Bharati Hospital Research Articles

A Prospective Observational Study of Patient Related Outcome of Post Hysterectomized Females

Background: Women who had undergone hysterectomy have to overcome problems related to physical, social and emotional well being. As the hysterectomy is one of the most common surgeries, a study was conducted to answer the question for the optimal surgical recovery. This study aims to describe the relationships between recovery time and the components of quality of life after hysterectomy. Aims and Objectives: To study the physical, social, and emotional well being of post hysterectomised patient. Methodology: Study was conducted in Department of Obstetrics and Gynaecology at Bharati hospital, Pune. It was a prospective observational study of patient related outcomes to study the physical, social, and emotional well being of post hysterectomised patient. Post hysterectomized women above 40 years were included in this study. 196 post hysterectomised women were included. Study was conducted from October 2021 to January 2024. Results: From third month onwards, degree of difficulty of majority of patients was reduced in all mentioned activities. Majority of cases there was gradual health improvement noted. The pain score was reduced over 3 months in 92% cases and in almost all patients over 6 months. Conclusion: It is important to assess quality of life after any surgery, so timely intervention suchasphysiotherapy, counselling,psychotherapy and medical therapy canaidin improvement of both physical and emotional health for betterment of patient care.

Assessment of the Changes in the Salivary Profile and Its Clinical Correlation in Children with Acute Lymphoblastic Leukemia Undergoing Chemotherapy: A Follow-up Study.

To assess the changes in salivary profile and its clinical correlation in patients with acute lymphoblastic leukemia (ALL) undergoing chemotherapy. Children who have been diagnosed with ALL undergoing chemotherapy at Bharati Hospital, Pune, were included in the study. Those children were included who fulfilled the following inclusion and exclusion criteria. Stimulated salivary samples were collected in sterile vials at 1-, 3-, and 6-month intervals and ware assessed for salivary pH and buffering capacity. Caries and oral manifestations were also checked at each interval. A total of 25 children with ALL undergoing chemotherapy were included to participate in the study. The results were analyzed using Statistical Package for the Social Sciences software. There was a statistically significant difference in the change in salivary pH during the 1st and 6th months of chemotherapy (p-value of 0.001). Salivary buffering capacity was also found to be low in these patients during the 1st month of chemotherapy, which gradually increased during the entire course of chemotherapy (p-value of 0.011). Progression of dental caries was seen during the entire course of treatment. All the major changes were seen in the 1st month, that is, the induction phase of chemotherapy. Hence, we can say this is the most affected phase of chemotherapy. The parents and children should be educated and motivated to maintain proper oral hygiene. Whenever possible, all preventive dental procedures should be undertaken before the start of chemotherapy to avoid future complications. Paranjape MN, Shah P, Patil S, et al. Assessment of the Changes in the Salivary Profile and Its Clinical Correlation in Children with Acute Lymphoblastic Leukemia Undergoing Chemotherapy: A Follow-up Study. Int J Clin Pediatr Dent 2023;16(S-3):S268-S271.

Knowledge and Attitude on COVID-19 Appropriate Behavior among Frontline Healthcare Workers in a Tertiary Care Hospital: A Cross Sectional Study

Introduction: Frontline healthcare workers (HCWs) are at higher risk of Covid-19 infection compared to general population. Adherence to COVID-19 preventive measure is an important factor in reducing the risk of exposure to the HCWs. Thus, we conducted a study to evaluate the knowledge and attitude toward COVID-19’s preventive measure among the HCWs. Material and Methods: We performed a cross-sectional study among HCWs in COVID care center of Bharati Hospital, Sangli, between June 2021 to December 2021, A validated self-questionnaire on the knowledge of hand-washing and donning-doffing, as well as the attitude towards covid-19 appropriate behavior was administered to the HCWs. A statistical analysis was performed using a Microsoft Office 365 and SPSS-22. Results: Evaluation of knowledge on hand-washing and donning-doffing shown that majority of study participants had an average knowledge (77.12%), whereas only 7.7% had good knowledge and another 14.9% had poor knowledge. Knowledge of HCWs were significantly associated with donning-doffing training (p <0.05). Majority of study participants (94.29%) demonstrated an appropriate behavior to COVID-19. Conclusion: As the study demonstrated an average knowledge on Covid-19 appropriate behavior after receiving a training, a periodic training on infection control and prevention in a healthcare setting and orientation programs related to COVID-19 appropriate behavior is indicated.

