management with the reported series on gastric volvulus in a paediatric age group. Materials and Methods: This was a retrospective study of eight children with an age range between 10 days and 2 years who were managed for gastric volvulus between 2002 and 2007. The records of these patients were reviewed for clinical features, investigations, management and outcome. Results: All patients were less than 3 years of age with female preponderance (n = 5. Three patients had acute presentation and three had acute-on-chronic symptoms, while two had chronic gastric volvulus. The commonest symptom was abdominal distension. Two patients were diagnosed by barium studies and six had clinical suspicion because of their symptoms and were confirmed intra-operatively. Seven had secondary gastric volvulus of organo axial type with associated pathologies as congenital diaphragmatic hernia (n = 5, Para oesophageal hiatus hernia (n = 2, and one had primary gastric volvulus in a postoperative period in an operated case for a tracheo-oesophageal fistula (n = 1. Seven patients were symptom free at follow-up; one patient succumbed due to septicaemia in the immediate post-operative period which was not related to the pathology of gastric volvulus. Conclusion: Gastric volvulus is a rare condition in children and requires prompt diagnosis and urgent intervention in acute presentation where it mimics acute abdomen and strong clinical suspicion.
Pallavi Dnyaneshwar Admane
Full Text Available Objective: Antimicrobial agents are the greatest contribution to 20th century, which are used for cure and prevention of infections. Widespread use of antimicrobials has facilitated the development of resistance.Aim: the study was to assess the use of antimicrobials in tertiary care hospital in Maharashtra.Method: Prescription audit was done to assess the use of antimicrobials. Total 1942 prescriptions were analyzed for average number of drugs prescribed, antimicrobials prescribed by generic name or brand name, percentage of antibiotics among the prescribed drugs, use of fixed drug combinations, if any.Statistical analysis used: Data was analyzed by percentage.Result: Demographic analysis showed that out of 1942 patients in OPD, most were male (56.38 and in the age group between 35 to 50 years. In 1942 prescription, 30.25% drugs were antimicrobials. Three drugs were prescribed in 52.15% of the prescription, followed by 4 drugs in 19.78% prescriptions. 79.18% prescriptions were prescribed by generic name while 20.82% were prescribed by brand name. 29.18% of drugs were fixed dose combinations of all the antibiotics were prescribed empirically on the basis of provisional diagnosis. Of the total of antibiotics prescribed, amoxicillin was prescribed in 50.66% of patients, followed by cotrimoxazole in 26.05 % patients, cephalexin (8.50% were used commonly. Conclusion: The rational use of antimicrobial agents is one of the main contributors to control worldwide emergence of antibacterial resistance, side effects and reduced cost of the treatment.
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
Kashef, Mohammad Amin; Friderici, Jennifer; Hernandez-Montfort, Jaime; Atreya, Auras R; Lindenauer, Peter; Lagu, Tara
There have been no recent studies describing the management and outcomes of patients with infective endocarditis (IE). We conducted a retrospective cohort study of adult patients admitted to a tertiary medical center from 2007 to 2011 with a Duke criteria consistent discharge diagnosis of IE. We examined concordance with guideline recommendations. Outcomes included embolic events, inhospital and 1-year mortality, length of stay (LOS) and cardiac surgery. We used descriptive statistics to describe the cohort and Fisher exact and unpaired t tests to compare native valve endocarditis (NVE) with prosthetic valve endocarditis (PVE). Of 170 patients, definite IE was present in 135 (79.4%) and possible IE in 35 (20.6%); 74.7% had NVE, and 25.3% had PVE. Mean ± standard deviation age was 60.0 ± 17.9 years. Comparing PVE to NVE, patients with PVE were less likely to have embolic events (14.0% vs. 32.3%; P = 0.03), had shorter LOS (median 12.0 days vs. 14.0 days; P = 0.047), but they did not show a statistically significant difference in inhospital mortality (20.9% vs. 12.6%; P = 0.21). Of 170, patients 27.6% (n = 47) underwent valve surgery. Most patients received timely blood cultures and antibiotics. Guideline-recommended consults were underused, with 86.5%, 54.1%, and 47.1% of patients receiving infectious disease, cardiac surgery, and cardiology consultation, respectively. As the number of consultations increased (from 0 to 3), we observed a nonsignificant trend toward reduction in 6-month readmission and 12-month mortality. IE remains a disease with significant morbidity and mortality. There are gaps in the care of IE patients, most notably underuse of specialty consultation. Journal of Hospital Medicine 2017;12:414-420. © 2017 Society of Hospital Medicine
Tonita M Noronha
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.
Ghadersohi, Saied; Young, Nancy M; Smith-Bronstein, Virginia; Hoff, Stephen; Billings, Kathleen R
To describe the presentation and management of acute complicated mastoiditis in children. Retrospective case series. An analysis of pediatric patients with acute complicated mastoiditis treated at an urban, tertiary care children's hospital from 2007 to 2014 was performed. Forty-eight patients presented with a total of 67 complications of acute mastoiditis. Mean age at presentation was 4.8 years (range = 0.1-15.3 years). The most common complications were subperiosteal abscess (n = 22, 45.8%), epidural abscess (n = 16, 33.3%), and sigmoid sinus thrombosis (n = 14, 29.2%). The most common pathogens isolated included Streptococcus pneumoniae (n = 14, 29.2%) and group A streptococcus (n = 10, 20.8%). Multidrug resistance was not associated with complication type. Surgical management included myringotomy ± tympanostomy tube placement in 46 (95.8%) patients (the only surgery in 10), drainage of subperiosteal abscess without mastoidectomy in 18 (37.5%) patients, and mastoidectomy in 21 (43.8%) total patients. Patients presenting with intracranial complications were the most likely to undergo a mastoidectomy. Anticoagulation was used in the management of nine of 14 (64.3%) patients presenting with sigmoid sinus thrombosis. Neurosurgical interventions (n = 7, 14.6% patients) were primarily performed to manage increased intracranial pressure. Subperiosteal abscess was the most common complication of acute mastoiditis, and when occurring as the sole complication was successfully managed with antibiotics and surgical intervention that did not include mastoidectomy. Epidural abscess and sigmoid sinus thrombosis were more prevalent than reported in prior series and were managed more aggressively. These patients were more likely to need neurosurgical interventions. 4. Laryngoscope, 127:2321-2327, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.
Akhtar, Ali; Khan, Amer Hayat; Sulaiman, Syed Azhar Syed; Soo, Chow Ting; Khan, Kashifullah
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.
Maheshwari, A. K.; Kumar, P.; Alam, M. T.; Aurangzeb, M.; Imran, K.; Masroor, M.; Parkash, J.
Objective: To determine the frequency of hyperthermia in acute ischemic stroke patients visiting a tertiary care hospital in a developing country. Study Design: Cross-sectional, observational study. Place and Duration of Study: Medical Wards of Civil Hospital, Karachi, from January to June 2013. Methodology: 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). Result: A total 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 percentage) were males and 45 (42.5 percentage) females. Among all patients, 51.9 percentage presented with loss of consciousness, 30.2 percentage with slurred speech, 77.4 percentage with limb weakness, and 9.4 percentage with decrease vision. A total of 17 (16 percentage) patients with ischemic stroke developed hyperthermia. When the prevalence of hyperthermia was stratified according to age, among patients of < 60 years of age, 26 percentage developed hyperthermia compared to 7.1 percentage in patients of = 60 years of age (p=0.008). On gender stratification, among male patients, 14.8 percentage developed hyperthermia compared to 17.8 percentage in female patients (p=0.43). Conclusion: It is concluded from this study that the frequency of hyperthermia in ischemic stroke was 16 percentage 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. (author)
Full Text Available Introduction: Electroconvulsive therapy (ECT is frequently used treatment procedure, and is utilized more often for severe, treatment-resistant, or refractory psychiatric disorders. However, published data on the use of ECT is limited, more so for special population like older adults. Aim: The aim of the study was to explore the clinical, demographic, and diagnostic profiles of older adults, and the parameters of ECT treatment, in a tertiary care Geriatric Mental Health set up. Materials and Methods: Approval to review the case notes was obtained from the Institutional Ethical Committee. The individuals were aged 60 years and above and had received ECT between January 2014 and May 2017. The relevant details pertaining to the aims of the study were recorded in a spreadsheet. Results: Twenty-five courses (absolute number = 191 of ECT were given to 21 patients (mean age = 67.44 ± 9.8 years with mean of 7.64 ± 3.6 ECT per patient. Majority of the patients belonged to age group 60–69 years, and were male (81%. Depression was the most common diagnosis for giving ECT (43% in these individuals, and poor response to pharmacological treatment (81% was the most common indication. The mean duration of the seizure elicited was 28.8 ± 13.2 s, and a therapeutic response was seen in 86% of cases. No major complications were noted during ECT treatment. Conclusion: When used judiciously and with trained staff, ECT is an effective and relatively safe mode of treatment even in older adults.
Galate, Lata Baswanna; Agrawal, Sachee R; Shastri, Jayanthi S; Londhey, Vikram
Chikungunya fever (CHIK) is an arboviral disease. Dengue fever (DENG) and CHIK are indistinguishable clinically and need to be differentiated by laboratory investigations. 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). 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). 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. IgM ELISA for Chikungunya infection should be included in the routine laboratory tests for acute febrile illness.
Xu, Shengyong; Yu, Xuezhong; Li, Yi; Shi, Donglei; Huang, Jingya; Gao, Qian; Zhang, Ting; Guo, Shigong
To investigate the status of antibiotics use in acute appendicitis patients who undergo appendectomy in a Chinese tertiary care hospital. A retrospective analysis of 93 patients who underwent appendectomy from June 1, 2011 to May 30, 2012 and had recorded use of intravenous antibiotics. We defined simple appendicitis and suppurative appendicitis as mild appendicitis. Gangrenous appendicitis and perforated appendicitis were classified as advanced appendicitis. The occurrence of advanced appendicitis, postoperative complications and length of hospital stay were the three major end points for outcomes analysis. 100 % of the patients received antibiotics therapy before and after operation. 45 patients received Fluoroquinolones (48.4 %), 41 patients received Cephalosporins (44.1 %) and 7 patients received Carbapenems (7.5 %). We found no statistical difference between antibiotics selection and the occurrence of advanced appendicitis (P = 0.3337). Both the monovariate analysis and multivariate analysis showed no statistical difference between antibiotics selection and the postoperative complications (P > 0.05). The average stay of patients receiving Fluoroquinolones was 2.6 days shorter than patients who received Cephalosporins (P = 0.0085). It is a lack of a standardized guideline for antibiotics selection in our hospital. All the antibiotics prescription were empirical. We tended to choose high levels of antibiotics, pay insufficient attention to the anaerobic bacteria and have a long duration of antibiotics therapy. We also found that antibiotics selection bore no relationship with the occurrence of advanced appendicitis and postoperative complications. Fluoroquinolones may lead to a shorter hospital stay, but this result may also be affected by the fewer underlying diseases and lower severity of the patients.
