Care Hospital In Bengaluru Research Articles

IJCM_76A: Assessment of quality of life after normal vaginal delivery and caesarean section among mothers at a government tertiary care hospital, Bengaluru - A cross sectional study.

Background: Quality of life comprises multifaceted dimensions encompassing physical, emotional, social, and psychological aspects. Assessing quality of life is essential not only for mothers but also for their children, family members, and the community. Understanding the impact of different modes of delivery on women’s well-being is crucial for healthcare providers to offer appropriate support and interventions. Objective: To assess and compare the quality of life after normal vaginal delivery and caesarean section among mothers at a government tertiary care hospital, Bengaluru. Methodology: A cross-sectional study was conducted among mothers at a tertiary care hospital in Bengaluru. A pilot study was conducted and sample size was calculated as 200, with 100 participants in each group. Samples were selected using a simple random sampling method, and data were collected using a pre-tested, semi-structured questionnaire. The Short Form Health Survey (SF-36) was used to assess the quality of life. The collected data was entered into MS Excel and analyzed using SPSS 21.0 Results: Out of 200 participants, the mean age of the study population was 24.32 ± 5.58 years. Comparison between the vaginal and cesarean groups revealed that the vaginal birth group had higher mean scores in the physical health domain. Factors such as physical functioning, emotional well-being, socioeconomic status, and comorbidities were found to be significantly associated with modes of delivery. Conclusion: Different modes of delivery have their own unique challenges and benefits, this study illuminated distinct differences in quality of life. Normal vaginal delivery was associated with a quicker physical recuperation compared to caesarean section, while caesarean sections demanded a longer recovery period and potential physical limitations.

A study on the effectiveness of training programs in improving biomedical waste handling in a tertiary care hospital, Bengaluru: A pre-post study

BackgroundIn addition to being centres for healing, hospitals are major producers of infectious waste. The current study was carried out at a 700-bed tertiary care hospital in Bengaluru to assess Biomedical Waste (BMW) management practices at the source of generation and to ascertain the efficacy of training on the knowledge, attitude, and practice (KAP) of healthcare workers (HCW). MethodsBefore the structured training program, each participant filled out the pre-test questionnaire. The structured training program on BMW (M and H) rules was conducted using audiovisual learning techniques. Immediately after the end of the training session, participants were given the 1st post-test questionnaire. Three months after the training session, the participants were given the 2nd post-test questionnaire. ResultsOut of 183 participants involved in the study, 33.9 % of the participants were males, while 66.1 % were females. Wilcoxon Signed Rank Test was applied to the pre-and post-interventional knowledge and practices. There was a significant mean difference between pre-interventional (4.7 ± 1.7) and post-interventional knowledge (post-test 1–8.8 ± 1.3; post-test 2–7.3 ± 1.4) regarding Bio-medical waste management. Similarly, a significant difference in mean between pre-interventional (5.9 ± 1.4) and post-interventional practices (post-test 1–8.6 ± 1.1; post-test 2–7.3 ± 1.2) regarding BMW management. ConclusionThe study concluded that regular training programs on BMW and its hazards for all HCWs including group D workers should be conducted.

Dapsone-Induced DRESS Syndrome: A Case Report

Drug reaction with eosinophilia and systemic symptoms DRESS syndrome sometimes known as drug-induced hypersensitivity syndrome represents a unique and potentially life-threatening adverse response triggered by medications. It typically presents as a skin rash resembling measles affecting individuals of various age groups accompanied by symptoms like fever swollen lymph nodes irregular blood cell counts and a range of multiorgan issues. Its incidence is 11000 to 10000 exposures and its mortality is 10-20. We report a case of a patient diagnosed with DRESS syndrome secondary to Dapsone use. The main objective of this case report is to describe the characteristics complications and treatment of drug-induced DRESS syndrome. The presented case report of a 17-year-old female patient admitted to a tertiary care hospital in Bengaluru with a history of peeling skin all over the body for 10 days and was diagnosed with DRESS syndrome secondary to Dapsone use. During the admission she was prescribed Wysolone and Atarax Hydroxyzine. The patient was simultaneously treated with local ointments and her condition symptomatically improved. This case emphasizes the fatal and life-threatening adverse reactions of Dapsone and their management.