Prospective Observational Study to Determine Perinatal Outcome in Patients with HELLP Syndrome

Background: HELLP syndrome is a serious obstetric complication in pregnancy characterised by hemolysis, elevated liver enzymes and low platelet count. Incidence is 9.7% and prevalence ranges from 0.5-0.9%. The aim of the study was to study the incidence, different clinical presentations and diagnosis of HELLP syndrome in Pre eclampsia and eclampsia and to analyse the severity, complications, maternal and perinatal outcome. Aim & Objective: To determine perinatal outcome in patients diagnosed with HELLP syndrome. Methodology: The clinical trial was conducted for a period of two years OBGY department of Bharati Vidyapeeth University, Pune. It is an prospective observational study where a total number of 30 cases of HELLP syndrome above 28 weeks of gestational age were admitted in Bharati hospital during the study period of 24 months. Data analysis was done and appropriate statistical tests were used. Results: A total of 30 females with HELLP syndrome visiting tertiary care teaching hospital were included in the study. The mean age of the patients was ranging between 21 to 43 years. The mean gestation age was ranging between 28 to 38 weeks. Majority 13 (43.3%) of women were primigravida, followed by G2A1 7(23.3%), G2P1L1 3(10.0%), G3P1L1 and G3P1L1A1 2(6.7%) each, G3A2, G4P1D1A2 and G2P2L1 1(3.3%)each. There were total 8 (26.6%), 7 (23.4%) of HELLP syndrome patients had pre eclampsia and GDM, respectively, one and 2 of these patients were also having hypothyroidism respectively. 2 (6.7%) each patients had hypothyroidism, anemia and chronic hypertension. While, eclampsia, epilepsy, IVF and gestational hypertension were reported in 1 (3.3%) patient each. Majority of women with HELLP syndrome had brisk (24 (80%) type of deep tendon reflexes, followed by exaggerated 3 (10%) and there were 3 (10%) women with normal reflexes. Majority of women the mode of delivery was emergency LSCS (60%), mean of the APGAR score at 1 minandat 5 minutes was recorded among 25 (83.33%) patients. The NICU admission was require damong 14/30 (46.7%) of new born, while it was not required in 16 (53.3%) of new born. Conclusion: This study was done to intensify our efforts to reduce pre eclampsia with HELLP syndrome by undergoing regular antenatal care, early detection of pre eclampsia and its prompt management and early detection of complications with timely intervention.

A Prospective Observational Study of Maternal Perception of Reduced Fetal Movements and Fetal Outcome

Background: Maternal perception of reduced fetal movements (RFM) is associated with increased risk of still birth, preterm labor & fetal growth restriction. RFM is thought to represent fetal compensation to conserve energy due to insufficient oxygen & nutrient transfer resulting from placental insufficiency. Intrauterine fetal death is preceded by RFM for 24 hours in up to 50% cases. In infants who are alive at presentation, RFM is associated with increased incidence of still birth, fetal growth restriction & feto-maternal hemorrhage. However RFM is may also occur in non pathological conditions such as anterior placental site, increased maternal activity & standing position. Inadequate clinician response to complaint of RFM is important contributory factor to still birth. Aims and objectives: To assess association between maternal perceptions of reduced fetal movements and fetal outcome. Methodology: Study was conducted in Department of Obstetrics and Gynecology at Bharati hospital, Pune. It was a prospective observational study of fetal outcomes in mothers perceiving reduced fetal movements. Women after 28 weeks of pregnancy presenting with reduced fetal movements out of that 202 pregnant women were included. Study was conducted from October 2020 to October 2022. Results: Majority of the fetuses were healthy. There was strong association between reduced fetal movements and Oligohydramnios. We found significant association between NICU admission, birth weight, APGAR, and RFM category, while no significant association between RFM category and status at birth and type of delivery. There were 2 IUD’s noted. Conclusion: Fetal movements monitoring is necessary during antenatal period, after 28 weeks of pregnancy, it is a good predictor of fetal outcome, and helps in timely intervention.