Ahmed, Aliya; Latif, Naveed; Khan, Robyna
Background: Post-operative pain is often inadequately treated. Optimal utilization of the available resources is essential for improving pain management. Aims: The aim of our study was to determine pain management strategies employed after major abdominal surgeries at our institute and their efficacy and safety. Settings and Design: Prospective observational study conducted at a tertiary care hospital. Materials and Methods: Patients undergoing elective major abdominal surgeries were included. Post-operative analgesic strategy, co-analgesics used, pain and sedation scores, motor block, nausea and vomiting were recorded and patient satisfaction was determined. Results: Data was collected on 100 patients. Epidural analgesia was used in 61, patient controlled intravenous analgesia (PCIA) in 25 and opioid infusion in 14 patients. Multimodal analgesia was employed in 98 patients. The level of epidural was between L1-L3 in 31, T10-L1 in 20 and T8-T10 in 10 patients. Pethidine was used in 80% of patients receiving PCIA. Patients with epidurals at T8-T10 had lower pain scores. Fifteen patients had motor block, 73% of which were with epidural at L1-L3. Fourteen patients complained of nausea. Ninety nine out of 100 patients were satisfied with their analgesia. 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. PMID:24249983
Irfan Ahmad Shah
Full Text Available Objective: The objective of this study was to describe the demographic features, clinical presentation, and management and outcome of fifty cases of nonalcoholic Wernicke's encephalopathy from a tertiary care hospital of a region with reported incidence of thiamine deficiency disorders. Materials and Methods: In a retrospective study, fifty adult cases of Wernicke's encephalopathy were analyzed. The diagnosis of Wernicke's encephalopathy was made according to the European federation of neurological societies guidelines 2010. Response to thiamine replacement and associated brain magnetic resonance imaging (MRI findings were also considered as supportive evidence. Results: The mean age of patients was 50.38 years with 20 males and 30 females. The most common clinical manifestations were alteration in sensorium in 30 (60%, ataxia in 18 (36%, memory impairment in 15 (30%, nystagmus in 35 (70%, ophthalmoparesis in 11 (22%, and seizures in 4 (8%. A total of 42 patients had a history of recurrent vomiting. All patients had polished rice as their staple diet. Thirty-five patients had associated polyneuropathy and 15 had a gastrointestinal disorder. Twenty patients underwent MRI which showed both typical and atypical lesions. Majority of patients showed partial or complete response to intravenous thiamine. On discharge, the most common residual symptoms were lower limb weakness, ataxia, and memory impairment. Conclusion: The study shows high incidence of nonalcoholic Wernicke's encephalopathy in the region with predominant causative factor being a thiamine deficient diet. Recurrent vomiting can be a prominent early symptom of thiamine deficiency and its recognition can help in the early diagnosis of Wernicke's encephalopathy and related thiamine deficiency disorders. Thiamine fortification of food should be done in areas with reported incidence of thiamine deficiency disorders.
Cheema, H. A.; Malik, H. S.; Parkash, A.; Fayyaz, Z.
Objective: To determine the frequency, presentation and outcome of various inherited metabolic diseases in children presenting in a tertiary care hospital, Lahore, Pakistan. Study Design: An observational study. Place and Duration of Study: Gastroenterology, Hepatology and Nutrition Department of The Children Hospital and Institute of Child Health, Lahore, from January 2011 to October 2014. Methodology: All children aged < 14 years with high suspicion of a metabolic disorder were inducted. Routine and radiological investigation were carried out at the study place. Comprehensive diagnostic testing of particular metabolic disorder was sent abroad. Those with a specific metabolic disorder were included in the study while those with normal metabolic work-up were excluded. All data was collected on preformed proforma. Result: A total of 239 patients were enrolled. Nineteen different types of inherited metabolic disorders were diagnosed in 180 patients; age ranged from 8 days to 14 years. Consanguinity was positive in 175 (97 percentage) among the parents of the affected children, with previously affected siblings in 64 (35.5 percentage). The most frequent disorders were inherited disorders of carbohydrate metabolism (92, 51 percentage), lipid storage disease (59, 32.7 percentage), organic acidemia and energy defects (18, 10 percentage), amino acid disorder (6, 3.3 percentage), and miscellaneous (4, 2.2 percentage). Fifty-eight (32.2 percentage) presented with acute metabolic crisis, 28 (15.5 percentage) patients presented with early onset liver failure, and 24 (13.3 percentage) with mental retardation. Out of these, 16 (8.8 percentage) expired. Conclusion: Glycogen storage disorders being the commonest followed by Gaucher disease and Galactosemia. The associated complications resulted in high morbidity and mortality. (author)
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.
Ready-to-use-therapeutic foods (RUTF) are an important component of the effective outpatient treatment of severe wasting because most of the child deaths in the world especially in developing countries is due to malnutrition. The objective of the study was to evaluate the effectiveness and acceptability of ready to use therapeutic food among malnourished children in a tertiary care hospital. Methods: An observational exploratory study based on sixty subjects with 3-120 months of age, malnourished children were chosen by universal sampling from Children Hospital Lahore, Pakistan, during the time period 1st September 2012 to 30th November 2012 with the approval of ethical committee. The study tool for investigation was a well-structured questionnaire. Results: The highest proportion of malnourished children belonged to urban areas (71.67%) and age group <24 months (65%). The effect of RUTF on weight for height and weight for age Z score from baseline to the end of follow-up was statistically significant (Paired sample t-test) (p=0.000, 0.000) but there was no significant effect of RUTF on height for age (p-value=0.14).The acceptance of food among patients was good, the proportion of patient was higher who consumed ready to use therapeutic food easily (70%), percentage of vomiting (16.7%) and complaints of diarrhoea (46.7%) after taking RUTF was less in patients. All mothers were satisfied from ready to use therapeutic foods (100%). Conclusion: Malnourished children gained weight after the short term supplementation of ready to use therapeutic food but had no significant effect on height of the patients. Its acceptability in term of taste, amount consumes and demand was good. Mother's perception was also satisfactory regarding these foods. (author)
Cheema Rizwan A; AlKhars Wajeeha; AlAskar, Essam; Amin, Yasir M
Because no previous studies have addressed the issue, we describe clinical characteristics and surgical outcome of patients with rhegmatogenous retinal detachment (RRD) in a pediatric population of the Eastern province of Saudi Arabia. We conducted a retrospective review of all consecutive cases of pediatric RRD (0-18 years) patients presenting at Dhahran Eye Specialist Hospital, a tertiary care hospital, in the Eastern Province of Saudi Arabia over a period of 3 years. Twenty patients were included in the study, accounting for 9.4% of all retinal detachment surgery cases performed over a period of 3 years (January 2006 to December 2008). The median age was 11.0 years, (range, birth to 18 years). Trauma, (45%) myopia/vitreoretinal degeneration (10%) and prior ocular surgery (25%) were significant risk factors for RRD. Proliferative vitreoretinopathy (PVR) more than grade C was present in 14/20 (70%) of cases. Most patients (15/20, 75%) were treated with pars plana vitrectomy and placement of an encircling buckle, while silicone oil or gas was used as tamponade in 13/20 (65%) patients. Surgery was successful in 17/20 (85%) cases in achieving retinal re-attachment. Visual acuity improved significantly following surgery (Mean preop 2.146 LogMAR, Mean postop 1.497 LogMAR) ( P= .014). Longer duration of RRD ( P =.007) and macular involvement ( P =.05) were associated with worse anatomical outcomes following surgery. Pediatric RRD in the Eastern province is often associated with predisposing pathology. Surgery is successful in achieving anatomical reattachment of the retina in a majority of cases with improvement of visual acuity. (author)
Banerjee, I; Bhadury, T
Self-medication is a widely prevalent practice in India. It assumes a special significance among medical students as they are the future medical practitioners. To assess the pattern of self-medication practice among undergraduate medical students. Tertiary care medical college in West Bengal, India. A cross-sectional questionnaire-based study was conducted among the undergraduate medical students. Out of 500 students of the institute, 482 consented for the study and filled in the supplied questionnaire. Fourteen incomplete questionnaires were excluded and the remaining 468 analyzed. It was found that 267 (57.05%) respondents practiced self-medication. The principal morbidities for seeking self-medication included cough and common cold as reported by 94 students (35.21%) followed by diarrhea (68 students) (25.47%), fever (42 students) (15.73%), headache (40 students) (14.98%) and pain abdomen due to heartburn/ peptic ulcer (23 students) (8.61%). Drugs/ drug groups commonly used for self-medication included antibiotics (31.09%) followed by analgesics (23.21%), antipyretics (17.98%), antiulcer agents (8.99%), cough suppressant (7.87%), multivitamins (6.37%) and antihelminthics (4.49%). Among reasons for seeking self-medication, 126 students (47.19%) felt that their illness was mild while 76 (28.46%) preferred as it is time-saving. About 42 students (15.73%) cited cost-effectiveness as the primary reason while 23 (8.62%) preferred because of urgency. Our study shows that self-medication is widely practiced among students of the institute. In this situation, faculties should create awareness and educate their students regarding advantages and disadvantages of self-medication.
Munir, S. I.; Waheed, K.; Khanum, A.; Iqbal, R.; Eusaph, A. Z.; Hanif, A.
Objective: To determine the frequency and risk factors of Group B Streptococci (GBS) in pregnant patients in third trimester in a tertiary care hospital in Lahore. Study Design: Cross-sectional, prospective study. Place and Duration of Study: Lady Willingdon Hospital, Lahore, from October 2014 to March 2015. Methodology: Sterile lower vaginal swabs were taken from 200 women aged 20 years and over, in third trimester, with no history of vaginal bleeding, ruptured membrane, recent intake of antibiotics or chronic illness. These swabs were cultured for detection of GBS. The risk factors of GBS and its frequency were noted in the pregnant population. Quantitative and qualitative data was analyzed by SPSS version 20. Chi-square test was applied to see association between diagnosis of GBS and other categorical variables. P-value 0.05 was considered as statistically significant. Results: In this study, the mean age of all the females was 26.36 ±4.32 years and mean duration of pregnancy was 35.54 ±2.65 weeks. Frequency of GBS in pregnant women was found as 14 percentage. We observed significant association of GBS with parity and previous history of miscarriage (p-value = 0.033 and 0.010 respectively). Moreover, significant association between vaginal discharge and GBS was also found (p = 0.027). Conclusion: GBS is present in a small but significant number of pregnant women in our setting and it has association with multiparity, vaginal discharge during pregnancy, and previous history of miscarriage. (author)
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.
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
Yasmeen, S.; Waheed, K.A.I.; Gul, R.
Objective: To study the spectrum of neonatal admissions and their outcome in a tertiary care hospital. Study Design: A descriptive observational study. Place and Duration of Study: The study was conducted in Neonatal Unit of The Children's Hospital and Institute of Child Health, Lahore for a period of one year from 1st Jan 2015 to 31st Dec 2015. Material and Methods: Data of all admitted patients during the study period were reviewed and analysed in terms of gender, gestational age, age at presentation, weight, cause of admission and their outcome. Neonates with incomplete data were excluded subsequently. Diagnosis were made on clinical examination, radiological findings and laboratory investigations. Data were analysed using SPSS version 20. Results: Out of 11427 neonates admitted during the study period, 397 were excluded because of deficient record. Of the 11030 neonates males were 7673 (69.6%) and females were 3353 (30.4%). Full-term neonates were 8123 (73.64%) while preterm were 2907 (26.35%). Low birth weight (LBW) babies were 5636 (51.1%). Newborns presented within first 24 hours of life were 1478 (13.4%). Birth asphyxia 3518 (31.89%) was the most common cause of hospital admissions followed by prematurity 2907 (26.36%) and neonatal sepsis 1865 (16.91%). Out of 11030 babies, 7055 (64%) were discharged, 2805 (25.4%) left against medical advice and 1170 (10.6%) neonates expired. Highest number of deaths was because of prematurity 469 (39.32%) followed by asphyxia neonatorum 359 (30.68%) and neonatal sepsis 180 (15.38%). Conclusion: Birth asphyxia, prematurity and sepsis constitute three fourths of hospital admissions in our neonatal unit. Most common cause of mortality was prematurity followed by birth asphyxia and neonatal sepsis. (author)
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.
Full Text Available Objective: To identify the obstetric risk factors, incidence, and causes of uterine rupture, management modalities, and the associated maternal and perinatal morbidity and mortality in one of the largest tertiary level women care hospital in Delhi. Materials and Methods: A 7-year retrospective analysis of 47 cases of uterine rupture was done. The charts of these patients were analyzed and the data regarding demographic characteristics, clinical presentation, risk factors, management, operative findings, maternal and fetal outcomes, and postoperative complications was studied. Results: The incidence of rupture was one in 1,633 deliveries (0.061%. The vast majority of patients had prior low transverse cesarean section (84.8%. The clinical presentation of the patients with rupture of the unscarred uterus was more dramatic with extensive tears compared to rupture with scarred uterus. The estimated blood loss ranged from 1,200 to 1,500 cc. Hemoperitoneum was identified in 95.7% of the patient and 83% of the patient underwent repair of rent with or without simultaneous tubal ligation. Subtotal hysterectomy was performed in five cases. There were no maternal deaths in our series. However, there were 32 cases of intrauterine fetal demise and five cases of stillbirths. Conclusions: Uterine rupture is a major contributor to maternal morbidity and neonatal mortality. Four major easily identifiable risk factors including history of prior cesarean section, grand multiparity, obstructed labor, and fetal malpresentations constitute 90% of cases of uterine rupture. Identification of these high risk women, prompt diagnosis, immediate transfer, and optimal management needs to be overemphasized to avoid adverse fetomaternal complications.
