Care Hospital In Haryana Research Articles

Compliance and effectiveness of syndromic approach in females with reproductive tract infections

Background: India has strengthened its fight against sexually transmitted infections (STIs) and reproductive tract infections (RTIs) by implementing syndromic approach at peripheral health centres. However, effective control of STIs and RTIs still remains a huge challenge. One of the biggest hurdles could be patient compliance towards the complete course of treatment. Yet, little is known about its association with the effectiveness of syndromic management of STIs and RTIs. Aim: This study aimed to assess the patient compliance with syndromic management and its effectiveness. Methods: A prospective, analytic study was conducted at a tertiary care hospital in Haryana, India, from March to November 2016. One hundred female patients suffering from any of the following complaints, (a) vaginal discharge; (b) cervical discharge; (c) lower abdominal pain; (d) burning micturition and (e) itching, were screened for RTIs. All eligible patients were interviewed in depth, and treatment was given to them according to syndromic management guidelines of National AIDS Control Organization (NACO). Patients were assessed in terms of clinical cure at the end of the treatment. Assessment of compliance to treatment regimen was made by using modified Morisky scale. Data were entered into excel sheet and analysed by SPSS software version 20 by IBM, Chicago, IL, USA. Chi-square and Fisher's exact test were applied. P Results: Out of the 100 patients, 68 were cured. Of the 68 cured patients, 66 (97.1%) participants had high motivation, whereas 57 (83.8%) patients had high knowledge. Of the 32 patients who were not cured, 29 (90.6%) participants had low motivation and 30 (93.8%) participants had low knowledge. P values of motivation ( Conclusion: This study showed the effect of compliance on the effectiveness of syndromic management but did not find the array of factors which could affect the compliance.

Prescription pattern of antiepileptic drugs in indoor patients at tertiary care hospital in Haryana, India

Background: Epilepsy is a challenging medical problem in India with an annual incidence of 27.27 per 100,000 population and prevalence of 572.8 per 100,000. People with epilepsy require prolonged treatment and monitoring. The main goal in the treatment of epilepsy should be adequate control of seizures, without causing any life-threatening reactions due to the medications. This study was done to get an insight into the prescription pattern of anti-epileptic drugs (AEDs) in different types of epilepsy.Methods: A prospective study was carried out for six months (Feb to June 2016) in admitted patients in super speciality ward (Lala Shyam Lal) in neurology department of PGIMS, Rohtak, Haryana. The prescription data of 100 patients of seizures was analysed.Results: Idiopathic generalised epilepsy was commonest type of epilepsy (42%) and sodium valproate was the commonest drug prescribed for its treatment (66.66%) followed by phenytoin (23.33%) Symptomatic epilepsy was second commonest seizure (30%) and phenytoin (60%) was the commonest drug prescribed for it followed by sodium valproate (30%). Common adverse effects associated with anti-epileptic drugs (AEDs) were nausea, drowsiness, weight gain, diplopia and ataxia.Conclusions: Idiopathic generalized epilepsy was the commonest type of epilepsy recorded and sodium valproate was the commonest prescribed drug.

Anemia at the time of delivery and its association with pregnancy outcomes: A study from a secondary care hospital in Haryana, India.

Maternal anemia has been reportedly associated with increased risk of maternal and fetal morbidity and mortality. Adverse pregnancy outcomes such as preterm birth, low birth weight, and stillbirth have been reported to be associated with anemia. However, different studies have shown inconsistent results. In the present study, we report the association between maternal hemoglobin levels at the time of delivery and outcomes among women at a secondary care hospital in northern India. Secondary analysis of routinely collected hospital data from January 2015 to December 2016 was carried out. Sociodemographic details, hemoglobin levels at the time of admission, and birth outcomes were retrieved from the records of women admitted for delivery. The outcomes were compared among anemic and nonanemic women. About 78% of the women were found to have anemia at the time of delivery. A significantly higher proportion of anemic women had preterm labor.