Cytomorphological Patterns of AFB Positive Tubercular Lymphadenitis: A Cross-sectional Study

Introduction: Tuberculosis (TB) remains a global threat despite advancements in diagnostic technologies and treatment options. Tubercular lymphadenitis is the most common presentation of Extra Pulmonary Tuberculosis (EPTB) in developing countries, accounting for approximately 30-52% of cases. Fine Needle Aspiration Cytology (FNAC) plays a crucial role in the cost- effective and efficient outpatient diagnosis of tubercular lymphadenitis. Understanding the different cytomorphological patterns and Acid Fast Bacilli (AFB) density in tubercular lymphadenitis aids in early diagnosis, management, and reducing morbidity and mortality. Aim: To analyse the various cytomorphological patterns observed in tubercular lymphadenitis, along with AFB density. Materials and Methods: The present cross-sectional cytomorphological study study was conducted between September and October 2021. Data from September 2020 to August 2021 were collected from the records of Shanthabai Devarao Shivaram(SDS) Tuberculosis Research Centre and Rajiv Gandhi Institute of Chest Diseases, a tertiary care hospital in Bengaluru, Karnataka, India. Out of a total of 128 patients with lymphadenopathy who underwent FNAC, four cases were excluded due to failed aspiration. The remaining 124 cases were available for analysis. Smears that exhibited features suggestive of tuberculosis were selected and categorised based on cytomorphological patterns into the following groups: Pattern-1 (Exudative), Pattern-2 (Epithelioid granuloma without necrosis), Pattern-3 (Epithelioid granuloma with necrosis), and Pattern-4 (Predominantly Necrosis without epithelioid granuloma). Ziehl-Neelsen (ZN) stained AFB positive smears were further categorised into four groups based on mycobacterial load. The categories included scant (1-9 AFB in 100 fields), 1+ (10-99 AFB in 100 fields), 2+ (1-10 AFB per field), and 3+ (>10 AFB per field). Higher numbers indicated greater infectivity. Statistical analysis was performed using the Chi-square test. A probability level of less than 0.05 (p<0.05) was considered statistically significant. Results: Out of the 124 cases studied, 81 (65.32%) were females and 43 (34.68%) were males, with a female preponderance (1.9:1). The overall prevalence of tubercular lymphadenopathy was 89 cases (71.77%), with Pattern 4 (Acellular necrosis without granuloma) being the most common cytomorphological pattern 25 cases (28.09%) followed closely by Pattern-2 (Epithelioid cell granuloma without necrosis) 23 cases (25.84%). AFB positivity was observed in 57 cases (64.04%). Pattern-1 (Exudative pattern) showed 100% AFB positivity (21 out of 21 cases), while Pattern 4 (Predominantly necrosis without epithelioid granuloma) demonstrated 92% AFB positivity (23 out of 25 cases). Conclusion: Understanding the various cytomorphological patterns in tubercular lymphadenitis is crucial for its diagnosis. Additionally, identifying AFB positivity, acid-fast bacilli distribution, and Bacterial Index (BI) in various patterns aids in planning early treatment and ensuring a favourable prognosis. FNAC serves as an easy, inexpensive, and quick procedure that can help avoid unnecessary surgical intervention or biopsy in the diagnosis of tubercular lymphadenitis.

Expression of androgen receptor in human placentas from normal and preeclamptic pregnancies

Background: Human placenta is a diary of all the prenatal events and it’s study may provide valuable insight into pathophysiology of many diseases. One such disease preeclampsia (PE) is a leading contributor of maternal/fetal mortality and morbidity. In a quest to improve the treatment protocols, newer etiologies are researched, the latest being Androgen Receptor (AR) expression in PE placentae. Methodology: Study was conducted in a tertiary care hospital in Bengaluru over a period of 18 months. Placentae (15) from singleton pregnancies with PE formed the study group while placentae (5) from normotensive pregnancies were the control group. Gross and histopathological findings followed by immunohistochemistry of AR was performed on all placentae and categorized based on the percentage of villi stained. Intracellular localisation and the type of cells staining were also recorded. Results: Mean age was 28 years, majority (73%) of PE were in 28-32 weeks gestation group, with 46% being primigravidae. Past history of PE was observed in 75% while 53% had family history of PE. Decreased placental weight, increased syncytial knots, accelerated villous maturation and stromal fibrosis, fibrinoid necrosis and mural hypertrophy of arterioles were statistically significant findings in PE group. AR staining was seen in 16/20 (80%) with 11/15 PE cases showing 2+ and 3+ staining. Cytoplasmic staining was commonly seen in Syncytiotrophoblast, Cytotrophoblast & stromal cells in both groups. Conclusion: AR expression was seen both in PE and non-PE placentae, although AR expression is increased in the former. Stillbirths were associated with positive AR despite clinically classified as mild PE, while negative AR was associated with live births. AR expression could be a new marker for PE with adverse outcome especially in recurrent cases.