Baig MS, Bagle TR,Gadappa SN, Deshpande Sonali, Doifode SM
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.
Full Text Available Purpose: To study the clinical profile of serpiginous choroiditis in eastern India. Materials and Methods: Ninety-one eyes of 54 patients with serpiginous choroiditis presenting to a tertiary care centre in eastern India between January 2006 and December 2010 were included in the study. Clinical presentation, treatment given, and visual outcome of the eyes were studied. Results: Thirty-five (64.8% patients were male and 19 (35.2% were female in the age group of 13-62 years (mean age: 34.1 μ 18.7 years. Blurring of vision (71; 78% and floaters (36; 39.5% were commonest symptoms. In 75 (82.4% eyes, choroiditis started from optic nerve head and spreading centrifugally. Overall, 38 (41.75% eyes had macular involvement at first visit. Mantoux test reading was 10 mm or more (Group A in 12 (22.22% patients and less than 10 mm (Group B in 42 (77.77% patients. Difference between Groups A and B in macular involvement at first visit (10; 50% vs. 28; 39.4% and rate of recurrence (3; 15% vs. 14; 19.7% was not statistically significant (P = 0.37 and 0.68. Oral steroid (51; 94.4% was the commonest mode of treatment. Fifty-one (56% eyes had two lines or more improvement in vision. Conclusions: The present study details the clinical presentation, treatment, and visual outcome of serpiginous choroiditis. Mantoux test reading does not affect the clinical presentation or the treatment outcome in these eyes.
Toms John Peedikayil Neetu
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
Alrifai, Muhammad Talal; AlShaya, Mohammed Abdullah; Abulaban, Ahmad; Alfadhel, Majid
Infantile spasms are a devastating infantile epileptic syndrome with multiple etiologies. Hereditary neurometabolic disorders are rarely recognized causes of infantile spasms. The aim of this study was to identify hereditary neurometabolic disorders when they were the cause of infantile spasms in patients presenting to a tertiary care center in Saudi Arabia. We conducted a retrospective review of children presenting to the Pediatric Department of King Abdulaziz Medical City in Riyadh, Saudi Arabia over a 15-year interval. Eighty patients with infantile spasms were identified. A hereditary neurometabolic disorder was diagnosed in 10 patients (12.5%). Of these patients, two had a Leigh-like disorder and one patient had each of the following diagnoses: ethylmalonic aciduria, nonketotic hyperglycinemia, hyperinsulinemic hypoglycemia, leukodystrophy, short-chain acyl-coenzyme A dehydrogenase deficiency, molybdenum cofactor deficiency, primary carnitine deficiency, and neonatal hypoglycemia due to panhypopituitarism. This article is the first to report the association of the last three conditions with infantile spasms. Compared with the other etiologies, the hereditary neurometabolic disorder group had a strong history of similar disease in the same family (P = 0.002), and most of the patients were born of consanguineous parents (P = 0.021). In addition, a typical hypsarrhythmia pattern was more common in the hereditary neurometabolic disorder group (P = 0.003). Furthermore, this group had a poor response to therapy (P = 0.04). Otherwise, there were no significant differences regarding the type of spasms, neuroimaging or outcome; however, there was a trend toward poorer outcomes and death in the hereditary neurometabolic disorder group. Hereditary neurometabolic disorders are relatively common causes of infantile spasms in this subpopulation of Saudi patients. An early diagnosis via proper metabolic and genetic testing has significant implications for applying specific
Full Text Available BACKGROUND Our aim was to study the clinical and immunological profile of patients with newly detected connective tissue disease presented to a tertiary care centre. MATERIALS AND METHODS The study involved 51 patients with newly-detected Systemic Lupus Erythematosus (SLE (fulfilling the revise SLICC criteria for SLE and Systemic Sclerosis (SS, Mixed Connective Tissue Disease (MCTD, etc. attending Sir. T. Hospital, Bhavnagar, between January 2013 and December 2016. All patients were assessed for clinical features and immunological profile. RESULTS Out of the 51 patients, 30 having SLE, 10 having SS, 9 with MCTD, 1 with dermatomyositis and 1 with Rowell’s syndrome. Among them, 47 were females and 4 were males. The mean age at presentation was between 15-25 years. The LE-specific skin lesions were noted as malar rash in 25 patients (83%, subacute and acute lupus rashes (80% and discoid rash (13%. Among LE-nonspecific lesions, non-scarring alopecia was most common followed by oral ulcers, Raynaud’s phenomenon, joint pain, scarring alopecia, erythema multiforme, livedo reticularis, vasculitic lesions, urticaria and calcinosis cutis were seen. In MCTD, muscle weakness was common finding. In systemic sclerosis, hide-bound skin and decreases mouth opening were seen in all cases and Raynaud’s phenomenon, joint pain, hair loss, calcinosis cutis and respiratory system involvement were other features. Serum ANA was positive in 76% while negative in 3.8% of individuals. The most common pattern observed in ANA profile was speckled (56% followed by homogenous (32% and nucleolar (28%. CONCLUSION There is diversity in clinical presentation of autoimmune connective tissue disease with regards to their genetic and environmental backgrounds. Cutaneous features are utmost important having diagnostic and prognostic value as well.
Full Text Available Palliative care is a growing area of practice throughout the world and its promotion relies on adequately trained health care professionals. However, there are only a limited number of postgraduate academic courses or clinical training opportunities available, especially in resource challenged areas of the Asia Pacific region. This article outlines a creative endeavour between Flinders University, Adelaide Australia, the Singapore National Cancer Centre and the Asia Pacific Hospice and Palliative Care Network to provide an educational opportunity for students from the region. The strengths of the programme include its strong theoretical and evidenced-based framework, its multidisciplinary inclusiveness and its innovative and interactive teaching style. The main teaching challenge for the teaching team is to deliver culturally appropriate curricula to students from diverse cultural and linguistic backgrounds. This postgraduate programme is an important initiative for the region and for the development of future leaders and pioneers in the discipline.
El Hussein, Mohamed Toufic; Jakubec, Sonya L
The strategy of mnemonics has long been used as an aid to learning biology, physiology, pathophysiology, and health assessment in nursing. An application of an alphabetical mnemonics strategy to teaching and learning nursing processes and constructing care plans has been explored for patients with increased intracranial pressure (ICP), hepatic failure, and chronic renal failure. A specific application of this strategy for teaching care planning for patients with ICP is described. Student feedback appears to be positive, and reviews of the teaching-learning experience have received approval in students' evaluation of instruction. The mnemonics strategy presented has the potential for applicability and transferability to other areas of nursing care planning and other course contexts. Copyright 2015, SLACK Incorporated.
Full Text Available In Romania, Japanese language, literature and culture are taught at university level in two private universities and two state universities. Japanese departments are part of either a Faculty of Letters or a Faculty of Languages and Literatures. Students have to choose another language to study, in addition to Japanese. This gives them a dual major / dual specialization. A large number of graduates decide on pursuing a teaching career in one of their specializations. My paper looks at the way in which university provides an educational background for teachers at lower and upper education. It also looks into the way it shapes secondary education through its curriculum. This refers to compulsory education in an integrated national system of education. But, in the last ten years, this perspective has broadened. Language schools, which are not part of this integrated system, have appeared. Some of them teach exclusively Japanese language and Japanese culture classes. In the beginning, the students were mainly adults, age 18+ but in the last several years, more children have started to be interested in attending classes in these language schools. My paper also discusses this new perspective. A questionnaire and its results will also be presented on this topic. It will show not only the increasing number of young learners but also, their very young age, which goes as far as primary school. This tendency, in studying Japanese as a foreign language, could provide a preview into its development at the secondary level.
Full Text Available Objectives: Service quality is one of the important gears to appraise services and determine the gray areas that need improvement. In countries with a resource-poor health system, the first step of measuring quality is yet to be taken. This study seeks to inform policy makers in developing contextual service quality models by identifying service quality gaps in tertiary care teaching hospitals using patients’ perspective. Methods: A cross-sectional study was performed using multistage cluster sampling, and a modified version of the SERVQUAL (SERV-service, QUAL-quality instrument was administered to determine patient’s expectations and perceptions. A total of 817 completed questionnaires were obtained from patients and/or their attendants using convenience sampling. Results: Data analysis revealed statistically significant negative quality gaps between expectations and perceptions of tangibility, reliability, empathy, assurance, responsiveness, and communication. The difference in mean expectation and perception for responsiveness across the sexes was significant (p < 0.003; p < 0.037, respectively as well as in perception of communication (p < 0.026. Other dimensions and overall hospital expected and perceived quality were independent of sex. Educational status showed significant difference in expectation and perception in responsiveness (p < 0.005, but the perception of each dimension was significantly different in different educational categories (assurance: p < 0.001; empathy: p < 0.001; reliability: p < 0.001; tangibility: p < 0.001; responsiveness: p < 0.001; communication: p < 0.001; and for overall service quality: p < 0.001. Age and service departments showed no relationship with any of the perceived or expected dimension of service quality of hospitals. Conclusions: Tertiary care hospitals failed to meet patients’ expectations in all major areas of service quality, posing a question of how hospitals implement and evaluate their
Fatima, Iram; Humayun, Ayesha; Anwar, Muhammad Imran; Iftikhar, Adil; Aslam, Muhammad; Shafiq, Muhammad
Service quality is one of the important gears to appraise services and determine the gray areas that need improvement. In countries with a resource-poor health system, the first step of measuring quality is yet to be taken. This study seeks to inform policy makers in developing contextual service quality models by identifying service quality gaps in tertiary care teaching hospitals using patients' perspective. A cross-sectional study was performed using multistage cluster sampling, and a modified version of the SERVQUAL (SERV-service, QUAL-quality) instrument was administered to determine patient's expectations and perceptions. A total of 817 completed questionnaires were obtained from patients and/or their attendants using convenience sampling. Data analysis revealed statistically significant negative quality gaps between expectations and perceptions of tangibility, reliability, empathy, assurance, responsiveness, and communication. The difference in mean expectation and perception for responsiveness across the sexes was significant ( p < 0.003; p < 0.037, respectively) as well as in perception of communication ( p < 0.026). Other dimensions and overall hospital expected and perceived quality were independent of sex. Educational status showed significant difference in expectation and perception in responsiveness ( p < 0.005), but the perception of each dimension was significantly different in different educational categories (assurance: p < 0.001; empathy: p < 0.001; reliability: p < 0.001; tangibility: p < 0.001; responsiveness: p < 0.001; communication: p < 0.001; and for overall service quality: p < 0.001). Age and service departments showed no relationship with any of the perceived or expected dimension of service quality of hospitals. Tertiary care hospitals failed to meet patients' expectations in all major areas of service quality, posing a question of how hospitals implement and evaluate their quality assurance policy.
Full Text Available Background: Ventilator-associated pneumonia (VAP is an infection of the lung that develops 48 h or longer after mechanical ventilation. Objectives: The present study was aimed to find out the bacteriological profile of VAP along with the resistance pattern of bacteriological isolates. Materials and Methods: A prospective observational study was conducted from January 2013 to May 2014 among 791 patients admitted in critical care units of our tertiary care hospital. After selection by applying inclusion and exclusion criteria endotracheal aspirates were collected from ventilated patients. Samples were subjected to further processing by Gram-staining, culture, biochemical testing and antibiogram. Results : Out of 791 patients admitted in intensive care unit in this tertiary care hospital with VAP 540 (68.2% patients were culture positive. Pseudomonas aeruginosa was most commonly isolated pathogen of both early onset and late onset VAP. In early VAP Acinetobacter baumannii showed 62.5% metallo-beta-lactamase (MBL positivity. P. aeruginosa showed 27.5% MBL positivity, whereas in late onset VAP, 71.4% A. baumannii isolates and 75.8% P. aeruginosa isolates showed MBL positivity, respectively. Conclusion : Simple prevention of aspiration, sterilization of equipments, hand washing of personnel can reduce VAP in hospital care setting.
de la Fuente, Jaime; Garrett, C Gaelyn; Ossoff, Robert; Vinson, Kim; Francis, David O; Gelbard, Alexander
To examine the distribution of clinic and operative pathology in a tertiary care laryngology practice. Probability density and cumulative distribution analyses (Pareto analysis) was used to rank order laryngeal conditions seen in an outpatient tertiary care laryngology practice and those requiring surgical intervention during a 3-year period. Among 3783 new clinic consultations and 1380 operative procedures, voice disorders were the most common primary diagnostic category seen in clinic (n = 3223), followed by airway (n = 374) and swallowing (n = 186) disorders. Within the voice strata, the most common primary ICD-9 code used was dysphonia (41%), followed by unilateral vocal fold paralysis (UVFP) (9%) and cough (7%). Among new voice patients, 45% were found to have a structural abnormality. The most common surgical indications were laryngotracheal stenosis (37%), followed by recurrent respiratory papillomatosis (18%) and UVFP (17%). Nearly 55% of patients presenting to a tertiary referral laryngology practice did not have an identifiable structural abnormality in the larynx on direct or indirect examination. The distribution of ICD-9 codes requiring surgical intervention was disparate from that seen in clinic. Application of the Pareto principle may improve resource allocation in laryngology, but these initial results require confirmation across multiple institutions.