Catheterization-associated urinary tract infections: Epidemiology and incidence from tertiary care hospital in Haryana

Background: Urinary tract infections (UTIs) attributed to the use of an indwelling catheter is one of the most common infections acquired by patients in health-care facilities. This infection is associated with varied microbiological etiology. This along with existing underlying condition increases hospitalization, medication, morbidity, and also adds to the financial burden. Aims and Objectives: The aim of the study was to provide a baseline information in the context of incidence of catheter-associated UTI (CAUTI), to identify the associated microbial, and to determine their susceptibility pattern to commonly used antimicrobial agents for prophylactic and empiric therapy in this group of patients. Materials and Methods: This prospective study was done on nonrepetitive urine samples from catheterized patients. Semi-quantitative bacterial culture was performed, and isolates were identified by standard biochemical tests. Antimicrobial sensitivity tests were carried out by disc diffusion technique using Mueller-Hinton Agar as recommended by Clinical Laboratory Standard Institute. Results: Significant bacteriuria was observed among 17/161 (10.55%) urine samples. Among bacterial isolates, Gram-negative bacilli predominates. Escherichia coli 7/17 (41.17%) being the most common isolate. The incidence of UTI/1000 catheter days and urinary catheter utilization ratio observed in our study was 4.41 and 18.05, 0.673 and 0.066 for intensive care unit and wards, respectively. Conclusion: Burden of CAUTIs is vast with regards to incidence, patient outcomes, cost, reimbursement, and suffering. Our study underscores the pressing need for the development of antimicrobial urinary catheters and also we strove to minimize the effect of exogenous factors on the incidences of CAUTI and regarding the development of protocols and checklists on the insertion and management of indwelling urinary catheters based on the UTI prevention guideline.

Hematological profile of pregnant and non-pregnant females: A comparative study in a tertiary care hospital in Haryana, India

Background: There are marked variations in the various haematological parameters during the pregnancy and also during the different trimesters of pregnancy. Due to paucity of literature on the haematological profile of pregnant population in Haryana, India the present study aims to fill the gap by drawing a comparison between cases and controls for the different haematological indices among patients attending a tertiary care hospital and also highlight the difference among the pregnant women across the three trimester(s). Methods: A case control study was conducted to study and compare the haematological profile among 119 pregnant and 119 non-pregnant women attending the out-patient department of ESIC medical, college & hospital Faridabad,a tertiary care hospital in Faridabad district of Haryana. Statistical analysis of the data was done using SPSS software 17.0. Unpaired students t-test was applied to compare various haematological parameters between cases and controls. One way Anova was applied and Tukey and Games Howell post hoc test was applied to study between group and within group differences among the three trimester with hematological indices. Result: White blood cells (WBCs), neutrophils, nucleated Red Blood Cells(NRBC), immature granulocytes(IG) and Red cell Distribution Width-Standard deviation (RDW-SD) were found to be higher among cases as compared to controls. Hemoglobin, hematocrit, mean corpuscular volume(MCV),mean corpuscular haemoglobin(MCH), lymphocyte and platelet count were found to be significantly higher among controls as compared to cases. On one-way ANOVA a statistically significant difference in hemoglobin, hematocrit, WBCs, neutrophils, lymphocytes, immature granulocytes and nucleated RBC’s was found between the three trimester(s). Conclusion: Haemoglobin and haematocrit and platelets showed a fall while WBCs and neutrophils showed a rise when compared to the nonpregnant state.The findings of the study will be a value addition in comparative analysis of studies between pregnant and non-pregnant females. DOI: 10.21276/AABS.1701

Study to Assess the Knowledge, Attitude and Practices of Biomedical Waste Management among Healthcare Personnel at a Tertiary Care Hospital in Haryana