A study of assessment of knowledge, attitude and practice of antibiotic stewardship among healthcare providers in a tertiary care hospital of Sangli

Background: Antimicrobials are routinely used for variety of clinical conditions but are also misused leading to drug resistance bacteria in clinical practice. Consultants can gain the knowledge about it and can also have the depth of problem faced, their prescribing behavior mainly depends on their attitude and understanding of condition. Our aim of this study is to evaluate the knowledge and beliefs about antibiotics prescribing among health care workers in a tertiary care hospital of Sangli. Methods: Our present study was conducted in the Bharati hospital, BV (DU) medical college and hospital, Sangli. Ethical clearance from the institutional ethics committee was obtained and it was, cross-sectional questionnaire-based study carried out in the form of a survey in which a pretested, semi-structured, validated questionnaire was provided to junior residents, senior residents and faculty of different specialties and responses were recorded. Questionnaire comprises of 9 in knowledge, 10 in attitude and 10 in practice section. Results: Out of all participants 84.5% believed that no need of antibiotics for running and blocked nose. Majority 89.6% were expressed that sample culture should be sent before starting antibiotics. 90.4% participants believed that education of patients will help. Only 76.8% strictly adhere to the antibiotic policy of our hospital. Conclusions: The present study on antibiotic usage gives useful information about the knowledge, attitudes and practices of prescribers and help plan suitable educational modifications that aim at improving the antimicrobial prescribing and minimizing the development of drug resistance in our developing country.

Incidentally Detected Anaemia in Elderly: A Cross-sectional Study from a Tertiary Care Hospital, Pune, Maharashtra, India

Introduction: Iron Deficiency Anaemia (IDA) is most prevalent nutritional deficiency observed worldwide. The elderly population is particularly susceptible. It is a significant risk factor for increased mortality and morbidity, reducing mobility and quality of life. Currently less Indian data is available for incidentally detected anaemia in elderly. The known causes of anaemia in elderly are nutritional, anaemia of chronic disease and malignancy. Aim: To evaluate the haematological profile and to identify potential aetiologies of anaemia in elderly who had an incidental diagnosis of anaemia. Materials and Methods: This was a prospective cross-sectional observational study, which included 90 incidentally diagnosed patients with anaemia above 60 years of age, admitted in Bharati Hospital and Medical College, Pune, Maharashtra, India during March 2021 to September 2022. Complete Blood Counts (CBCs) with peripheral blood smear, Haematocrit (Hct), reticulocyte counts, Red Blood Cells (RBC) indices like Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin (MCH) and cell morphology were all examined for each patient. The statistical programme Statistical Package for the Social Sciences (SPSS) (version 26.0) was used to analyse the data. The Chi-square test was used to evaluate the qualitative parameters. Results: The mean age was 66.44±5.87 years; 52 (57.8%) were men, and 38 (42.2%) were women. The most prevalent co-morbid conditions were diabetes and hypertension. The common clinical signs observed were pallor, oedema, knuckle pigmentation. In this study, IDA was the most frequent aetiology 53 (58.9%), second being megaloblastic anaemia 24 (26.7%), followed by dimorphic anaemia 13 (14.4%). Gastritis was commonest finding on gastroscopy. Conclusion: Anaemia is a common finding amongst elderly population which remains undiagnosed and is ignored. The main cause is nutritional deficiency leading to IDA, megaloblastic anaemia or dimorphic anaemia. Hence, geriatric population should undergo regular screening for early recognition of anaemia. Further large population studies are required for detailed evaluation to determine the causes of anaemia in elderly.

Clinical prolife and outcome in COVID-19 patients on treatment regimen of remdesivir, favipiravir, and non-antiviral drugs

Background: Although various drugs have been used in the treatment of COVID-19 infections, specific drug with good therapeutic outcome is still unclear. They are using remdesivir, favipiravir, ivermectin, azithromycin, and so on. Aim and Objectives: This study aimed to evaluate the clinical profile of patients treated with different regimens and their outcome in improvement or morbidity of patients. Materials and Methods: We conducted a cross-sectional questionnaire-based study after approval by the institutional ethics committee. Data were collected from case files of COVID-19-positive patients treated in COVID-19 ward in Bharati Hospital, Sangli. We collected as per our protocol pro forma as – routine COVID treatment with remdesivir, favipiravir, and non-antiviral drugs. We analyzed various clinical profiles (presenting complaints), duration of stay in COVID wards, their outcome as improved and discharged, or deaths occurred. Results: It was observed that majority 54% of patients were from 40 to 50 years’ range. There was male preponderance 64%. Clinical symptoms were fever (92%), cough (85%), sore throat (77%), headache (53%), and breathlessness (10%). Majority of them were diabetes mellitus (51%), obesity (22%), and hypertension. Ventilatory support needed in 18%, rest recovered on pharmacotherapy. Conclusion: One of the highly infectious diseases causing COVID-19 is contagious and transmitted through airborne droplets generated by sneezing, smooching, and coughing. So as per the WHO and CDC guidelines avoid close contact with these infected persons in a market or public place. Vaccines available against COVID-19 Covishield and Covaxin to prevent the severity and to have immunity against COVID should be taken by all.