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
Rizvi, Z.; Usmani, R.A.; Zahra, T.; Rasool, H.; Rizvi, A.
Quality of any service is the most important aspect for the manufacturer as well as the consumer. The primary objective of any nation's health system is to provide supreme quality health care services to its patients. The objective of this study was to assess the quality of diagnostic fine needle aspiration cytology service in a tertiary care hospital. As Patient's perspectives provide valuable information on quality of process, therefore, patient's perception in terms of satisfaction with the service was measured. Methods: In this cross sectional analytical study, 291 patients undergoing fine needle aspiration cytology in Mayo Hospital were selected by systematic sampling technique. Information regarding satisfaction of patients with four dimensions of service quality process, namely procedure, sterilization, conduct and competency of doctor was collected through interview on questionnaire. The questionnaire was developed on SERVQUAL model, a measurement tool, for quality assessment of services provided to patients. All items were assessed on 2- point likert scale (0=dissatisfied, 1=satisfied). Frequencies and percentages of satisfied and dissatisfied patients were recorded for each item and all items in each dimension were scored. If the percentage of sum of all item scores of a dimension was =60, the dimension was 'good quality'. Whereas <60% was 'poor quality' dimension. Data was analysed using epi-info-3.5.1. Fisher test was applied to check statistical significance. (p-value <0.05) Results: Out of the 4 dimensions of service quality process, Procedure (48.8%), Sterilization (51.5%) and practitioner conduct (50.9%) were perceived as 'poor' by the patients. Only practitioner competency (67.4%) was perceived as 'good'. Comparison of dimensions of service quality scoring with overall level of patient satisfaction revealed that all 4 dimensions were significantly related to patient dissatisfaction (p<.05
Kusumam Vilangot Nhalil
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
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
B A Fomda
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
Ahn, June H; Lee, Kwan H; Chung, Jin H; Shin, Kyeong-Cheol; Lee, Choong K; Kim, Hyun Jung; Choi, Eun Young
The 2016 American Thoracic Society and Infectious Diseases Society of America (ATS/IDSA) guidelines removed the concept of healthcare-associated pneumonia (HCAP). We examined whether the 2016 ATS/IDSA guidelines are applicable in Korea.We conducted a retrospective, observational study of pneumonia patients who were hospitalized at a tertiary teaching hospital from March 2012 to February 2014. Identified pathogens that were not susceptible to β-lactams, macrolides, and fluoroquinolones were defined as community-acquired pneumonia drug-resistant pathogens (CAP-DRPs). We analyzed the risk factors for 28-day mortality and the occurrence rate of CAP-DRPs.Of the 1046 patients, 399 were classified with HCAP and 647 with CAP. HCAP patients were older and had more comorbidities than CAP patients. Initial pneumonia severity index (PSI) was higher in patients with HCAP than with CAP. HCAP was associated with not only an increased rate of CAP-DRPs (HCAP, 19.8%; CAP, 4.0%; P risk factor for 28-day mortality in HCAP patients (odds ratio 1.02, 95% confidence interval 1.01-1.04). CAP-DRPs and IIAT were not associated with mortality.Patients with HCAP revealed higher rates of CAP-DRPs, IIAT, and mortality than patients with CAP. However, CAP-DRPs and IIAT were not associated with mortality. PSI was the main predictive factor for 28-day mortality in patients with HCAP.
Full Text Available This article explores how Applied Ethics, especially Business Ethics, is taught at the University of South Africa (Unisa. This discussion refers to the content of a particular Unisa module, Theoretical and Applied Ethics, which serves as an introduction to Bio-medical Ethics, Business Ethics and Environmental Ethics. The fundamentals of this course are: defining ethics; providing methods for moral decision-making; describing the role of ethics in a particular field and addressing common dilemmas in a specific context. The intention is to empower students to identify issues they are likely to face in the workplace, and to grow in confidence in their ability to make sound moral decisions when required to do so. The aim of this article is to contribute to the ongoing discussion between tertiary institutions about how the teaching of Business Ethics can be promoted, how moral decision-making in the workplace can be encouraged and what role theological ethics can play in this regard.
Sawe, Hendry R; Mfinanga, Juma A; Lidenge, Salum J; Mpondo, Boniventura C T; Msangi, Silas; Lugazia, Edwin; Mwafongo, Victor; Runyon, Michael S; Reynolds, Teri A
In sub-Saharan Africa the availability of intensive care unit (ICU) services is limited by a variety of factors, including lack of financial resources, lack of available technology and well-trained staff. Tanzania has four main referral hospitals, located in zones so as to serve as tertiary level referral centers. All the referral hospitals have some ICU services, operating at varying levels of equipment and qualified staff. We analyzed and describe the disease patterns and clinical outcomes of patients admitted in ICUs of the tertiary referral hospitals of Tanzania. This was a retrospective analysis of ICU patient records, for three years (2009 to 2011) from all tertiary referral hospitals of Tanzania, namely Muhimbili National Hospital (MNH), Kilimanjaro Christian Medical Centre (KCMC), Mbeya Referral Hospital (MRH) and Bugando Medical Centre (BMC). MNH is the largest of the four referral hospitals with 1300 beds, and MRH is the smallest with 480 beds. The ratio of hospital beds to ICU beds is 217:1 at MNH, 54:1 at BMC, 39:1 at KCMC, and 80:1 at MRH. KCMC had no infusion pumps. None of the ICUs had a point-of-care (POC) arterial blood gas (ABG) analyzer. None of the ICUs had an Intensive Care specialist or a nutritionist. A masters-trained critical care nurse was available only at MNH. From 2009-2011, the total number of patients admitted to the four ICUs was 5627, male to female ratio 1.4:1, median age of 34 years. Overall, Trauma (22.2%) was the main disease category followed by infectious disease (19.7%). Intracranial injury (12.5%) was the leading diagnosis in all age groups, while pneumonia (11.7%) was the leading diagnosis in pediatric patients (resources, making it difficult or impossible to provide optimum care to critically ill patients and likely contributing to the dauntingly high mortality rates.
Full Text Available Introduction: Identifying the cause of maternal death is important. The aim of this study was to determine the causes of maternal deaths and the factors associated with it. Methods: This was an observational, cross-sectional, analytical study conducted at Department of Obstetrics and Gynecology, Manipal Teaching Hospital from July 2013 to June 2017. Women who died during pregnancy, delivery, or puerperium were included in the study. Demographic factors, clinical profile, cause and type of maternal deaths were noted by taking history and by inquiring with the medical personnel involved in managing patients. Data analysis was done using SPSS version 16. Results: There were 15 maternal deaths and 9923 livebirths. The maternal mortality ratio was 151 per 100,000 live births. Mean age of mothers was 28 years (SD = 7.5. Most of them were from rural areas, had low educational status. The mean gestational age at time of death was 33 weeks (SD = 7.5. Most of deaths (73%, n = 11 occurred in the postnatal period and 60% (n = 9 were critical at presentation. Direct obstetric causes like eclampsia was the most common (26.7%, n = 4 direct obstetric cause and cardiac disease was one of the important indirect cause (13.3%, n = 2. Delay in seeking health care and delay in reaching health center was the major reason for maternal deaths. Conclusion: Maternal mortality were mostly associated with direct obstetric causes, eclampsia being the most common. Most of the deaths were associated with delay in seeking health care and reaching health care centers.
Full Text Available Introduction: Maternal mortality traditionally has been the indicator of maternal health all over the world. More recently review of the cases of severe acute maternal morbidity (SAMM, also termed as "near miss obstetrics events", has been found to be a useful supplementary indicator to investigate maternal health care. Cases of near miss are those in which women present with potentially fatal complication during pregnancy, delivery, or the puerperium and survive merely by chance or by good hospital care. This study was done with the objective to analyze cases of SAMM at Lumbini Medical College Teaching Hospital (LMCTH, Nepal. Methods: A retrospective study of all cases meeting the WHO criteria for SAMM, during May 2015, was done. Cases meeting the WHO eligibility criteria for near miss cases were included in the study. Medical record of such cases in past one year was reviewed. Their socio-demographic variables, parity, gestational age, associated organ dysfunction, ICU and hospital stay, management, and fetal and maternal outcome were noted. Results: During the study period, there were total of 28 cases of SAMM and two maternal mortality out of 2735 live births. Thus rate of SAMM was 1.02%, and maternal mortality rate was 0.07%. Majority of patients were unbooked (n=18, 64.28% and 10 (35.71% were illiterate. Commonest causes for admission to ICU was hemorrhage (n=10, 35.71% followed by hypertensive disorders (n=9, 32.06%, sepsis (n=2, 7.14%, and obstructed labour (n=2, 7.14%. Laparotomy was performed in six (21.42% women, obstetric hysterectomy in four (14.28%, and pelvic devascularization in two (10.71%. Conclusion: SAMM is a useful adjunct to maternal mortality to assess maternal health care. Improving facility based care and prompt referral, education of primary health care (PHC staff can be a short term measure to quickly reduce the number of maternal deaths. Facility based monitoring and reporting of SAMM outcome is an
Ruane, Thomas J.; Brody, Howard
The continuity of health care includes three elements: cognitive, management, and relationship. Exploration of each expands the understanding of continuity in medical practice. Continuity of care can be evaluated in both undergraduate and residency programs by the application of the criteria offered. (Author/MLW)
Full Text Available High prevalence of sleep problems, fatigue and depression are reported in maintenance hemodialysis (MHD patients. To assess fatigue, depression, sleep problems and their co-relates among MHD patients in a tertiary care center in India, we studied 47 patients on MHD for >3 months. Patients demographic, medical and co-morbidity profile were recorded. Pittsburgh Sleep Quality Index (poor sleeper if score >5 and Epworth Sleepiness Scale (EPSS, abnormal daytime sleepiness if score >13 were used to assess sleep abnormalities and quality. Beck Depression Inventory (BDI was used to screen for depression. Depression was classified on BDI scores as mild-moderate (score 11-30 and severe (score >30. Fatigue Severity Scale was used to assess fatigue (score ≥36 indicates fatigue. The correlations of these parameters among themselves and with social and demographic parameters were also analyzed. The mean age of the study population was 37.1 ± 13.1 (range 19-65 years years, with 89.3% being males. The majority (68.1% of the MHD patients was poor sleepers, but only five (10.6% patients had borderline or abnormal daytime sleepiness. Of the patients, 44.7% reported fatigue and (72.3% had depression (mild to moderate in 59.7% and severe in 12.6%. Fatigue scores were found to be significantly associated with lesser frequency of dialysis (P < 0.05. There was higher daytime sleepiness in patients who were working (mean EPSS score 6.2 ± 3.7 than who were unemployed (mean EPSS score 3.9 ± 2.7. Depression was found to be higher in those who were paying for the treatment themselves (mean BDI score 20 ± 11.8 as compared with those who were getting medical expenditure reimbursed (mean BDI score 12.9 ± 8.8. Fatigue positively correlated with that of daytime sleepiness (P = 0.02, poor nighttime sleep (P = 0.02 and depression (P=0.006. In the present study, there was no correlation (P <0.05 found between daytime and night time sleep and depression. We found a high
Chandra, Hem; Rinkoo, Arvind Vashishta; Verma, Jitendra Kumar; Verma, Shuchita; Kapoor, Rakesh; Sharma, R K
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
Full Text Available Background & objectives: Detection of maternal alloimmunization against red cell antigens is vital in the management of haemolytic disease of the foetus and newborn (HDFN. This study was conducted to measure the presence of allosensitization to blood group antibodies in the antenatal women attending a tertiary care hospital and to observe the proportion of minor blood group antibodies to assess the benefit of screening for the same. Methods: All antenatal women registered in the hospital between January 2008 and January 2009, were screened for irregular antibodies using a commercial 3-cell antibody screening panel. Antibody identification was performed on samples found positive using a commercial 11 cell-panel. Results: Screening was performed on 5347 women, 339 (6.34% of whom were Rh negative. Allosensitization was found in 79 women (1.48%; confidence interval 1.17 -1.84. In 29 of these 79 (37% women the allo-antibodies could not be identified. In the remaining 50 women, 54 antibodies were characterized. A total of 40 clinically significant antibody specificities were identified among 36 women, of whom four were Rh(D positive. Allosensitization with clinically significant antibodies was found in 9.43 per cent (confidence interval 6.55-13.06 Rh(D negative and in 0.08 per cent (confidence interval .02-0.2 Rh(D positive women. Anti D was the most frequent antibody found in 8.85 per cent Rh(D negative women. The remaining clinically significant antibodies identified included anti-C, c, E, Jk a , Jk b , M and S. In Rh(D negative women, anti-D and antibodies of the Rh system contributed 83.3 and 94.4 per cent of clinically significant antibodies. However, in Rh(D positive women, non-Rh antibodies comprised three out of four clinically significant antibodies. Interpretation & conclusions: The presence of alloimmunization in our study corroborated with data reported from India. The most frequent antibody was anti-D. However, a significant fraction was
Full Text Available 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% (p<0.001 and were the main reasons for hospitalizations (33.3% of 45 and 55.6% of 81 hospitalized patients, p = 0.017 in 2004/05 compared to 2014/15. The leading infectious diseases in hospitalized patients were tuberculosis (n = 4 and bacterial skin infections (n = 2 in 2004/05; Malaria (n = 9, pneumonia (n = 6, Chickenpox (n = 5, other viral infections (n = 5 and bacterial skin infections (n = 5 in 2014/15. Infectious diseases like malaria, cutaneous diphtheria, louseborne-relapsing fever or scabies were only found in the second study period. Almost one third of the admitted asylum 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.