Assessment of psychological distress and its association with socio-demographic variables among cancer patients in a tertiary care hospital in Bengaluru, Karnataka: a cross sectional study

Background: Cancer diagnosis is known to cause significant mental distress and anxiety. Psychologically distressed patients are less compliant to treatments and endure longer hospitalization. Assessment of distress is critical to develop necessary interventions. Our research aims to assess the severity, contributing factors, and relationships between socio-demographic characteristics and psychological distress in cancer patients. Methods: A cross sectional study with random sample of 188 cancer patients were assessed for distress with NCCN distress thermometer (DT) from a tertiary care facility. Descriptive analysis and Chi-square test performed using SPSS-28. Results: 75% reported "moderate and above" distress levels, with a mean distress of 5.5±2.99. Respondents below 40 years, females, currently unmarried, nuclear families, highly educated, and financially dependent were more likely to experience severe distress (score 8-10). Significant emotional concerns were associated with severe distress, followed by practical problems. Conclusions: Distress can be routinely screened with a simple visual analogue scale like DT. A severely distress patient had 3 or more physical, practical, emotional and 2 or more social and spiritual concerns and a person with mild distress had just one emotional concern and spiritual concern and none of the other three. Early identification, routine screening and psychosocial support can reduce distress with optimal efficacy.

Determinants of Childhood Asthma: A Case Control Study from a Tertiary Care Hospital in Bengaluru, South India.

Childhood asthma is a common, and often serious, chronic disease with episodic exacerbations in infants and children. There is an increasing trend in the prevalence of childhood asthma in developing countries. Objectives: To identify the determinants of childhood asthma. A case control study with 30 cases of childhood asthma and 30 gender- and aged-matched controls selected from the paediatric outpatient department and paediatric ward of a tertiary hospital. The primary caregiver was interviewed to capture sociodemographic details, prenatal and birth history, and history of exposure to environmental risk factors. Odds ratios with 95% confidence intervals were calculated to determine the strength of association between childhood asthma and independent co-variates, followed by subgroup multiple logistic regression analysis. We found that children with a parental history of allergy/atopy [OR=2.88 (1.94-4.27), P<0.001], residence in houses located in industrial areas [AOR=2.72 (2.6-323.1), P<0.001], exposure to incense at home [AOR=2.03 (1.14-29.42), P<0.001], or a history of allergic rhinitis [AOR=3.09 (2.22-243.25), P<0.001] had significantly higher odds of developing childhood asthma. Our study found that having homes located in industrial areas, burning incense at home, parental history of allergy, and history of allergic rhinitis in the child are determinants of childhood asthma. The findings from our study can be used to generate awareness regarding risk factors that are linked to childhood asthma.

Evaluation of the Adverse Effects of Monoclonal Antibodies in Breast Cancer Treatment in a Tertiary Care Hospital in Bengaluru, India, in 2020

Evaluation of the Adverse Effects of Monoclonal Antibodies in Breast Cancer Treatment in a Tertiary Care Hospital in Bengaluru, India, in 2020

Acquiescent, Defensive and Prosocial Reasons for Employee Silence in a Private Healthcare Organization, Bengaluru