Prediction of Postoperative Pulmonary Complications in Patients Undergoing Functional Endoscopic Sinus Surgery: A Cohort Study

Introduction: Considering the pathophysiology of nasal obstruction, changes in certain parameters such as Peripheral Blood Eosinophil Count (PBEC), bedside pulmonary function test, Peak Expiratory Flow Rate (PEFR), and Electrocardiography (ECG) may have some correlation with postoperative pulmonary complications such as upper airway obstruction, loss of pharyngeal muscle tone, and postobstructive pulmonary oedema. Aim: To observe and analyse the changes in PBEC, bedside pulmonary function test, PEFR, and ECG in patients undergoing Functional Endoscopic Sinus Surgery (FESS). Materials and Methods: A prospective cohort study was conducted at Bharati Hospital, Pune, Maharashtra, India over a two-year duration from December 2020 to October 2022. A total of 50 patients aged above 18 years undergoing FESS surgery were included in the study. The statistical analysis was performed using the Chi-square test and student’s t-test. After thorough preoperative evaluation, the aforementioned predictors were recorded. General anaesthesia management for FESS surgery was done according to the standard protocol. Vigilant intraoperative monitoring of vital parameters including peak airway pressure and plateau pressure was performed. After shifting the patients to the recovery room, they were observed for: 1) Hypoxia; 2) Hypercarbia; 3) Laryngospasm; 4) Bronchospasm; and 5) Pulmonary oedema. Results: A total of 50 patients aged between 18 years and 65 years with the mean age was 41.7±15.4 years were included in the study, with 32 males and 18 females. Only 24% of the study population showed postoperative hypoxia, while the rest of the complications were not observed in any patient. Changes in eosinophil count, PEFR, and ECG did not have any correlation with postoperative hypoxia and were statistically insignificant. Bedside pulmonary function tests, including the Sabrasez breath-holding test and the Sabrasez single breath count test, showed changes in 30% and 76% of patients, respectively. Forced Expiratory test change was seen in 72% of patients. Among these, 19.4% showed hypoxia. Out of the 12 cases showing postoperative hypoxia, seven had a disease duration of less than six months. Conclusion: The Sabrasez breath-holding test and Sabrasez single breath count are good predictors for postoperative hypoxia in patients undergoing FESS surgery. Shorter duration of nasal obstruction also showed postoperative hypoxia.

Evaluating the effect and user satisfaction of an adapted and translated mobile health application ASTHMAXcel© among adults with asthma in Pune, India

Objective ASTHMAXcel© is a mobile application previously shown to improve asthma knowledge, control, and quality of life. In this study, we translated the application to Marathi for pilot testing in Pune, India in order to evaluate its impact on user satisfaction and asthma knowledge among adult asthma patients. Methods ASTHMAXcel© was adapted to Marathi with the help of asthma patients and clinicians from Bharati Hospital. 57 different asthma patients were then recruited and received the Asthma Knowledge Questionnaire (AKQ), Asthma Control Questionnaire (ACQ), and Mini Asthma Quality of Life Questionnaire (Mini-AQLQ) to complete at baseline. Study participants then completed the adapted ASTHMAXcel© application. Post-intervention, participants filled out a post-AKQ and Questionnaire for User Interface Satisfaction (QUIS). A subset of participants was also interviewed for qualitative feedback. Paired t-tests and Pearson’s correlation were used for statistical analysis. Results Mean AKQ improved from 5.0+/−2.4 to 12.4+/−1.6 (p = 0.0001). QUIS results revealed that participants were highly satisfied with the application, scoring an average of 50 out of 54 maximum points. Better baseline asthma control was correlated with greater overall experience with the application (–0.110, p = 0.0417). Finally, the qualitative feedback revealed four themes for future refinement. Conclusion The adapted version of ASTHMAXcel© was linked to significant improvement in patient asthma knowledge and a high level of user satisfaction. These results support the potential utility of mHealth applications in promoting guideline-based asthma care in India. However, further studies are needed to establish a causal relationship between ASTHMAXcel© and improved clinical outcomes.