Khawaja, N P; Tayyeb, R; Malik, N
Pakistan is one of the most populous nations in the world, with an annual growth rate of 2.8 and high total fertility rate, even among developing nations. The Pakistan Reproductive Health and Family Planning Survey highlighted the wide gap between knowledge (97%) and use of contraceptives (28%) among currently married women. Our actual need is to enhance contraceptive practice in our country. This study was designed to investigate contraceptive knowledge and practice in Pakistani women attending a tertiary care hospital. This questionnaire-based study was conducted at the Gynaecology Unit II of Sir Ganga Ram Hospital, Fatima Jinnah Medical College, Lahore, Pakistan. A total of 204 married women of reproductive age were interviewed by a registrar to record their age, occupation, educational status, number of children, knowledge about contraceptive methods, source of the knowledge, attitudes and practices of contraception. About 57% of women were between 26 and 35 years of age, while 52% of men were between 31 and 40 years. Educational status of the majority of females was below matriculation (33%), while 34% males were above matriculation; 88% of females were housewives and less than 1% of men were out of work. Regarding the social status of couples, 64% were living on income less than 5000 rupees /month (about 60 pound sterling). Of the women, 67% were para 2-5; 68% had some sort of awareness regarding contraception. The main source of information was television (26%) and relatives (24%). The majority knew about the pill (68%) and IUCD (55%). Only 47% were using some sort of contraception. The most common method chosen was the barrier method (15%), followed by IUCD (10%) and the pill (10%). The least common methods were sterilisation (2%) and the rhythm method (2%); 85% of the women and 74% of the men in the study group had a positive attitude toward contraception. In order to improve contraceptive use in Pakistan we need to use multiple media sources to educate
Maestre-Moreno, J F; Fernández-Pérez, M D; Triguero-Cueva, L; Gutiérrez-Zúñiga, R; Herrera-García, J D; Espigares-Molero, A; Mínguez-Castellanos, A
Stroke is a very common cause of death, especially in southern Spain. The present study analyses in-hospital mortality associated with stroke in an Andalusian tertiary care hospital. We gathered the files of all patients who had died at Hospital Universitario Virgen de las Nieves in Granada in 2013 and whose death certificates indicated stroke as the cause of death. We also gathered stroke patients discharge data and compared them to that of patients with acute coronary syndrome (ACS). A total of 825 patients had a diagnosis of stroke (96 deaths, 11.6%); of these, 562 had ischaemic stroke (44 deaths, 7.8%) and 263 haemorrhagic stroke (52 deaths, 19.7%). Patients with haemorrhagic stroke therefore showed greater mortality rate (OR=2.9). Patients in this group died after a shorter time in hospital (median, 4 vs 7 days; mean, 6 days). However, patients with ischaemic stroke were older and presented with more comorbidities. On the other hand, 617 patients had a diagnosis of ACS (36 deaths, 5.8%). The mortality odds ratio (MOR) was 2.1 (stroke/SCA). Around 23% of the patients who died from stroke were taking anticoagulants. 60% of the deceased patients with ischaemic stroke and 20% of those with haemorrhagic stroke had atrial fibrillation (AF); 35% of the patients with ischaemic stroke and AF were taking anticoagulants. Stroke is associated with higher admission and in-hospital mortality rates than SCA. Likewise, patients with haemorrhagic stroke showed higher mortality rates than those with ischaemic stroke. Patients with fatal stroke usually had a history of long-term treatment with anticoagulants; 2 thirds of the patients with fatal ischaemic stroke and atrial fibrillation were not receiving anticoagulants. According to our results, optimising prevention in patients with AF may have a positive impact on stroke-related in-hospital mortality. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.
Kumburu, Happiness Houka; Sonda, Tolbert; Mmbaga, Blandina Theophil; Alifrangis, Michael; Lund, Ole; Kibiki, Gibson; Aarestrup, Frank M
To determine the causative agents of infections and their antimicrobial susceptibility at a tertiary care hospital in Moshi, Tanzania, to guide optimal treatment. A total of 590 specimens (stool (56), sputum (122), blood (126) and wound swabs (286)) were collected from 575 patients admitted in the medical and surgical departments. The bacterial species were determined by conventional methods, and disc diffusion was used to determine the antimicrobial susceptibility pattern of the bacterial isolates. A total of 249 (42.2%) specimens were culture-positive yielding a total of 377 isolates. A wide range of bacteria was isolated, the most predominant being Gram-negative bacteria: Proteus spp. (n = 48, 12.7%), Escherichia coli (n = 44, 11.7%), Pseudomonas spp. (n = 40, 10.6%) and Klebsiella spp (n = 38, 10.1%). Wound infections were characterised by multiple isolates (n = 293, 77.7%), with the most frequent being Proteus spp. (n = 44, 15%), Pseudomonas (n = 37, 12.6%), Staphylococcus (n = 29, 9.9%) and Klebsiella spp. (n = 28, 9.6%). All Staphylococcus aureus tested were resistant to penicillin (n = 22, 100%) and susceptible to vancomycin. Significant resistance to cephalosporins such as cefazolin (n = 62, 72.9%), ceftriaxone (n = 44, 51.8%) and ceftazidime (n = 40, 37.4%) was observed in Gram-negative bacteria, as well as resistance to cefoxitin (n = 6, 27.3%) in S. aureus. The study has revealed a wide range of causative agents, with an alarming rate of resistance to the commonly used antimicrobial agents. Furthermore, the bacterial spectrum differs from those often observed in high-income countries. This highlights the imperative of regular generation of data on aetiological agents and their antimicrobial susceptibility patterns especially in infectious disease endemic settings. The key steps would be to ensure the diagnostic capacity at a sufficient number of sites and implement structures to routinely exchange, compare, analyse and report data. Sentinel sites
Sathyakumar, Samantha; Paul, Thomas Vizhalil; Asha, Hesargatta Shyamsunder; Gnanamuthu, Birla Roy; Paul, M J; Abraham, Deepak Thomas; Rajaratnam, Simon; Thomas, Nihal
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
Chowdhury, Ahmed Hossain; Khan, Sharif Uddin; Rahman, Kazi Mohibur; Hasan, A T M Hasibul; Ghose, Swapon Kumar; Haque, Badrul; Habib, Mansur; Mohammad, Quazi Deen
We have conducted this study to examine the clinical and morphological pattern of brain arteriovenous malformations (BAVMs) along with their treatment and short term outcome in a tertiary care hospital in Bangladesh. This retrospective chart review was carried out from the records of neuro-endovascular division at Department of Neurology, Dhaka Medical College Hospital (DMCH) from January 2010 to June 2013. A total 60 patients were evaluated. All the necessary information regarding the demographic, clinical, morphologic and treatment profile was gathered through a predesigned questionnaire. To our knowledge, we have the largest cohort of BAVM patients in Bangladesh and this is the first of this kind of study done in Bangladesh. The mean age at diagnosis was 30.3 years with a standard deviation of ±14.3 and the majority was teenagers (30%). Intracerebral hemorrhage was the commonest (70%) type of presentation at diagnosis, followed by headache (50%), altered consciousness (50%), vomiting (40%) and seizure (40%). Majority of the AVMs had feeders from anterior circulation (50%) and most of the AVMs (73.3%) were supplied from the main feeders, whereas the rest from distal vessels. Regarding venous drainage, AVMs drained mostly either to superficial (43.3%) or deep (40%) venous system. AVMs frequently had larger (40%) nidus size and a slow to medium flow (60%), through the nidus. An eloquent AVM location was found in 50% of the patients. Intranidal aneurysm was found in 10% AVM and angiopathic AVM in 13.3%. Patients were treated by endovascular embolization (31) or surgical excision (11) or conservative approach. There was one event of death, both in embolization group and surgically treated group before discharge. The patients were followed up for 1.3 ± 0.8 years. The rate of rebleed was 6.6, 30 and 60% during follow up in endovascular, surgical and conservatively treated group. Though five patients in conservative group died during this time, no deaths reported in
Full Text Available Abstract Background Opportunistic Infections (OIs and co-infections are the major cause of deaths amongst HIV infected individuals and this mostly depends upon the risk factors, type of exposure and geographic region. The commonest types of infections reported are tuberculosis, chronic diarrhoea, oral candidiasis, herpes simplex virus-2, cytomegalovirus, hepatitis B virus and hepatitis C virus. Due to the scarcity of OIs data available from this region, we had designed a study to determine the frequency of different OIs amongst HIV seropositive patients. Methods Analysis of the different spectrum of OIs/Co-infections were carried out with 204 HIV sero-positive patients (142 males and 62 females who visited the HIV/AIDS Apex Clinic in a tertiary care hospital from March 2006 to March 2009. The CD4+ count was estimated using FACS Calibur, the routine smear test, serology, nested RT-PCR and DNA sequencing were carried out to determine the different OIs. Results In this study, HIV seropositive patients were mostly from middle age group (31-40 yrs with CD4+ counts in majority of symptomatic AIDS patients below 200 cells/mm3. The common co-infections/opportunistic infections were OC (53.43%, CD (47.05%, HSV-2 (36.76%, TB (35.29%, CMV (26.96%, HBV (15.19% and HCV (7.35%. Dual infections, like HSV-2 & CMV (15.38%, HSV-2 & TB (14.61%, HSV-2 & oral candidiasis (24.61% and CMV & oral candidiasis (14.61% were significant in follow-up patients. Triple infections were also common e.g., TB, CD, OC infection occurring frequently in about 14.21% of the study population. Multiple infections like OC, TB, CD amongst the viral co-infected patients with HSV-2, HCV, CMV and HBV are also reported in this study. The genotyping analysis of the HCV co-infected HIV individuals shows that two belonged to HCV genotype 1 and 8 belonged to genotype 3. Conclusions A wide spectrum of OIs were observed amongst HIV-infected patients in the HIV/AIDS Apex Clinic. Oral candidiasis
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Background: The burden of injuries and disabilities in Pakistan is significant. Our study attempted to describe the circumstances, risk groups, types and severity of injuries experienced by patients attending a tertiary care hospital in Karachi, Pakistan.