Background: Biomedical Waste (BMW) collection and proper disposal has become a significant concern for both the medical and general community. It is estimated that 10-25% of healthcare waste is hazardous, with the potential to create a variety of health problems. Handling, segregation, mutilation, disinfection, storage, transportation and final disposal are vital steps for safe and scientific management of biomedical waste in any establishment. Objectives: To assess the knowledge, attitude and practice among healthcare personnel working in a tertiary care centre. Methods: A hospital based cross sectional study was conducted in the months of February and March 2015. Study participants included resident doctors, interns, nursing staff, laboratory technicians, ward boys and sweepers working in the institute who deal with biomedical waste and were selected randomly to make the sample size of 200 with equal representation in each category. A pretested semi-structured questionnaire was used. Results: The study showed gaps in the knowledge of all categories of respondents. The knowledge of the existence of biomedical waste management was better among doctors (96%) as compared to nurses (88%), paramedical staff (70.9%) or the cleaning staff (16.9%). The knowledge of practical aspects of BMW management was better in nurses, paramedical staff and cleaning staff. Conclusion: The present study highlighted the lack of knowledge at every level. Waste management is everybody’s concern. The need of a comprehensive training for all the categories of hospital staff is highly recommended.

Barriers and facilitators to infection control at a hospital in northern India: a qualitative study

BackgroundHospital acquired infections occur at higher rates in low- and middle-income countries, like India, than in high-income countries. Effective implementation of infection control practices is crucial to reducing the transmission of hospital acquired infections at hospitals worldwide. Yet, no comprehensive assessments of the barriers to sustained, successful implementation of hospital interventions have been performed in Indian healthcare settings to date. The Systems Engineering Initiative for Patient Safety (SEIPS) model examines problems through the lens of interactions between people and systems. It is a natural fit for investigating the behavioral and systematic components of infection control practices.MethodsWe conducted a qualitative study to assess the facilitators and barriers to infection control practices at a 1250 bed tertiary care hospital in Haryana, northern India. Twenty semi-structured interviews of nurses and physicians, selected by convenience sampling, were conducted in English using an interview guide based on the SEIPS model. All interview data was subsequently transcribed and coded for themes.ResultsPerson, task, and organizational level factors were the primary barriers and facilitators to infection control at this hospital. Major barriers included a high rate of nursing staff turnover, time spent training new staff, limitations in language competency, and heavy clinical workloads. A well developed infection control team and an institutional climate that prioritizes infection control were major facilitators.ConclusionsInstitutional support is critical to the effective implementation of infection control practices. Prioritizing resources to recruit and retain trained, experienced nursing staff is also essential.

Trend of Poisoning in Females at a Tertiary Care Hospital of Haryana

Trend of Poisoning in Females at a Tertiary Care Hospital of Haryana

Abstract #1180: Trimester Specific Reference Interval for Thyroid Hormones During Pregnancy at a Tertiary Care Hospital in Haryana, India.

Abstract #1180: Trimester Specific Reference Interval for Thyroid Hormones During Pregnancy at a Tertiary Care Hospital in Haryana, India.

A study to assess the association of maternal factors and the outcome of pregnancy among mothers delivering in a tertiary care hospital in Haryana, India

Background: Low birth weight is a major cause of infant mortality and is considered as a sensitive index of the nation’s health and development. World Health Organization (WHO) defines low birth weight (LBW) as weight at birth of less than 2,500 grams (up to and including 2499 grams) irrespective of the gestational age. LBW is the leading cause of neonatal and postnatal deaths and as such it remains a worldwide issue and one of the most important public health problems, particularly in developing countries. The objectives of the study were to study the outcome of pregnancy whether normal, low birth weight, or still-birth, and to study the association of maternal risk factors- haemoglobin level, diabetes mellitus, hypertension and outcome of pregnancy. Methods: It was a cross sectional study carried out among the pregnant females delivering in MM Institute of Medical Sciences and Research, Mullana, Haryana, India from January 2010 to December 2010. A total of 500 cases were interviewed for the study purpose by systematic random sampling, using a semi structured pretested questionnaire. Data was analyzed using SPSS17 software. Results: Outcomes of pregnancy recorded were 28.8% low birth weight, 5.4% stillbirth and 65.8% normal birth weight. The mean birth weight was recorded as 2.556±0.411kgs. The incidence of LBW was maximum (54.3%) among the mothers who did not seek ANC while it was minimum (12.7%) in the ones who had sought ANC for more than 3 times. 57.6% mothers were anaemic and severe anaemia in 1.4% contributed towards more number of stillbirths and LBW infants (57.14% and 42.86% respectively). 4.2% mothers were found to be suffering from pregnancy induced hypertension (PIH). 69.41% of the mothers with any infection had delivered a low birth weight baby and 4.70% had a stillborn baby . Conclusions: The present study confirms birth weight as an important determinant of neonatal and post-neonatal outcomes.