Employees are the main pillars of an organization that have individual opinions, ideas and information that helps in workplace and organizational improvement. In modern organizations, employees are not the economic man rather it is essential for them to express emotions, perception, thoughts, experience and attitude regarding their workplace and organization as demanded by the nature of work and its environment. They are the foundation of feedback in dealing with and resolving the complexities. So, with this context the aim of the study was to identify the reasons for employee silence in an organization and impact of the socio-demographic variables on employee silence in a tertiary care hospital. Quantitative data (n=334) were collected from the employees of a tertiary care hospital in Bengaluru, India. Exploratory factor analysis was carried out to find the factors causing employee silence among the employees of the organization and independent sample t-test and One-way ANOVA was performed to find the association between the socio-demographic variables and employee silence. Results from the study have identified four major factors of silence namely; indifference of the management, fear of the management, maintenance of good relationship and prosocial tendency as possible causes of silence. These factors were correlated using Pearson’s correlation to find the association between the identified factors and indifference of the management and fear, maintenance of good relationship and prosocial tendency had a strong positive correlation. Further the study showed there is a relationship between age, education level and work experience with employee silence and it differs with different categories of age, education and years of experience. Since the study is related to healthcare organization more emphasis should be given to the employees as the quality of services delivered would mainly depend on them. The study reveals the need for having a positive interpersonal relationship which gives way for continuous feedback between the management and employees which in turn would lower employee silence in an organization

A Clinical Study on Musculoskeletal Changes Seen in Type 2 Diabetes Mellitus: A Single-Center Study

Abstract Background: Type 2 Diabetes mellitus (T2DM) may affect the musculoskeletal (MSK) system in a variety of ways. The impacts can be debilitating enough to impair functional ability and quality of life. MSK complications are the most common endocrine arthropathies which are often under-recognized and poorly treated. This study was done to evaluate the prevalence of MSK complications and its correlation with microvascular complications of T2DM given the paucity of similar studies in India particularly South India. Materials and Methods: A cross-sectional study was conducted on 130 diabetic patients at a tertiary care hospital in Bengaluru. The patient’s demographic details, clinical profile including history, general physical examination, systemic examination, and relevant investigations were done to record microvascular complications. A thorough MSK system examination along with imaging of bones and joints was also performed. Results: Out of 130 diabetic patients, 21 patients (16.2%) had MSK complications of which 47.6% (n = 10) of them had carpal tunnel syndrome and 42.8% (n = 9) had frozen shoulder and 9.5% (n = 2) had diabetic amyotrophy. It was also noted that patients who were on oral hypoglycemic agents alone were more likely to develop MSK complications (57.14%) than patients solely on insulin (14.2%). Poor glycemic control, existing microvascular complications, and low high-density lipoprotein were found to be associated with increased risk of MSK complications. Conclusion: The prevalence of MSK complications in T2DM patients is quite significant and is also associated with microvascular complications. Improved glycemic control in T2DM was found to reduce the burden of such complications. Early identification of MSK complications can improve the quality of life in diabetic patients and hence demands proper screening and follow-up.

Utility of the RIPS Scale and 2CAN Score for In-Hospital Stroke Prediction.

In-hospital strokes are a small but sizeable proportion of all strokes. Identification of in-hospital strokes is confounded by stroke mimics in as many as half of in-patient stroke codes. A quick scoring system based on risk factors and clinical signs during the initial evaluation of a suspected stroke might be helpful to distinguish true strokes from mimics. Two such scoring systems based on ischemic and hemorrhagic risk factors are the risk for in-patient stroke (RIPS) and the 2CAN score. This prospective clinical study was conducted at a quaternary care hospital in Bengaluru, India. All hospitalized patients aged 18 years and above for whom a "stroke code" alert was recorded during the study period of January 2019 to January 2020 were included in the study. A total of 121 in-patient "stroke codes" were documented during the study. Ischemic stroke was the most common etiological diagnosis. A total of 53 patients were diagnosed to have ischemic stroke, 4 had intracerebral hemorrhage, and the rest were mimics. Receiver operative curve analysis was performed and at a cut-off of RIPS ≥3, it predicts stroke with a sensitivity of 77% and a specificity of 73%. At a cut-off of 2CAN ≥3, it predicts stroke with a sensitivity of 67% and a specificity of 80%. RIPS and 2CAN significantly predicted stroke. There was no difference in the use of either RIPS or 2CAN for differentiating stroke from mimics, and hence they may be used interchangeably. They were statistically significant with good sensitivity and specificity, as a screening tool to determine in-patient stroke.

