Care Hospital In Mumbai Research Articles

Speciation and antifungal susceptibility testing of Candida isolates in various clinical samples in a tertiary care hospital in Mumbai

Background: Over the last few years fungal infection rates have increased and a change is seen in their epidemiology and antifungal susceptibility pattern. Hence this study was conducted to learn the distribution of Candida species in various samples and their antifungal susceptibility pattern.Material and Methods: A total of 60Candida isolates were included in the study. Identification was done by colony morphology and Gram stain. Speciation was carried out by Germ-tube test, urease test, chlamydoconidia production test, colony characteristics on chromogenic agar medium, sugar assimilation test,sugar fermentation testand Vitek2 compact(Biomeriux, France) using ID-YST cards. Antifungal testing was done on Vitek2 compact using AST YS01 cards which included fluconazole, voriconazole, amphotericin b, caspofungin, micafungin and flucytosine.Results: 60 Candida isolates were included in this study. Samples from which Candida species were isolated were sputum (45%), urine (33.5%), pus (12%), vaginal swab (5%), endotracheal secretion (1.5%), blood (1.5%) and tissue (1.5%). Isolates from males and females were 30% and 70% respectively. Isolates from geriatric age group (>65 years) and adults (18-65 years) were 52% and 48% respectively. Isolates from samples received from IPD, OPD and ICU were 58%, 34% and 8% respectively. Out of all isolates, Candida albicans was 58%, Candida tropicalis 20%, Candida glabrata 10%, Candida parapsilosis 9% and Candida krusei3%. All Candida species (except Candidaglabrata) showed 100% sensitivity to amphotericin b and caspofungin. Sensitivity to azole group of drugs was 100% among NAC except C. glabrata and C. krusei and more than 90% among C. albicans.Conclusion: Candida albicans was the commonest isolate followed by C. tropicalis among the NAC. Overall also, C. Albicans were predominant as compared to Non albicans Candida (NAC) species. All Candidaisolates except (C. glabrata) showed good sensitivity to all antifungals.

Etiology and outcome of mono-articular arthritis: a follow up study

Background: Monoarthritis is a common rheumatological complaint. Inspite of investigations, many cases remain undiagnosed. Prompt investigation and treatment is important in acute arthritis especially septic arthritis else joint destruction, permanent disability or even death can result. This study was conducted to etiologically categorise patients as inflammatory, non-inflammatory and infective arthritis and to study the outcome.Methods: This observational prospective study conducted at a tertiary care hospital in Mumbai enrolled 40 patients above the age of 12 yrs presenting with first episode of mono-articular arthritis. They were treated with standard treatment guidelines and followed up every 3 monthly for one year. Outcome was assessed using ESR, CRP values and Health Assessment Questionnaire.Results: Mean age at diagnosis was 38 years with a male to female ratio of 1.4:1. Acute and chronic mono-articular arthritis cases were 16.2% and 83.7% respectively. Knee joint was most commonly involved (38%). Etiologically inflammatory, infectious and non-inflammatory cases were 59.5%, 29.7% and 10.8% respectively. In 21% cases etiology was tuberculosis. 27 % evolved into oligoarthritis over one year. The serial ESR, CRP values and Stanford Health Assessment Questionarre scores decreased significantly across all etiological groups with treatment.Conclusions: Knee is the most commonly affected joint in mono-articular arthritis. Tuberculosis is the most common etiology. Irrespective of the etiology, if patients are treated according to standard guidelines promptly mono-articular arthritis has a good response to therapy as assessed by the health assessment questionnaire (HAQ) and serial measurements of proinflammatory markers like ESR, CRP.

Improving Compliance Rate of Critical Value Reporting in a Tertiary Care Hospital in Mumbai

Improving Compliance Rate of Critical Value Reporting in a Tertiary Care Hospital in Mumbai

A Prospective Clinical Study on the Impact of Occupation on Inguinodynia after Inguinal Hernia Repair