Treatment Approach Analysis of Hospitalized Patients with Liver Cirrhosis; A Prospective Observational Study

The analysis of medications prescribed for managing patients with liver cirrhosis provide essential insight into appropriate therapeutic regimens and prevents inappropriate therapeutic outcomes. This study aimed to analyze the treatment approach of hospitalized patients with liver cirrhosis and identify drug-drug interactions (DDIs) and hepatic dose adjustment associated with treatment. A prospective observational study was conducted for 12 months in the Medicine Department of Bharati Hospital and Research Center, located in Pune, India. Medication charts of 113 patients who were diagnosed with cirrhosis were reviewed. Pharmaceutical care-related standard tools were applied to identify DDIs and medications requiring hepatic dose adjustment. Investigating the number of complications showed that ascites (40.7%) were the most common complication associated with liver cirrhosis. The treatment approach analysis revealed that antibiotics (23.6%), diuretics (22.5%), and analgesics (13.8%) were the most frequently prescribed pharmacological class of medications. The most commonly identified DDIs was an interaction between Mefenamic Acid-Furosemide (46.3%). In addition, approximately half of prescribed Paracetamol (48.1%) required its dose to be adjusted according to the patient's liver function test. Therefore, periodic analysis of prescribed medications needs to be performed since the inappropriate selection of medications can further lead to drug-related problems like DDIs or hepatic dose adjustment. Our findings provide feedback to prescribers to improve the appropriate selection of medications and enhance patient safety.

Knowledge, attitude, and practice of ‘over-the-counter’ medications among medical and non-medical professionals during COVID-19 pandemic

Background: India is one of the emerging markets for over-the-counter (OTC) drugs and offers significant growth potential for the industry. There has been a huge rise in the use of OTC drugs since the beginning of the pandemic for which some major reasons are lack of time, non-availability of prescribers, and hospital exposure during a pandemic. Aim: To assess knowledge, attitude, and practice (KAP) of ‘over-the-counter’ medications among medical and non-medical professionals during the COVID-19 pandemic. Settings and Design: The study was conducted at Bharati Hospital and Research Center, Pune, Maharashtra, India. Materials and Methods: A descriptive observational study was conducted. Statistical Analysis Used: Descriptive (mean, percentage, and standard deviation) and inferential (chi-square test) statistics were used. Statistical analysis was done using the Statistical Package for the Social Sciences(SPSS) software version 10.0. Results: Out of 310 samples majority showed poor knowledge (50.65%), high practice (56.13%), and negative attitude (70%) towards the use of OTC drugs. There is a significant association found between age (p-value 0) and health care status (p-value 0) with the level of knowledge. Age group (p-value 0.046) and employee status (p-value 0.00033) showed a significant association with the practice of OTC drugs. Healthcare status showed a significant association (p-value 0.0007) towards attitude toward the use of OTC drugs. Conclusion: Participants reported overall poor knowledge with a negative attitude and adopted the high practice use of OTC drugs during the COVID-19 pandemic. Increased awareness about self-medication is important to avoid complications associated with the high practice of OTC medications.

Emergent Large Vessel Occlusion in Ischemic Stroke in SARS-COV-2 Virus (Severe Acute Respiratory Syndrome Corona Virus 2) Pandemic: An observational analytical study on proportion

Background and aim: Various neurological manifestations have been described with COVID-19 infection after it first appeared in 2019. Increased risk of strokes secondary to a hypercoagulable state is now well identified. In this study, we analysed the proportion of large vessel occlusions in patients with COVID-19 admitted at our hospital occurring before and during the COVID-19 pandemic to ascertain whether SARS-CO-2 Virus infection has a tendency to provoke thrombotic tendency. Methods: It was an observational study done retrospectively at Bharati Hospital and Research Centre (BHRC), Pune. We measured the proportion of large vessel occlusion before and after the onset of the Covid 19 pandemic. Results: A total of two hundred and seventy-six patients (191 female and 85 male) were identified during the study period. The mean age of the patients was 57±15 years. Of these (n=276), a total of 144 (52.2%) had large vessel occlusion, while 132(47.8%) had small vessel occlusion. Of the patients with large vessel occlusion, 52.78% had a history of hypertension, 40.28% had a history of diabetes mellitus, and 19.45% had a history of cardiac disease. In the pre-pandemic period, 43 (41.7%) patients had large vessel occlusion, while this number rose to 101 (58.4%) during the pandemic period (p=0.007). In the pre-pandemic period, 7.8% of patients succumbed to the stroke by the 10th day of admission, while during the pandemic period, 6.3% of patients succumbed to the stroke (p= 0.655). Conclusion: Emergent Large vessel occlusions were significantly higher during the pandemic period as compared to the pre-pandemic period. Further studies are required to examine this association and the pathophysiological mechanisms of stroke in COVID-19 patients.