A spectrum of dermatological manifestations associated with hypothyroid condition – A pilot study

BACKGROUND: Hypothyroidism, a major health problem, is associated with a wide range of diseases. One of the organs affected by hypothyroidism, which shows a wide range of clinical signs, is the skin. OBJECTIVES: The objective of this study was to determine various cutaneous manifestations of hypothyroidism that can be used as a diagnostic marker and may help in the early diagnosis and treatment of hypothyroidism. METHODOLOGY: A cross-sectional observational study was carried out on 100 consecutive diagnosed cases of hypothyroidism patients in the dermatology department of a tertiary care hospital in Bengaluru during June 2021–September 2021. A pretested standard pro forma was used to collect and maintain the details of the patients. The study was ethically approved by the institution. RESULTS: The majority were female (84%) and patients' age ranged from 16 to 65 years, covering all groups with 31% having comorbidities. Seventy-one percent had pruritus and 14% with urticaria, 13% with palmar and sole hyperkeratosis, 3% with burning skin symptoms, and 5% with cold skin symptoms. The majority (38%) had pruritus as an early symptom. Pruritus symptom patients were categorized into mild pruritus (25%) and moderate pruritus (75%). A significant number of patients presented with hair changes in the form of dry brittle hair in 50 patients and with other associated skin conditions which included 20 patients with melasma, 10 patients with seborrheic dermatitis, eight patients had acrochordons, four patients had vitiligo, five had polymorphic light eruptions like lesions, three patients had lichen planus, and two each had psoriasis and acne vulgaris. CONCLUSION: The present study was undertaken to know the spectrum of dermatological manifestations associated with a hypothyroid condition. It was observed the female sex, pruritis, and hair changes were common in these patients. Recognition of hypothyroidism is important to ensure that appropriate treatment is provided at the earliest, thus preventing complications.

Classification of Acute Leukaemia based on Blast Morphology, Cytochemistry and Flow Cytometry

Introduction: Acute leukaemias are a heterogeneous group of malignancies due to the abnormal proliferation of immature cells. The classification of acute leukaemia has been transformed over a period. French American British’s (FAB) classification of acute leukaemia is based on morphology and cytochemistry. Later, the World Health Organization (WHO) classification stressed immunophenotyping to be done in the classification of acute leukaemia. Immunophenotyping is a powerful tool for classification and also for treatment and prognosis. Aim: To study the morphology of blasts in the peripheral smear and bone marrow cytochemistry and to compare with immunophenotyping in the classification of acute leukaemia. Materials and Methods: A cross-sectional study was undertaken in the Department of Transfusion Medicine and Immunohematology, at St. Johns National Academy of Health Sciences a Tertiary Care Hospital in Bengaluru over a period of one year from November 2018 to October 2019. The morphology of the blast was studied in peripheral blood and bone marrow aspirate stained by Leishman stain. Cytochemistry in peripheral smear and bone marrow with Sudan Black B and Periodic Acid-Schiff (PAS) stain was done in all acute leukaemia. The flow cytometry samples were processed within 24 hours of collection of the samples with a panel of markers including myeloid and lymphoid lineage and precursor markers. The results of morphology were confirmed with flow cytometry and final reports were released. Results: A total of 112 cases of acute leukaemia were studied and classified based on morphology, cytochemistry, and immunophenotyping of blasts. A total of 46 cases of Acute Myeloid Leukaemia (AML) and 63 cases of Acute Lymphoblastic Leukaemia (ALL). Two cases were found with Chronic Myeloid Leukaemia (CML) in blast crisis, one with myeloid and another with lymphoid blast crisis. One biphenotypic leukaemia was noted. Sudan Black was positive in 35 (76%) of AML and PAS was positive in 28 (44%) of ALL. The most common AML subtype was AML-M2 and the most common ALL subtype was B cell ALL. The most common symptom was fever and the sign was pallor. Conclusion: The present study showed that morphological diagnosis is important, based on which the cytochemistry and flow cytometry is performed for diagnosis. In cases of the diagnostic dilemma of acute leukaemia with morphology and cytochemistry, immunophenotyping supports diagnosing and classifying acute leukaemia.