Methods: A retrospective study was conducted in the department of Emergency Medicine (ED at Aga Khan University Hospital of Karachi, Pakistan. Past medical records from June 2006 till May 2007 of injured patients presented to ED were reviewed. Data were recorded regarding the basic epidemiological features, hospital stay, body parts injured and severity of injuries.
Results: A total of 631 patients with injuries were identified. The majority of them were males (80%; n=502, aged 21-40 years (63%. Road traffic injuries (RTIs 65% (n=411 followed by gunshots (14%, n=85 were the most common types of injuries. Upon arrival to hospital 82% (491/598 of patients had a Glasgow Coma Scale (GCS ≥13. The mean hospital stay and Injury Severity Score (ISS of patients were 3.5 days (SD ±6.4 and 4 (SD ±5.2 respectively. The head, neck and face were the most affected body parts (50%; n=276. Three percent (n=17 were pronounced dead on arrival to the ED. Among RTIs, multivariable logistic regression identified sex (aOR: 3.797; 95% CI: 1.066–13.528, and mode of travel (aOR: 2.883; 95%CI: 1.330–6.250 as independent predictors for severe GCS (GCS<8.
Conclusions: RTIs were the most common type of injuries, common among young males. In RTIs, children were mostly pedestrians, and females and motor vehicle occupants were more likely to have severe GCS. This study may assist local authorities in Karachi to prioritize interventions to address common injuries in those who are high at risk.
The conventional risk factors for coronary artery disease (CAD) include hypertension, diabetes mellitus, hyperlipidaemia and cigarette smoking(1). There is a large body of evidence, which implicates these factors in the causation of coronary artery disease. Objective: To study the attern of the above-mentioned as well as additional risk factors including age, gender, family history, obesity and hepatitis B and C seropositivity in the population of patients undergoing coronary angiography at our tertiary care hospital.Methodology:In this cross-sectional survey, 465 patients undergoing coronary angiography were studied using a questionnaire as well as clinical and laboratory data. The information obtained included age, sex, clinical presentation, past medical history, family history, the presence or absence of previous ischemic heart disease, diabetes, hypertension and a history of smoking. A history of duration of diabetes and hypertension, their treatment and the presence or absence of complications was also noted. A proportion of patients had their fasting blood lipid levels measured. Height, weight and waist circumference as well as HepBsAg and anti-HCV levels were also determined.Results: The 465 patients studied included 383 males and 82 females. The mean age of all patients was 49.68 +- 0.464 years and the difference between genders was not significant. A past history of ischaemic heart disease was present in 31% of patients. Diabetes mellitus was present in 23% of males and 45% of females. A history of hypertension was present in 30.8% males and 70.7% of the females. Of the patients who could be studied, the mean LDL was 110.29 +- 1.706 mg/dL, the mean HDL was 41.01 +- 0.319 mg/dL and the mean TG was 189.67 +- 4.21 mg/dL. The difference in lipid profile values between male and female patients was not significant (p-value >0.05). Waist circumference was increased in 69.7% males and 93.9% females and here the difference between genders was significant, Hep
Talha, M.; Qureshi, M.A.
Objective: To assess functional outcome of transforaminal lumbar inter body fusion (TLIF) with specific reference to improvement in pain by visual analogue score (VAS) and Oswestry disability index (ODI). Study Design: Quasi-experimental study. Place and Duration of Study: The study was conducted at the Department of Spine Surgery of a tertiary care hospital in Rawalpindi from May 2004 to May 2013. Material and Methods: Thirty nine patients who underwent TLIF and completed one year of follow up in our department during the study period were included in the study. Cases were evaluated clinically and radiologically preoperatively and assessed for pain with VAS and general well being with ODI. After TLIF they were reassessed at 1, 3, 6 months and 1 year for improvement in VAS and ODI. Patient satisfaction and work status after surgery was also recorded at 1 year of follow up. Results: Out of 39 cases 19(48.7 percent) were operated for degenerated disc disease (DDD), 11(28.2 percent) for spinal stenosis and 7(17.9 percent) for spondylolisthesis and 2(5.2 percent) for trauma. A total of 28(71.79 percent) were males and 11(28.21 percent) were females. Common levels operated were 12 (30.8 percent) at L4-5, 11 (28.2 percent) at L5-S1, and 12(30.8 percent) at L4,5-S1, 2(5.1 percent) at L2-4 and 1(2.6 percent) each at L3-4 and L3-5. At 1 year of follow up median VAS score improved significantly from 7 to 2 and median ODI improved significantly from 76 to 34. Regarding patient satisfaction 26 (66.7 percent) patients were satisfied, 9 (23.1 percent) were partially satisfied and 4 (10.2 percent) were not satisfied with the surgical outcome. Conclusion: TLIF is a safe and effective procedure for reducing chronic low back pain as a result of DDD, instability and spondylolisthesis. (author)
cases (11, 20.37% sphincter function remained status quo same as in the preoperative period. CONCLUSION A spinal dysraphism patient should receive treatment from an experienced multidisciplinary team including neonatologist, neurosurgeon, and plastic surgeon and rehabilitation experts. Inadequate treatment at peripheral centers should be avoided. Patient should be referred to higher tertiary centre where the complete team is available. The post-operative care is equally important to avoid complications and for better outcome.
Full Text Available BACKGROUND Poisoning is a global public health problem causing significant morbidity and mortality. It is important to know the pattern and outcome of acute poisoning cases for proper planning, prevention and management of these cases. The aim of the study is to determine the mode (suicidal, accidental, homicidal and type of poisoning in North Indian population; relation to age, sex, occupation, marital status; outcome of different type of poisons and requirement of ventilatory support in different type of poisonings. MATERIALS AND METHODS This observational study was conducted in Department of Medicine of a tertiary care hospital in North India. A total of 379 patients were enrolled in the study after obtaining informed consent. RESULTS Poisoning was more common among males (59.89%. Maximum number of patients were in the age group 21-30 years (40.63% and consumption was found to be more prevalent in rural population (75.99%. Most of the patients were farmers and students. Most common types of poisoning were organophosphate (n=95, 25.07%, snake bite (n=77, 20.32% followed by aluminium phosphide (n=71, 18.73%. Out of 379 patients, 318 (83.91% improved while 61 (16.09% expired. Mortality was highest in aluminium phosphide poisoning. Requirement of ventilatory support was most commonly associated with aluminium phosphide poisoning (37.89% followed by organophosphate poisoning (28.42%. CONCLUSION Poisoning was more common in young males. Pesticides and snake bite were major causes of poisoning. Of the total, 318 improved while rest of the 61 expired. Mortality was higher with use of aluminium phosphide poisoning (57.38%, snake bite (21.31% and organophosphate consumption (9.84%. Requirement of ventilator was most commonly associated with aluminium phosphide poisoning. We suggest strict statutory measures covering import, manufacture, sale, transport, distribution and use of pesticides. Training of peripheral health center personnel to manage cases
Full Text Available Abstract Background Mycotic keratitis is an important cause of corneal blindness world over including India. Geographical location and climate are known to influence the profile of fungal diseases. While there are several reports on mycotic keratitis from southern India, comprehensive clinico-microbiological reports from eastern India are few. The reported prevalence of mycotic keratitis are 36.7%,36.3%,25.6%,7.3% in southern, western, north- eastern and northern India respectively. This study reports the epidemiological characteristics, microbiological diagnosis and treatment outcome of mycotic keratitis at a tertiary eye care center in eastern India. Methods A retrospective review of medical and microbiology records was done for all patients with laboratory proven fungal keratitis. Results Between July 2006 and December 2009, 997 patients were clinically diagnosed as microbial keratitis. While no organisms were found in 25.4% (253/997 corneal samples, 23.4% (233/997 were bacterial, 26.4% (264/997 were fungal (45 cases mixed with bacteria, 1.4% (14/997 were Acanthamoeba with or without bacteria and 23.4% (233/997 were microsporidial with or without bacteria. Two hundred fifteen of 264 (81.4%, 215/264 samples grew fungus in culture while 49 corneal scrapings were positive for fungal elements only in direct microscopy. Clinical diagnosis of fungal keratitis was made in 186 of 264 (70.5% cases. The microscopic detection of fungal elements was achieved by 10% potassium hydroxide with 0.1% calcoflour white stain in 94.8%(238/251 cases. Aspergillus species (27.9%, 60/215 and Fusarium species (23.2%, 50/215 were the major fungal isolates. Concomitant bacterial infection was seen in 45 (17.1%, 45/264 cases of mycotic keratitis. Clinical outcome of healed scar was achieved in 94 (35.6%, 94/264 cases. Fifty two patients (19.7%, 52/264 required therapeutic PK, 9 (3.4%, 9/264 went for evisceration, 18.9% (50/264 received glue application with bandage
Benjamin Louis Moresco
Full Text Available ObjectivesThis study aimed to assess factors related to adherence to the Pediatric Advanced Life Support guidelines for severe sepsis and septic shock in an emergency room (ER of a tertiary care children’s hospital.MethodsThis was a retrospective, observational study of children (0–18 years old in The Children’s Hospital of San Antonio ER over 1 year with the International Consensus Definition Codes, version-9 (ICD-9 diagnostic codes for “severe sepsis” and “shocks.” Patients in the adherent group were those who met all three elements of adherence: (1 rapid vascular access with at most one IV attempt before seeking alternate access (unless already in place, (2 fluids administered within 15 min from sepsis recognition, and (3 antibiotic administration started within 1 h of sepsis recognition. Comparisons between groups with and without sepsis guideline adherence were performed using Student’s t-test (the measurements expressed as median values. The proportions were compared using chi-square test. p-Value ≤0.05 was considered significant.ResultsA total of 43 patients who visited the ER from July 2014 to July 2015 had clinically proven severe sepsis or SS ICD-9 codes. The median age was 5 years. The median triage time, times from triage to vascular access, fluid administration and antibiotic administration were 26, 48.5, 76, and 135 min, respectively. Adherence to vascular access, fluid, and antibiotic administration guidelines was 21, 26, and 34%, respectively. Appropriate fluid bolus (20 ml/kg over 15–20 min was only seen in 6% of patients in the non-adherent group versus 38% in the adherent group (p = 0.01. All of the patients in the non-adherent group used an infusion pump for fluid resuscitation. Hypotension and ≥3 organ dysfunction were more commonly observed in patients in adherent group as compared to patients in non-adherent group (38 vs. 14% p = 0.24; 63 vs. 23% p = 0.03.Conclusion
Full Text Available Background : Idiopathic pulmonary fibrosis (IPF is rare and can be challenging to diagnose. Limited data is available from the Middle Eastern region, especially Saudi Arabia. Methods: This was a retrospective study that looked at all the patients diagnosed with IPF between 2007 and 2012 at two tertiary care hospitals in Saudi Arabia. We collected the demographical, clinical, laboratory and radiological data from the patients′ medical records. Medications administered and 1 year survival was also assessed. Results : Between 2007and 2012, 134 IPF patients were identified. Their baseline characteristics (Mean ± SD included: age 64 ± 13 years, body mass index 29 ± 8 kg/m 2 , FEV 1 56 ± 15 percent of predicted, FVC 53 ± 13 percent of predicted, FEV 1 /FVC 0.81 ± 0.09, total lung capacity 75 ± 13 percent of predicted, diffusing capacity of the lung for carbon monoxide 57 ± 15 percent of predicted, on home oxygen at presentation 71 (53%, mean ejection fraction 0.50 ± 0.07, mean pulmonary artery systolic pressure (via echocardiogram 40 + 22 mmHg, presentation mean S pO2 92 ± 7%, presentation 6-min walk distance 338 ± 64 m and lowest S pO2 during 6-min walk test 88 ± 5%. Patients were predominantly female (56%, and 42% of patients had diabetes and were active smokers. The IPF patients′ frequency of hospital admission (n = 99 was 2.4 ± 1.7 per year and duration of hospital stay (n = 99 was 17.4 ± 23.8 days. Overall 1 year survival in all IPF patients was good, 93% (124 patients remained alive after 1 year. Conclusions : In Saudi Arabia, IPF patients tended to be slightly older and the disease progression was somewhat slower than reported IPF cohorts in other populations. They had frequent hospital admissions and a long hospital length of stay. The influence of genetics and co-morbid diseases on the incidence and outcome of IPF should be explored further.