CASE SERIES - INSULIN INFUSION THERAPY IS EFFECTIVE IN HYPERTRIGLYCERIDEMIAINDUCED ACUTE PANCREATITIS

Objective: Hypertriglyceridemia (HTG) is responsible for up to 10% of all acute pancreatitis (AP) cases. The objective of this study is to present the effects of insulin infusion therapy in HTG-induced AP. Methods: We had 11 patients with AP and high triglycerides between June 2020 and January 2021 admitted to Bharati Vidyapeeth Medical College and Hospital in Pune, Maharashtra, India. Following laboratory and imaging evaluations, all patients were treated with insulin infusions and supportive care. Following the achievement of triglyceride (TG) level <1000 mg/dL, patients were given Fenofibrate 160 mg OD and Saroglitazar 4 mg OD. We observed their recuperation during the treatment duration. Results: Our study included 11 AP patients ranging from 18 to 50 years of age, five men and six females. This group included diverse patient population obese, non-obese, diabetic, and non-diabetic patients. TG values ranged from 2200 to 8000 mg/dL, with a mean of 5345.4±1203.8 mg/dL. There were nine patients with moderate pancreatitis, two with mild pancreatitis, and none with severe pancreatitis. Insulin infusions in the range of 302–1008U were required for 2–4 days. TG dropped 17–41% on the 2nd day of insulin infusion and 59–75% on the 3rd day. In all patients, TG levels fell below 1000 mg/dL after 4 days of insulin infusion, and then they were treated with oral anti-lipid medications. Hospital stay ranged from 9 to 25 days, with a 100% recovery rate. Conclusion: Insulin infusion can be used to treat HTG-induced AP with minimal risk of complications.

Abstract- Poster

ObjectiveAlcohol consumption and misuse are common in India, and various social and psychological factors contribute to this problem. The goal of this research is to uncover psychosocial elements that contribute to alcohol use and abuse, as well as to examine socio-demographic aspects to evaluate a person’s susceptibility to alcohol consumption.MethodThe study was based on a questionnaire that was used to determine the factors that impact drinking and estimate peer influence. Alcoholic patients at Bharati Hospital in Sangli’s mental opd served as study participants. All of the participants were given a questionnaire to fill out in order to learn about the reasons for their drinking and their socioeconomic level. The research question explored the association between alcoholism and factors such as educational attainment, family history, income, depression, physical abuse, and the impact of friends.ResultThe study looked at psychosocial factors that influence alcohol use in the target group and answered research questions about those factors. Peer pressure, psychological issues, academic considerations, social factors, and family background are the leading reasons of alcohol and drug misuse.According to research, one of the factors that leads to alcohol usage is family history. Individuals, especially adolescents, respond to peer pressure to drink alcohol in order to avoid social rejection by their peers.