A Retrospective Cross-sectional Study of Paediatric Dermatoses during the COVID-19 Pandemic in a Tertiary Care Hospital in Bengaluru, Karnataka, India

Introduction: Dermatologic conditions constitute at least 30% of all outpatient visits to paediatricians and 30% of all visits to dermatologists involve children. Skin conditions that manifest themselves during childhood and adolescence are referred as paediatric dermatoses and make up their own unique category of skin conditions. Aim: To identify the dermatological conditions which were prevalent during the Coronavirus Disease 2019 (COVID-19) pandemic in a tertiary care hospital in Bangalore. Materials and Methods: This retrospective cross-sectional study was conducted by reviewing records of Outpatient Department (OPD) of Dermatology and Paediatrics in our tertiary care center, Bengaluru from February 2020 to February 2022. The demographic details and diagnosis are recorded. The diagnosis was made according to ICD-10 (International Classification of Diseases 10th Revision) and the prevalence of different dermatoses was calculated. Mean and standard deviation was calculated for descriptive statistics. Data were statistically evaluated with IBM Social Package for Statistical Analysis (SPSS) Statistics for Windows version 26.0., IBM Corp., Chicago, IL. Results: The total number of paediatric cases attended dermatology OPD during the two year pandemic was 558. The prevalence of paediatric dermatoses in the present study was 193 (34.58%). There were 283 girls and 275 boys with Male : Female is 1:1.02. There is a female preponderance of 50.7% against 49.28%. The majority was infectious lesions 153 (27.41%), congenital dermatoses 9 (1.61%), Papulosquamous disorders 23 (4.12%), Pilosebaceous disorders 111 (19.89%), dermatitis 193 (34.58%) followed by Miscellaneous 69 (12.36%). Conclusion: This study was conducted during COVID-19 pandemic which in comparison to the other studies shows a similar distribution of dermatoses. But there was a significant shift of age group affected which can be well explained by the lockdown and social isolation.

An observational study of simultaneous pulse oximetry and arterial oxygen saturation readings in intensive care unit/high dependency unit in COVID-19 patients

Background: The coronavirus-2019 (COVID-19) pandemic has increased the use of pulse oximeters worldwide. It has become an inevitable tool in the monitoring of the disease. However, the accuracy of pulse oximeters in COVID-19 has not been established. Aims and Objectives: The aims of the study were to examine the relationship between oxygen saturation as measured by pulse oximeter (SpO2) and oxygen saturation measured by arterial blood gas analysis (SaO2) measurements in COVID-19 patients admitted to the intensive care unit (ICU)/high dependency unit (HDU) and to assess the ability of SpO2 readings to detect low SaO2 and low oxygen tension in COVID-19 patients. Materials and Methods: This prospective observational study was conducted in the COVID-19 ICU and high dependency unit of a tertiary care hospital in Bengaluru, India. All patients admitted with confirmed COVID-19, meeting the eligibility criteria, were included in the study. We assessed bias and limits of agreement between paired samples of oxygen saturation from pulse oximetry (SpO2) and arterial oxygen saturation from blood gas analysis (SaO2). Results: The sample mean difference SpO2-SaO2 is −0.86% (bias) and the 95% confidence interval for the mean difference was −1.67 and −0.04. The lower limit of agreement was −7.32 with a 95% confidence interval (−8.74, −5.91). The upper limit of agreement was 5.61 with a 95% confidence interval of 4.19 and 7.02. Conclusion: SpO2 values are not completely dependable in estimating SaO2 in COVID-19 patients in ICU/HDU; therefore, arterial blood gas analysis measurement of oxygen saturation has to be done depending on the clinical scenario CTRI (CTRI/2020/11/029035).

Colonoscopy an Audit: Wiser the Decision Better the Outcome

Background and Aim of the Study: In a developing country like India, wherein routine screening colonoscopy is not a norm and prevalence of colonic polyps is considered to be rare, we conducted a study to analyse the indications, findings and our compliance with selected key performance indicators (KPI’s): Cecal intubation, polyp detection rate, colonoscopy withdrawal time, adverse events and bowel preparation at a large tertiary care hospital in Bengaluru, India which would aid in improving the quality of our practice. Materials and Methods: A retrospective study was conducted on 185 patients either admitted or seen on outpatient basis at Bowring and Lady Curzon hospital attached to Bangalore medical college and research institute (BMCRI), Bengaluru. The colonoscopy reports of all patients at our center from September 2017 to August 2018 were reviewed to obtain information on demographics, indications, findings and KPI’s and the data was analyzed using appropriate statistical methods. Results: Among 185 patients who underwent colonoscopy 63% were male and 53% were 31-59 years old. The major indications were bleeding per rectum (PR) [24%], colonic wall thickening on imaging(19%), chronic diarrhea (11%) and colorectal growth (8%). 82% of the patients had excellent bowel preparation with the cecal intubation achieved in 84%.The common pathological findings in the above mentioned indications were Colorectal cancer(CRC) [11%], ulcer(9%), Inflammatory bowel disease(IBD) [6%] and polyp(6%). Conclusions: Colonoscopy is very much essential to evaluate lower GI symptoms. The quality of practice lies on the bowel preparation as well as cecal intubation. Bleeding PR was the most common indication whereas colorectal cancer was the most common pathological finding although more than half of the examinations were normal.