Trimester-specific reference interval for thyroid hormones during pregnancy at a Tertiary Care Hospital in Haryana, India.

Background:Reference intervals for thyroid hormone during pregnancy need to be gestational age, method, and population specific and there is need to establish trimester-specific thyroid levels for the different population across the world. The aim of this study was to establish trimester-specific reference range for thyroid hormone during pregnancy in a tertiary care center in Haryana.Materials and Methods:A total of 1430 pregnant women were recruited for the study. Participants having any history of chronic illness, goiter on physical examination, thyroid illness in the past or present, consuming thyroid medications, family history of thyroid illness, presence of anti-thyroid peroxidase antibody, poor obstetrics history were excluded from the study and reference population was identified to calculate serum free triiodothyronine (FT3), free thyroxine (FT4) and thyrotropin (TSH) for each trimester of pregnancy.Results:The 2.5–97.5th percentiles for FT3, FT4, and TSH obtained in this study were 2.53–4.54 pg/ml, 0.88–1.78 ng/ml and 0.37–3.69 μIU/ml in the first trimester, 2.0–4.73 pg/ml, 0.91–1.78 ng/ml and 0.54–4.47 μIU/ml in the second trimester, 2.01–4.01 pg/ml, 0.83–1.73 ng/ml, and 0.70–4.64 μIU/ml in the third trimester of pregnancy. Mean TSH increased and mean FT3 decreased significantly with the progression of gestational period. FT4 decreased from trimester 1–3rd, but the decrease was nonsignificant from 2nd to 3rd trimester.Conclusions:Existing results for trimester-specific reference intervals for thyroid hormones are inconsistent and cannot be extrapolated due to differences in ethnicity, maternal iodine status, laboratory assay method, and rigor for selection of reference population. Thus, establishment of reference intervals in each region is of great importance.

Clinical profile and management outcome of diabetic foot ulcers in a tertiary care hospital in Haryana

Background: Diabetic foot ulcers are predisposing factor in 85% of lower limb amputations. This study was done to evaluate risk factors for the development of diabetes and associated foot problems in the rural area of Khanpur Kalan and adjoining villages of Haryana to educate the rural population for the promotion of healthy foot care and footwear habits. Objective: The aim of this study was to determine major risk factors and management outcome of diabetic foot ulcers to prevent amputation. Methods: This study was conducted in the Department of Plastic Surgery, Bhagat Phool Singh Government Medical College for Women, Khanpur Kalan, Sonepat, from December 2013 to November 2015 in 64 patients who reported in our outpatient department and emergency. Results: Sixty-four patients with type 2 diabetes mellitus were enrolled in the current study with different stages of diabetic foot presentations. They underwent different methods of surgical management: debridement, amputations, and skin grafting giving good and fast results. Eight patients underwent below-knee amputations, and six were subjected to forefoot amputation. Ten great toe amputations were performed. Two finger amputations were performed. Conclusion: Early diagnosis and management of diabetic foot ulcers can improve patient outcomes and reduce health-care costs.

Prevalence of thyroid dysfunction among women during the first trimester of pregnancy at a tertiary care hospital in Haryana.