Predictive Value of Brückner Test in Detecting Refractive Errors among Children

Introduction: Uncorrected refractive errors form a major ocular morbidity in children. They often go unnoticed and affect child development. The prevalence of refractive error in Indian children is 10.8%. They are known to affect the overall development of children. However, if the error is high it could lead to amblyopia or strabismus. Snellen’s visual acuity along with cycloplegic refraction is an accepted method to detect refractive errors, but in children, it needs special skill, patience and understanding. The Brückner test is useful for early detection of refractive errors especially in children. Aim: To re-evaluate the results of Brückner test in the form of sensitivity, specificity and provide data about a simpler, easy, ergonomic technique for mass screening of refractive errors. Materials and Methods: This cross-sectional study was conducted at Bharati Hospital (tertiary care hospital), Pune, Maharashtra, India, among 532 children (1064 eyes) in the age group of 2-15 years visiting the Ophthalmology Outpatient Department from October 2018 to September 2020. Position and size of pupillary crescent was recorded among children with direct ophthalmoscope. Children were classified according to errors of refraction as Emmetropia (no crescent), Myopia {inferior crescent (mild (<1/3), moderate (1/3-2/3), high (>2/3)}, Hypermetropia {superior crescent (mild (<1/3), moderate (1/3-2/3), high (>2/3)}. Subsequently, cycloplegic refraction was performed using auto-refractometer. Sensitivity, specificity, positive predictive value and negative predictive value of the test for emmetropia, myopia and hypermetropia were calculated. Subjective refraction was prescribed to children diagnosed with refractive errors during the course of this study. Results: A 275 females and 257 males (mean age 8.3 years) were included in this study, out of which, the study found 354 Emmetropic eyes, 326 Myopic eyes and 384 Hypermetropic eyes. Sensitivity of Brückner for emmetropia was 86.4%, specificity was 95.2%. Whereas for myopia, sensitivity was 95.1% and specificity was 94.6%. Also for hyperopia sensitivity was 95.3% and specificity was 98.8%. The crescent size was found to be significant (p-value<0.001) in diagnosing grades of myopia and hypermetropia as divided. Conclusion: The Brückner test has good sensitivity, specificity, positive and negative predictive value. It is a useful, accurate, and simple screening test.

Single vs Serial Dilatation of Access Tract in Percutaneous Nephrolithotomy: A Randomised Control Study on Its Feasibility and Effects in Management of Renal Calculi

Introduction: Percutaneous Nephrolithotomy (PCNL) is the recommended treatment for renal calculi. The tract dilatation method has a significant effect on the surgical outcome. One- shot Dilatation (OSD) involves dilatation using the dilator and Amplatz of desired size, while Serial Dilatation (SD) involves increasing the dilator size progressively up to the desired size. Aim: To compare the success and complication rates of SD techniques and OSD technique using Amplatz dilators. Materials and Methods: This was a randomised control study, conducted in a Tertiary Care Centre, of Bharati Hospital, Pune, Maharashtra, India, from March 2020 to December 2021. A non-probability sampling technique was followed and hundred consecutive patients of renal calculus were included in the study. The patients were then randomly allocated using random number table to undergo PCNL via a One-shot Dilatation (OSD-group I) or Serial Dilatation (SD-group II) of access tract. After the initial work up, the patients underwent PCNL, tract dilated as per the group enrolled. The two groups were then compared for patient demographics, stone characteristics (size, number, location), dilatation type, access time, tract size, access quality, bleeding at entry, operative time, radiation time, postoperative analgesic requirement, tube or tubeless procedure, time for removal of the nephrostomy tube and double ‘J’ stent placement. The statistical inference was obtained by Analysis of Variance (ANOVA) , Kruskall- Wallis t-test, Fisher’s exact test or Chi-square test. Significance was termed as a p-value<0.05. The analysis was performed on Pvalue.io. Results: In the patients from group I, there was lesser blood loss (Haemoglobin drop 0.9 vs 1.3 gm/dL), clot at entry( 6% vs 28%), and radiation exposure ( 60.9 sec vs 94.1 sec) as compared to group II patients. This was also reflected in reduced mean operative time (46.2 min vs 57.1 min) and lesser duration of hospital stay (3 vs 4 days) among group I patients. conclusion: The OSD was found to be superior to SD using Amplatz dilatation in PCNL in terms of having reduced blood loss and reduced exposure to radiation for the patient.

Coagulase Negative Staphylococcus Species Isolated from Blood Culture: A Pathogen or a Contaminant?