A Prospective Observational Study on Prescribing Pattern and Outcome of Acute Stroke from a Tertiary Care Hospital in Bengaluru, India

Introduction: Stroke is the most common cerebrovascular disorder and a second leading cause for death. Early diagnosis and treatment of stroke along with controlling of risk factors, post stroke infection and rehabilitation can enhance patient outcomes. Stroke is an important economic burden for the society, requiring increasing attention for more effective healthcare planning and resources allocation. Aim: To determine the prescribing pattern, risk factors and outcome of acute stroke in a tertiary care hospital. Materials and Methods: A prospective observational study was conducted in the Department of Medicine, at Kempegowda Institute of Medical Sciences Hospital and Research Centre, Bangalore, Karnataka, India, from January 2018-June 2019 for 18 months. After approval and clearance obtained from the Institutional Ethics Committee, 100 acute stroke subjects of either gender with or without co-morbidities were included in the study. Relevant information about the ongoing drug therapy, co-morbidities, personal and past history were obtained. The outcome of the stroke was assessed by Modified Rankin Scale (mRS). Chi-square test was used for categorical data, student t-test for continuous data and Analysis of Variance (ANOVA) test for temporal change in mean mRS. Results: The mean age of the subjects in the study was 68.41±12.98 years. Ischaemic stroke (72%) was more common than haemorrhagic stroke (28%). Hypertension and diabetes were significantly associated with stroke with p-value of 0.04 and 0.02 respectively. Association of smoking and alcohol with stroke was significant with p-value of 0.01 and 0.001 respectively. The most commonly prescribed drugs were aspirin, clopidogrel and statins. The mean mRS at admission for both ischaemic and haemorrhagic stroke came down after 28 days with treatment and rehabilitation. At the end of 28th day Ischaemic Stroke showed better outcome than haemorrhagic stroke (p-value: 0.03). Conclusion: Early diagnosis, lifestyle changes and combination drug therapy reduce complication of stroke and improve patients’ outcome. Risk factors such as hypertension, diabetes mellitus, smoking and alcohol should be controlled. Antiplatelet agents, antihypertensive agents and statins are commonly prescribed for secondary prevention and treatment of stroke. Greater awareness is needed to reduce the burden of stroke

Epidemiology of Animal Bites and Pattern of Referral for Post ExposureProphylaxis among Patients Attending a Tertiary Care Hospital inBengaluru - A Cross-Sectional Study

Background Rabies transmitted by animal bites is a devastating disease with 100 fatality rate. As per WHO every year 59000 people die from rabies around the world. India is endemic for rabies with about 20000 deaths per year. It is preventable with early and appropriate treatment with post exposure prophylaxis PEP. However rabies immunoglobulins RIG needed for PEP of Category 3 bites is unequally distributed and such cases are therefore referred to higher centres.Objectives To describe the epidemiology of animal bite patients attending a tertiary care hospital in Bengaluru and to assess the pattern of referral to tertiary care hospital for post exposure prophylaxis of animal bites.Methodology A record-based cross-sectional study was conducted using case record book at Anti-rabies clinic in Victoria Hospital Bengaluru from June 2021 to December 2021. Information was collected regarding the manner of bite referral and treatment taken.Results There were a total of 1824 cases throughout the study period of which 97.5 of cases were exposed to dogs 86 were category 3 bites. About 71.7 of cases were referred among which 85 were referred only for RIG 34.2 and 23.5 of cases had a delay i.e referred after 24 hours of the bite.Conclusion Majority of cases ware referred only for RIG which had a considerable delay. Hence the health care providers and general public should be made aware of the hazards of rabies and the need to act early to prevent rabies.