Ahmed, Aliya; Yasir, Muhammad
Background and Aims: Provision of effective and safe postoperative pain management is the principal responsibility of acute pain services (APSs). Continuous quality assurance is essential for high-quality patient care. We initiated anonymous reporting of critical incidents by APS to ensure continuous quality improvement and here present prospectively collected data on the reported incidents. Our objective was to analyze the frequency and nature of incidents and to see if any harm was caused to patients. Material and Methods: Data were collected from January 1, 2012 to September 30, 2013. An incident related to pain management was defined as An incident that occurs in a patient receiving pain management supervised by APS, and causes or has the potential to cause harm or affects patient safety. A form was filled including incident type, personnel involved, any harm caused, and steps taken to rectify it. Frequencies and percentages were computed for categorical variables. Results: A total of 2042 patients were seen and 442 (21.64%) incidents reported during the study period, including documentation errors (136/31%), noncompliance with protocols (113/25.56%), wrong combination of drugs (56/12.66%), premature discontinuation (74/16.72%), prolonged delays in change of syringes (27/6.10%), loss to follow-up (19/4.29%), administration of contraindicated drugs (9/2.03%), catheter pull-outs (6/1.35%), and faulty equipment (2/0.45%). Steps were taken to rectify the errors accordingly. No harm was caused to any patient. 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. PMID:26702208
Gorwill R Hugh
Full Text Available Abstract Background The purpose of this study was to investigate the indications for and approach to hysterectomy at Kingston General Hospital (KGH, a teaching hospital affiliated with Queen's University at Kingston, Ontario. In particular, in light of current literature and government standards suggesting the superiority of vaginal versus abdominal approaches and a high number of concurrent oophorectomies, the aim was to examine the circumstances in which concurrent oophorectomies were performed and to compare abdominal and vaginal hysterectomy outcomes. Methods A retrospective chart audit of 372 consecutive hysterectomies performed in 2001 was completed. Data regarding patient characteristics, process of care and outcomes were collected. Data were analyzed using descriptive statistics, t-tests and linear and logistic regression. Results Average age was 48.5 years, mean body mass index (BMI was 28.6, the mean length of stay (LOS was 5.2 days using an abdominal approach and 3.0 days using a vaginal approach without laparoscopy. 14% of hysterectomies were performed vaginally, 5.9% were laparoscopically assisted vaginal hysterectomies and the rest were abdominal hysterectomies. The most common indication was dysfunctional or abnormal uterine bleeding (37%. The average age of those that had an oophorectomy (removal of both ovaries was 50.8 years versus 44.3 years for those that did not (p Conclusions A significant reduction in LOS was found using the vaginal approach. Both the patient and the health care system may benefit from the tendency towards an increased use of vaginal hysterectomies. The audit process demonstrated the usefulness of an on-going review mechanism to examine trends associated with common surgical procedures.
Aug 3, 2017 ... Objective: To identify the gaps in the knowledge and practices of essential newborn care among postnatal mothers at Juba. Teaching Hospital .... Baby is kept warm after delivery by: -Skin to skin contact. 128. 33.3. -Wrapping baby in a cloth. 347. 90.4. Duration between birth and first bath: -Hours. 169. 44.1.
Peninsula Humane Society, San Mateo, CA.
Activities in this unit are designed to familiarize primary grade students with the responsibilities involved in pet ownership. Teaching plans are provided for a total of 12 lessons involving social studies, language arts, math, and health sciences. Activities adaptable for readers and non-readers focus on pet overpopulation, care of pets when…
Glasgow, Michael S.
Describes the use of integrated modular teaching of the human biology component of the Health Associate Program at Johns Hopkins University, where the goal is to develop an understanding of the sciences as applied to primary care. Discussion covers the module sequence, the human biology faculty, goals of the human biology faculty, laboratory…
This study was carried out to determine the importance of alternative sources of eye care services in delay in seeking ophthalmic treatment in University of Calabar teaching hospital (UCTH).Atotal of 580 patients who visited the hospital within 3 months of the study period October 2003 to December 2003, were examined ...
Bäz, L; Müller, N; Beluchin, E; Kloos, C; Lehmann, T; Wolf, G; Müller, U A
To assess the relationship between social status and quality of diabetes care in a tertiary care centre in Germany. Social status was assessed in 940 consecutive patients in a university outpatient department by a questionnaire. The assessment comprised three components: education, highest professional position and household net income (total score 3-21). Quality of diabetes care was measured by HbA(1c) , blood pressure and BMI. The influence of social status on quality measures was analysed at entry and last visit by fitting linear mixed models. At the entry visit, patients with lower social status had a higher HbA(1c) compared with patients with higher status (0.06% per each point of social score difference). After a mean follow- up of 6.0 years (Type 2 diabetes) and 9.4 years (Type 1 diabetes) no significant differences in HbA(1c) could be found. However, difference in BMI (-0.41 kg/m² per each point of social score) persisted at last observation. Blood pressure was only negligibly affected by the care programme. Low social status is associated with worse quality of diabetes care at entry in a tertiary care centre. The differences in HbA(1c) disappeared after treatment and structured education, whereas the difference in BMI persisted. There was no significant influence of social status or treatment on blood pressure. © 2011 The Authors. Diabetic Medicine © 2011 Diabetes UK.
Background: Obesity is a leading determinant for diabetes mellitus. The objective of this study was to assess the prevalence of overweight/obesity among diabetic patients seen at a tertiary hospital in South-South Nigeria. Methods: A retrospective study of 244 diabetic patients seen between January 2010 and June 2012.
Tripp, Dean A.; Nickel, J. Curtis; Krsmanovic, Adrijana; Pontari, Michel; Moldwin, Robert; Mayer, Robert; Carr, Lesley K.; Yang, Claire C.; Nordling, Jorgen
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 recruited from the community (n=117). Both groups completed questionnaires on demographics, pain (McGill Pain Questionnaire), IC/BPS symptoms, and psychological variables. Univariate and multivariate hierarchical regression modelling was conducted to examine the strength of associations and unique effects of psychosocial variables on patient SI. Results Compared to 6% in healthy controls, 23% of patients endorsed SI in the past two weeks. Correlations between SI, depression, and catastrophizing across controls and cases show that for controls, SI is associated with greater pain (0.31; p<0.01) and depression only (0.59; p<0.01). For tertiary care centre cases, SI is associated with pain (0.24; p<0.01), depression (0.64; p<0.01), and catastrophizing (0.35; p<0.01). Regression analyses indicated that psychosocial variables accounted for a significant amount of variance over and above IC/BPS symptoms. Catastrophizing (i.e., helplessness) about pain and depression were significant univariate predictors of SI, but only depression predicted SI in multivariable analyses. Conclusions Limitations of this study include its cross-sectional design and primarily correlation-based statistics. The present study 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/BPS involving not only treatment of disease symptoms, but also early detection/treatment of associated psychosocial problems. PMID:28096911
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
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. 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. 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. 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.
Full Text Available Background: The transformation of a surgical trainee into a surgeon is strongly influenced by the quality of teaching in the operating theater. This study investigates the perceptions of residents about the educational environment of the operating theater and identifies variables that may improve the operating theater education of our trainees. Materials and Methods: Residents in the department of surgery anonymously evaluated teaching in the operating room using the operating theater education environment measure. The residents evaluated 33 variables that might have an impact on their surgical skills within the operating theater. The variables were grouped into four subscales; teaching and training, learning opportunities, operating theater atmosphere and workload/supervision/support. Differences between male and female residents and junior and senior registrars were assessed using Mann-Whitney test. Statistical analysis was completed with the statistics package for the social sciences version 17. Results: A total of 33 residents were participated in this study. Twenty nine (88% males and 4 (12% females. 30 (90% were junior registrars. The mean total score was 67.5%. Operating theater atmosphere subscale had the highest score of 79.2% while workload/supervision/support subscale had the least score of 48.3%. There were significant differences between male and female resident′s perception of workload/supervision/support P 0.05. Conclusion: This study has shown a satisfactory teaching environment based on the existing local realities of means, resources and tools and highlighted the need for improvement in workload/supervision/support in our institution. An acceptable learning environment in the operating theatre will produce surgeons that are technically competent to bridge the gap in the enormous unmet need for surgical care in Nigeria.
Lage, Carmen; Suarez, Andrea Gonzalez; Pozueta, Ana; Riancho, Javier; Kazimierczak, Martha; Bravo, Maria; Jimenez Bonilla, Julio; de Arcocha Torres, Marıa; Quirce, Remedios; Banzo, Ignacio; Vazquez-Higuera, Jose Luis; Rabinovici, Gil D; Rodriguez-Rodriguez, Eloy; Sánchez-Juan, Pascual
The clinical utility of amyloid positron emission tomography (PET) has not been fully established. Our aim was to evaluate the effect of amyloid imaging on clinical decision making in a secondary care unit and compare our results with a previous study in a tertiary center following the same methods. We reviewed retrospectively 151 cognitively impaired patients who underwent amyloid (Pittsburgh compound B [PiB]) PET and were evaluated clinically before and after the scan in a secondary care unit. One hundred and fifty concurrently underwent fluorodeoxyglucose (FDG)-PET. We assessed changes between the pre- and post-PET clinical diagnosis and Alzheimer's disease treatment plan. The association between PiB/FDG results and changes in management was evaluated using χ2 and multivariate logistic regression. Concordance between classification based on scan readings and baseline diagnosis was 66% for PiB and 47% for FDG. The primary diagnosis changed after PET in 17.2% of cases. When examined independently, discordant PiB and discordant FDG were both associated with diagnostic change (p PET due to a higher likelihood of diagnostic change. We found that changes in diagnosis after PET in our secondary center almost doubled those of our previous analysis of a tertiary unit (9% versus 17.2%). Our results offer some clues about the rational use of amyloid PET in a secondary care memory unit stressing its utility in mild cognitive impairment patients.
Full Text Available The management of acute ischemic stroke has undergone a sea of change with the introduction of intravenous thrombolysis (IVT. Current guidelines state that the window period for IVT using rTPA is 4.5 hours. The MERCI, Multi Merci, and Penumbra trials in which patients with acute ischemic stroke were treated using endovascular treatment demonstrated better recanalisation in patients having a large vessel occlusion. However, recently published data from the three large trials IMS 3, Synthesis Expansion, and MR rescue, which compared endovascular treatment with intravenous therapy, failed to demonstrate superiority of endovascular treatment over IVT. In these trials, stent retrievers were used in very few patients. We present our results from a tertiary care center in India where patients are treated using intravenous as well as endovascular modalities. Among the 53 patients with acute ischemic stroke treated between 2010 and 2012, 23 were treated with IVT and 30 with endovascular methods. Stent retriever was used in majority of the endovascular cases. Aims: To compare the outcomes of acute ischemic stroke patients treated with IVT versus those who were managed using endovascular therapy. To evaluate outcomes of patients with acute ischemic stroke with a large vessel occlusion in whom endovascular modalities were used and to compare them with those of patients who were treated with IVT in presence of a large vessel occlusion. Settings and Design: Data of patients who underwent thrombolysis at our centre was collected over a 3-year period, that is, from 2010 to 2012. Endovascular treatment was done by an interventional neurologist. Materials and Methods: Data of patients with acute ischemic stroke who underwent IVT or endovascular treatment at our centre between 2010 and 2012 was analyzed. Parameters included age, National Institutes of Health Stroke Scale (NIHSS on admission, door to needle time, stroke subtype, modality of treatment, outcome based
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
Mathur, Rajkumar; Joshi, Nitin; Aggarwal, Gaurav; Raikwar, Ramsharan; Shrivastava, Vaibhav; Mathur, Poonam; Raikwar, Poonam; Joshi, Rupali
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. 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. Age of patients ranged from 21 to 40 years. 64% patients hailed from rural areas, 76% were from the lower socio-economic strata, 40% illiterate and 69% were short Statured. Vesico vaginal fistulae (VVF
Dias, Paul J; Plunkett, Adrian
In the UK the incidence of congenital heart disease is approximately 7 per 1000 live births. The case of a neonate with shock due to an undiagnosed heart defect who was resuscitated in a rural GP surgery and transferred directly to a paediatric centre with specialist tertiary services is described. This case emphasises the importance of the recognition of the sick infant and demonstrates what can be achieved within the current framework for delivery of care. Helicopter emergency medical teams have training in many advanced practical skills, diagnostic skills and clinical experience, which facilitate transfer of the patient to a place of definitive treatment, reducing morbidity and mortality.