Introduction: Coagulase negative staphylococci (CoNS) are the most frequent blood culture isolates and an important cause of nosocomial blood stream infections especially in catheterised patients. CoNS are also the most common contaminants of blood cultures and are proven to be especially problematic. These uncertainties may result in over diagnosis and indirect overuse of antimicrobials especially vancomycin. Aim: To determine the clinical significance of CoNS isolated from blood culture of patients admitted in a tertiary care hospital. Materials and Methods: A prospective cross-sectional study was conducted in Bharati Hospital Research Center, Pune, Maharashtra, India, from August 2019 to July 2020 (One year). Patients whose paired/multiple blood culture samples showed pure growth of CoNS were included in the study. CoNS were identified by Vitek 2 system and antimicrobial susceptibility was reported. Clinical history of all patients was taken who showed pure growth of CoNS in either one or multiple sites of the automated blood culture bottles. Isolated CoNS were considered as pathogen only if clinical and laboratory parameters are fulfilled. Chi-square test was used to find out statistical significance of isolated pathogenic CoNS. Results: A total 147 CoNS isolated from blood cultures of suspected patients of sepsis were included in study. About 23 (15.6%) CoNS were isolated from both the sites. Remaining 124 (84.4%) CoNS were isolated from single site. CoNS were considered as pathogen in all 23 cases based on clinical and laboratory criteria. The most frequent isolated CoNS was S. haemolyticus 7 (30.4%), followed by S. epidermidis 5 (21.7%), S. hominis 3 (13.1%) , S. lugdunensis 3 (13.1%), S. scuiri 2 (8.7%), S. xylosus 1 (4.3%), S. caprae 1 (4.3%), S. capitis 1 (4.3%). Methicillin resistance was observed in 15 (65.2%) CoNS strains. Conclusion: Patients suffering from CoNS from their blood stream should be carefully evaluated clinically. Proper blood collection techniques need to be followed to avoid contamination of blood culture samples and to avoid diagnostic dilemma.

Cognitive function and behavioral problems in children born to mothers with preeclampsia: an Indian study

ABSTRACT Studies from high-income countries report associations of preeclampsia (PE) with reduced cognitive function and adverse behavioural outcomes in children. We examined these associations in Indian children aged 5-7 years. Children of mothers with PE (n=74) and without PE (non-PE; n=234) were recruited at delivery at Bharati Hospital, Pune, India. The cognitive performance was assessed using 3 core tests from the Kaufman Assessment Battery and additional tests including Verbal fluency, Kohs block design, and Coding A (from Wechsler Intelligence Scale for Children). The parent-reported Strengths and Difficulties Questionnaire (SDQ) was used to assess children’s behavioral characteristics. Scores were compared between children from PE and non-PE groups, and associations analyzed further using regression models, adjusted for potential confounders. After adjusting for age, sex, socio-economic status and maternal education, children of PE mothers had lower Kohs block design scores (adjusted odds ratio per score category 0.57, [95% CI 0.34-0.96] p=0.034; 0.62 [95%CI (0.36, 1.07), p=0.09 on further adjustment for birth weight and gestation) compared to children of mothers without PE. In the SDQ, there was a lower prevalence of abnormal ‘conduct problem’ scores in PE group than non-PE group (OR=0.33, 95% CI 0.13-0.83, p=0.018, in the fully adjusted model); there were no differences for other behavioral domains. This preliminary study in Indian children suggests that fetal exposure to maternal PE may have an adverse impact on visuo-spatial performance but does not adversely affect behavior. Further studies with larger sample sizes are essential to understand effects of maternal PE on cognitive/behavioral outcomes in children.

Factors responsible for difficult to treat superficial fungal infections: A study from a tertiary healthcare centre in India.

Recurrent and clinically unresponsive dermatophytosis is being increasingly observed in India. However, there is little information regarding the extent of the problem and the factors responsible for these difficult to treat superficial fungal infections. To identify factors contributing to difficult to treat recurrent superficial fungal infections. This prospective cross-sectional study enrolled 105 patients of all age groups presenting with either recurrent or long-standing dermatophyte infection attending the outpatient department of Dermatology, Venerology and Leprosy of Bharati Hospital, Pune, India, between September 2018 and March 2020. Patients were clinically examined, clinical history was taken and questions were asked regarding their current complaints and recorded in a proforma. Data were analysed using the SPSS software package. The males outnumbered females (74.3% vs 25.7%). A strong association was observed between the presence of past history and duration of disease (p=.007). The association of use of topical steroids or keratolytic agents with the duration of disease was statistically significant (p=.022). There was a statistically significant inverse association of duration of disease with dermatologist consultation (p<.001). The association between consultation with non-dermatologist and the duration of disease was statistically significant (p=.035). Hyperhidrosis, obesity, positive family history, tight clothing and chronic diseases may be considered important factors in acquiring dermatophytic infection. However, when it comes to difficult to treat tinea infections, irrational usage of topical steroids, treatment from non-dermatologists and a past history of tinea appear to be more critical causative factors. Treatment of dermatophytosis by dermatologists/ trained physicians and increasing general awareness of the public regarding the current situation about tinea in the country would help to alleviate the current crisis.