Background:Undetected and untreated thyroid disorders are associated with adverse maternal and fetal outcomes. There are limited data on the prevalence of newly diagnosed thyroid disease during pregnancy from India. Therefore, this study was designed to evaluate the prevalence of thyroid dysfunction, especially hypothyroidism during the first trimester of pregnancy.Materials and Methods:The present cross-sectional study was conducted at Department of endocrinology and antenatal clinic in the Obstetrics and Gynecology Pt. B.D. Sharma PGIMS, Rohtak over a period of 1-year. The total sample population comprised of 461 pregnant women with uncomplicated intrauterine singleton pregnancies in the first trimester of gestation without any history of thyroid disease or intake of any thyroid medication. Morning blood samples from the participants were analyzed for thyroid function tests, which included FT3, FT4, thyroid-stimulating hormone (TSH) and anti-thyroid peroxidase antibodies (TPO).Results:A total of 461 women were enrolled for this study. Mean maternal age was 23.79 ± 3.47 years. Median gestational age was 8 weeks 5 days. The median FT3, FT4 and TSH were 3.3 pg/mL, 1.25 ng/dL, and 1.40 mIU/L, respectively. Anti-TPO was elevated in 128 (27.8%) pregnant women. 99 (21.5%) women had sub-clinical hypothyroidism and 39 (39.4%) among them were positive for anti-TPO (P ≤ 0.001). 2 (0.4%) of women had overt hyperthyroidism, whereas 15 (3.3%) of the women had sub-clinical hyperthyroidism.Conclusion:Considering the immense impact that maternal thyroid dysfunction has on maternal and fetal outcomes, prompt identification of thyroid dysfunction and its timely treatment is essential. Thus, universal screening of pregnant women for thyroid dysfunction should be considered especially in a country like India due to the high prevalence of thyroid dysfunction.

Awareness among junior residents regarding management of animal bite in a tertiary care hospital in Haryana

Background: Animal bites in humans are a major public health problem. Rabies is a highly fatal disease, killing an estimated 20,000 people in India annually. This virtually fatal disease is nearly hundred percent preventable by appropriate postexposure prophylaxis. The knowledge regarding animal bite management among health professionals is of utmost importance for prevention of this deadly disease. Objective: To assess the awareness about animal bite management in prevention of transmission of rabies to humans among junior residents. Materials and Methods: This cross-sectional study was undertaken among 120 randomly selected junior residents from various departments of the institute giving equal consideration to residents of clinical and paraclinical patients. The study was carried out in the month of September 2011 using the pretested semi-structured questionnaire. The data were analyzed by appropriate statistical tests using the SPSS software, version 18.0. Results: Residents of the clinical patients had better knowledge regarding burden of rabies (80%). Only 50% residents belonging to pre- and paraclinical patients had knowledge about correct categorization of animal bite wound. Only 52% residents of pre- and paraclinical patients were aware of intradermal antirabies vaccine schedule and immunoglobulin dose to be administered. Nearly two-thirds residents of clinical patients were aware of preexposure prophylaxis schedule. Conclusion: Owing to poor knowledge about prevention and management of such a deadly disease, special attention is needed in strengthening the fundamentals of management skills in internship and through orientation program to junior residents.

Acid-base disorders in critically ill neonates

Objective:To study acid–base imbalance in common pediatric diseases (such as sepsis, bronchopneumonia, diarrhea, birth-asphyxia etc.) in neonates.Design and Setting:An observational study was conducted in an emergency room of a tertiary teaching care hospital in Haryana, India.Patients and Methods:Fifty neonates (from first hour to one month) attending pediatric emergency services with various ailments. Blood gas analysis, electrolytes, plasma lactate, and plasma albumin were estimated in neonates.Results:Metabolic acidosis was the most common acid–base disorder. Hyperlactatemia was observed in more than half of such cases. Birth asphyxia was another common disorder with the highest mortality in neonates followed by bronchopneumonia and sepsis. Significant correlation between mortality and critical values of lactate was observed.Conclusion:Birth asphyxia with high-lactate levels in neonates constituted major alterations in acid–base disorders seen in an emergency room of a tertiary teaching care hospital. Plasma lactate concentration measurement provides an invaluable tool to assess type of metabolic acidosis in addition to predicting mortality in these neonates.