Full Text Available Ping Yang, Na Chen, Rong-Rong Wang, Lu Li, Sai-Ping Jiang Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China Background: With the increasing incidence rate of chronic kidney disease (CKD, inappropriate use of medicine in CKD patients is an important issue, as it may cause adverse effects in patients and progression to chronic renal failure.Objective: The aim of this study is to assess the frequency of inappropriate medicine use among CKD patients.Methods: A cross-sectional study was conducted from November 1 to December 1, 2014 in a Chinese teaching tertiary hospital. All medication prescriptions for CKD patients with serum creatinine level above normal value were enrolled. The prescriptions, including unreasonable dosage, contraindicated, and cautiously used medicines in CKD patients, were evaluated and the related medications were also analyzed and classified.Results: Two hundred and two patients were included, and a total of 1,733 lines of medication prescriptions were evaluated. The prevalence of inappropriate medication prescriptions in CKD patients was 15.18%, of which, unreasonable dosage (n=56, contraindicated (n=46, and cautiously used medicines (n=161 accounted for 3.23%, 2.65%, and 9.29%, respectively. Spearman’s rank correlation coefficient implied that there was a significant correlation between the severity of renal insufficiency and frequency of inappropriate medication prescriptions (P=0.02, r=0.056. Among the inappropriate medication prescriptions, nutraceutical and electrolytes (n=65, 24.71%, cardiovascular drugs (n=61, 23.19%, and antimicrobial drugs (n=55, 20.91% represented the top three medicine categories in CKD patients.Conclusion: The study confirmed that inappropriate medication prescriptions were prevalent in CKD patients. Improving the quality of medication prescriptions in CKD patients is necessary. Keywords: inappropriateness of
Animesh Gupta, Divya C V, Diwakar K Singh, Krutarth B, Maria N, Srinivas R
Full Text Available Background: Health Care-Associated Infections (HCAI affect millions of people each year and raise a great risk for patients in health care settings, leading to high rates of morbidity and mortality. Objective: To estimate the prevalence of HCAI and to explore the association between certain socio-demographic factors, invasive procedures and mean duration of hospital stay with HCAI in a tertiary-care hospital. Materials and Methods: Data was obtained from the patients who were admitted for more than 48 hours in the general wards and their records in tertiary-care hospital for duration of 3 months (February 2014 to April 2014. Results: Among 290 patients, the prevalence of HCAI was estimated to be 11.7%. The prevalence of HCAI was proportionately less among men (10.2% than in women (14.2%, was more (15.6% among patients who underwent invasive procedures after admission and with mean duration of hospital stay of 12.47 days. Conclusion: Health Care-Associated Infections (HCAIs were found to be significantly associated with increased duration of hospital stay and invasive procedures done after admission. Prevalence was higher in patients aged more than 40 years.
Juruan F. de Witt
Full Text Available Background: The Division of Radiodiagnosis at Tygerberg Academic Hospital, a 1384-bed tertiary training institution in Cape Town, South Africa provides a comprehensive 24-hour clinical radiology service, and has a duty registrar on-site at all times. The demand for computed tomography (CT imaging is increasing and plays a pivotal role in patient management.Objectives: The purpose of this study was to determine the accuracy of after-hour registrar CT reporting, to identify possible factors that may affect the error rate, and to assess whether or not errors had any clinical impact.Method: A set of senior registrar reports (provisional reports issued during a 28-day period was compared with the corresponding consultant reports (final reports. Discrepancies were identified and quantified, based on their impact on patient management.Results: The overall discrepancy rate was 8% (18 out of 225 and the overall accuracy rate was 92% (207 out of 225. The major error rate was 4% (9 out of 225 and the minor error rate was also 4% (9 out of 225.Conclusion: We observed that the accuracy of after-hour CT reporting by senior registrars at the Division of Radiodiagnosis at Tygerberg Hospital was on par with international standards. We investigated three factors which may have affected discrepancy rates, and only found one factor, namely the time of day, to be significant. Steps can be taken to create awareness of this fact amongst registrars, which hopefully would result in improved patient care and management.
Rosemary O Ugwu
Full Text Available Background: Globally, the major causes of neonatal deaths are birth asphyxia, prematurity and severe infections. Little attention is paid to deaths contributed by surgically amenable conditions. This study was undertaken to determine the burden and types of surgical problems encountered in the neonatal period, their outcome and challenges encountered. Patients and Methods: This was a retrospective study. The case notes of all neonates admitted into the newborn unit of our centre between April 2002 and March 2010 with surgical conditions were retrieved and the following information extracted: Sex, diagnosis, age at presentation, surgical intervention and outcome. Results: Out of 7,401 neonates admitted within the study period, 460 (6.2% had a surgical condition. Of the 1,657 babies that died within the same period, 196 (11.8% of them were those with surgical conditions. Congenital abnormalities accounted for 408 (88.7% of all the surgical cases. Intestinal obstruction 129 (31.6%, neural tube defects 101 (24.8% and anterior abdominal wall defect 58 (14.2% were the commonest congenital abnormalities, while fracture of the long bones following birth trauma 15 (28.8% and perforated NEC 14 (26.9% were the commonest acquired conditions. Surgery was performed in 166 (36.1% and 98 (59% had postoperative complications. Significantly, more deaths occurred in preterms than in term babies (P = 0.003 and in those delivered outside the hospital than in in-born babies (P = 0.02. The major cause of death was infection in 92 (47%. Conclusion: Neonatal surgical conditions contributed significantly to both neonatal admissions and overall neonatal mortality and thus highlights the need for investments in newborn surgical care in developing countries.
Eric S. Donkor; Patience B. Tetteh-Quarcoo; Patrick F. Ayeh-Kumi; Simon K. Attah; Kwabena O. Duedu; Emmanuel Afutu; Isaac Boamah; Michael Olu-Taiwo; Isaac Anim-Baidoo
Cockroaches are common in the environment of many hospitals in Ghana; however, little is known about their public health risks. To evaluate potential risks, we investigated the external and internal microbial flora of 61 cockroaches from a tertiary hospital in Ghana and evaluated the antibiotic resistance profiles of the common bacterial species. Standard methods were used in all the microbiological investigations and antibiotic susceptibility testing. A rotavirus carriage rate of 19.7% was o...
Ram Badan Singh; Rajeev Kumar Dubey; Vaibhav Pandey; Vijayendra Kumar; Shiv Prasad Sharma; Baghel Annavi
Introduction: Foreign bodies in the digestive tract are an important cause of morbidity and mortality in paediatric age group and pose diagnostic and therapeutic challenges We performed this study to evaluate our experience of foreign bodies of digestive tract in children over a five year period in a tertiary referral center. Patients and Method: A retrospective study was conducted over a 5-year period between April 2009 and March 2013. All patients who were managed for foreign body in digest...
Jain, S M; Bagde, M N; Bagde, N D
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. 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. 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. 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. 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. There is a need to arrange reorientation programs to sensitize nurses and establish cytology clinics to offer facilities for easily accessible and affordable screening.
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
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. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
Navarrete-Reyes, Ana Patricia; Medina-Rimoldi, Carlos Tonatiuh; Avila-Funes, José Alberto
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 2017; 17: 1893-1898. © 2017 Japan Geriatrics Society.
Qureshi, S; Agrawal, C; Madan, M; Pandey, A; Chauhan, H
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.
Sharma, Anupama; Dishant; Gupta, Vikas; Kaushik, Jaya Shankar; Mittal, Kundan
Aluminum phosphide (ALP) (celphos) is an agricultural pesticide commonly implicated in poisoning. Literature pertaining to the clinical manifestations and treatment outcome of its poisoning among children is limited. A retrospective chart review was conducted of the medical records of 30 children aged less than 14 years admitted to pediatric intensive care unit (PICU) of a tertiary care hospital in northern India. Demographic, clinical, and laboratory parameters were recorded. The outcome was categorized into "survivors" and "nonsurvivors." The Mean (SD) age of the enrolled children [19 males (63.3%)] was 8.55 (3.07) years. Among the 30 children, 14 (46.67%) were nonsurvivors and the rest 16 (53.33%) were survivors. Nonsurvivors had ingested significantly higher doses of ALP (P poisoning is predicted by dose of ALP ingestion, time lag to medical attention, and higher PRISM score at admission. Use of magnesium sulfate could be associated with better survival among them.
Ong, Kheng Yong; Chung, Wing Lam; Mamun, Kaysar; Chen, Li Li
Even while pharmacy practice evolves to a more patient-centric mode of practice, local hospitals, due to high patient load as well as space and resource constraints, find it challenging to conduct thorough medication review and physical medication reconciliation for all patients. In light of this, optimizing the local current healthcare system to involve community pharmacists in the care of patients from public hospitals could potentially better cater to the healthcare needs of the older population. Due to easy accessibility, community pharmacies are often the first point of contact in the healthcare system. Project Octo-Pills aims to engage community pharmacists in the collaborative care of patients from a tertiary hospital, providing patients with quality medication reconciliation and review services from a more convenient location within their neighborhood. This paper describes the model for this pilot initiative. Copyright © 2017 Elsevier Inc. All rights reserved.
Sood, Neeraj; Wagner, Zachary
To evaluate the effects of a government insurance programme covering tertiary care for the poor in Karnataka, India--Vajpayee Arogyashree Scheme (VAS)--on treatment seeking and postoperative outcomes. Geographic regression discontinuity. 572 villages in Karnataka, India. 3478 households in 300 villages where VAS was implemented and 3486 households in 272 neighbouring matched villages ineligible for VAS. A government insurance programme that provided free tertiary care to households below the poverty line in half of villages in Karnataka from February 2010 to August 2012. Seeking treatment for symptoms, posthospitalisation well-being, occurrence of infections during hospitalisation and need for rehospitalisation. The prevalence of symptoms was nearly identical for households in VAS-eligible villages compared with households in VAS-ineligible villages. However, households eligible for VAS were 4.96 percentage points (95% CI 1 to 8.9; p=0.014) more likely to seek treatment for their symptoms. The increase in treatment seeking was more pronounced for symptoms of cardiac conditions, the condition most frequently covered by VAS. Respondents from VAS-eligible villages reported greater improvements in well-being after a hospitalisation in all categories assessed and they were statistically significant in 3 of the 6 categories (walking ability, pain and anxiety). Respondents eligible for VAS were 9.4 percentage points less likely to report any infection after their hospitalisation (95% CI -20.2 to 1.4; p=0.087) and 16.5 percentage points less likely to have to be rehospitalised after the initial hospitalisation (95% CI -28.7 to -4.3; p<0.01). Insurance for tertiary care increased treatment seeking among eligible households. Moreover, insured patients experienced better posthospitalisation outcomes, suggesting better quality of care received. These results suggest that there are several pathways through which tertiary care insurance could improve health, aside from
Shaikh Abdul M
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
Baldacchino, Donia R
The study unit on 'The spiritual dimension in care'had a Judeo-Christian orientation. It was introduced to the Diploma nursing curriculum at the University of Malta in the academic year 2002-2003. The aim was to increase students' awareness about the essence of spirituality in care so as to enable them to implement holistic care. Spirituality may or may not incorporate religiosity. Thus, believers may have spiritual needs which may include religious needs whilst the atheists and agnostics may still have spiritual needs. While considering secularisation, the Christian culture of Malta was addressed in this study unit. This article describes the content structure of the study unit based on the ASSET model (Narayanasamy, A., 1999. ASSET: a model for actioning spirituality and spiritual care education and training in nursing. Nurse Education Today 19, 274-285) and outlines the various teaching methods used. Following feedback from the first and second cohort groups in 2003 and 2004, respectively, the reviewed study unit was delivered to the third cohort group of students (n=65) in Semester 2 in the academic year 2004-2005. Apart from the use of traditional teaching methods, such as lessons and a seminar, other methods