Review of Pediatric Polysomnographic Studies over a 2-year Period in a Tertiary Care Hospital in Bengaluru, India

ABSTRACT Introduction Pediatric polysomnography is the gold standard in diagnosing sleep-related breathing disorders, the most common cause of this being obstructive sleep apnea (OSA). Instituting good sleep hygiene measures, early recognition of symptoms and signs of sleep-disordered breathing, and timely referral for polysomnography play a vital role in improving a child's quality of life. We report our experience with sleep disorders in children and the challenges faced during diagnosis. Aims To review indications for pediatric sleep studies done over 2 years and their outcomes in a tertiary care center in Bengaluru, India. Methods Retrospective descriptive analysis of 65 pediatric sleep studies done between 2018 and 2020 (2-year period) for various indications. Results The total numbers of studies included in the analysis were 65, of which complete studies were done in 58 children and portable studies in 7 children. The most common indication for performing a sleep study was suspected OSA, followed by referrals for children with spinal muscular atrophy and Duchenne muscular dystrophy, respectively. Average age of the patient was 93.56 months (range 3–216 months). The number of boys and girls included in the study was 45 and 20, respectively. The average duration of sleep was 375.35 minutes, of which rapid eye movement (REM) sleep contributed to 45.33 minutes (12.13%) (range, 0–90 minutes). The average sleep latency time was 21.36 minutes (range, 0.5–138 minutes). The total apnea-hypopnea index (AHI) was 12.64/hour with 26 (40%) children having mild OSA, defined as an AHI of less than 5/hour; 17 (26.1%) having moderate OSA, defined as an AHI of 5 to 10/hour; 22 (33.8%) having severe OSA defined as an AHI of 15 to 30/hour. The mean REM AHI was 29.67/hour. Thirty-four children were started on bilevel positive airway pressure (BiPAP) following the study and four children had their BiPAP setting titrated following the study with one child whose high flow oxygen was continued. Conclusion Of the 65 pediatric sleep studies included, 39 children (60%) underwent some form of intervention following the study, indicating the clear benefit of performing polysomnography and indicating a high prevalence of sleep disorders in children. Mouth breathing was the most common symptom and OSA was the most common diagnosis. How to cite this article Kinimi I, Rao NM. Review of Pediatric Polysomnographic Studies over a 2-year Period in a Tertiary Care Hospital in Bengaluru, India. Indian J Sleep Med 2021;16(1):14–17.

Secondhand Smoke Exposure during Pregnancy and its Effect on Birth Outcomes: Evidence from a Retrospective Cohort Study in a Tertiary Care Hospital in Bengaluru.

Context:The effect of maternal smoking on birth outcomes is well-established, but the effect of maternal secondhand smoke (SHS) exposure is less clear, especially among Indian women.Aim:To evaluate the effect of SHS exposure during pregnancy on birth outcomes such as gestational age at birth, neonatal anthropometry, and Apgar score.Setting and Design:Retrospective cohort study at a tertiary hospital in Bengaluru.Methods:208 postnatal mothers: 104 each in “exposed” and “nonexposed” group, based on the history of SHS exposure during pregnancy. Sociodemographic and obstetric details were obtained by interview schedule and birth outcomes were obtained from patient charts.Statistical Analysis:Association of SHS exposure with birth outcomes was analyzed using inferential statistics such as Chi-square, t-test, and Mann–Whitney U-test, whereas the strength of association was expressed as relative risk with 95% confidence intervals. P < 0.05 was considered statistically significant.Results:SHS exposed and nonexposed groups were comparable with regard to potentially confounding socioeconomic and obstetric covariates. Babies born to SHS-exposed mothers had significantly lower mean birth weight, mean birth length, and mean birth head circumference by 172.5 g (P = 0.027), 1.6 cm (P = 0.001), and 1.1 cm (P = 0.001), respectively.Conclusion:Mothers exposed to SHS during pregnancy were twice likely to deliver low birth weight babies (relative risk [RR] = 1.9 [1.0–3.6], P = 0.02) and babies of low birth length (RR = 2.64 [1.4–4.6], P = 0.001) than unexposed mothers. With a significant risk of adverse birth outcomes found among mothers exposed to SHS during pregnancy, it is important that a “no tobacco smoke” environment at home should be recommended for pregnant women and their families.