Inguinodynia is defined as groin pain at or beyond 3 months following inguinal hernia repair. There is limited literature on this problem from India. Studies have investigated role of different risk factors for inguinodynia like mesh, inguinal nerves identification during surgery, technique of repair etc. However, to our knowledge there is no study on the impact of occupation on inguinodynia.Objective: This study attempts to study the role of occupation in incidence of inguinodynia following surgery.Methods: A prospective study was conducted at a secondary care hospital in Mumbai. 152 adult patients with uncomplicated inguinal hernias who underwent repair by open or laparoscopic technique were enrolled over 2 years. Patients were preoperatively questioned regarding the nature of their occupation and presence of pain associated with inguinal hernia, then divided into five occupation classes depending upon amount of weight lifting involved in their occupation. Postoperatively, they were followed up for 6 months and assessed for inguinodynia by a structured questionnaire. Incidence of inguinodynia was then compared between the different occupation classes.Results: The incidence of inguinodynia at the end of 3rd and 6th month follow-up was 12.10% (19/157 surgeries) and 10.19% (16/157 surgeries) respectively. Incidence of inguinodynia increased from 8.8% for a sedentary worker to 38.5% for an extremely heavyweight worker at 6 months follow-up. By Pearson’s Chi-Square test, the p-value was 0.003 which is statistically significant.Conclusion: Thus, the incidence of inguinodynia increased as amount of weight lifting at work increased, suggesting a role of occupation in inguinodynia.

Factors affecting compliance to antihypertensive treatment among adults in a tertiary care hospital in Mumbai

Background:Compliance to antihypertensive therapy reduces the risk of complications. It is important to understand the factors affecting compliance in patients so that the goal of successful treatment is not jeopardized.Objectives:To determine the proportion of participants' compliant to treatment and various factors associated with compliance of antihypertensive treatment.Settings and Design:A cross-sectional study of 330 hypertensive patients on treatment attending the outpatient department of a tertiary care hospital in Mumbai.Subjects and Methods:It was conducted over 8 weeks using a validated, pretested questionnaire including information on the individual's sociodemographic profile, compliance to antihypertensive therapy and lifestyle advice assessed using a 4-point Likert scale.Statistical Analysis:Data were entered into MS Excel 2007 and analyzed using SPSS 20.Results:Participants' mean age was 55.2 ± 12.6 years. 39.4% were compliant to their treatment. Common reasons for frequently skipping the dose – forgetfulness (41.2%) and discontinued the medication when feeling well (30.3%). Factors positively associated with compliance were gender and illiteracy. The proportion of noncompliance among smokers and alcoholics was statistically significant.Conclusion:Forgetfulness and subjective feeling of wellness were the prevalent reasons for noncompliance. Controlling habits such as smoking and alcohol may prove as key factors for compliance.

Utilization Pattern of Blood and Blood Components in a Blood Bank of a Tertiary Care Hospital in Mumbai

Utilization Pattern of Blood and Blood Components in a Blood Bank of a Tertiary Care Hospital in Mumbai

The prevalence of osteoporosis and osteopenia in persons attending a tertiary care hospital in Mumbai

Background: Osteoporosis is one of the common health problems with a progressive prevalence both in developed and developing countries. The different method are used to quantify osteoporosis like DEXA and Quantitative ultrasound (QUS). So study was mainly done to determine the prevalence of osteopenia and osteoporosis in patients attending OPD at tertiary care hospital and to compare the BMD in relation to modifiable and non-modifiable risk factors. Method and Materials: A prospective cross sectional study carried out in the orthpedic OPD of Dr RN Cooper Medical Hospital, Mumbai over the period of 6 months from June 2017 to November 2017. The study include 186 cases which include all patients attending OPD from 19 yrs to 90 yrs and those who were willing to give consent for study. BMD was tested using calcaneal quantitative ultrasound (BMD SONOST 2000) machine. The results were tabulated and analysed statistically. Test of significance (chi square test and Z test) were applied wherever necessary. Result: The prevalence of Osteoporosis in our study was 14.51% and prevalence of Osteopenia was 58.06% as per WHO criteria. In our study, we found that osteoporosis and osteopenia is more common in female with most common age is more than 40 yrs. The menopausal female, smoker and patients from lower socioeconomic strata have low BMD score. Conclusion: Osteoporosis is more prevalent in our society than it is seen so awareness of people about osteoporosis, good dietary habits, active life style, good control of systemic disorders, reduced intake of tobacco can make a huge difference in osteoporotic complication rate in our society.

Prescription pattern and awareness of disease and treatment in patients of Parkinson's disease.

This cross-sectional study aimed to evaluate the prescription pattern, awareness of disease and treatment in patients with Parkinson's disease (PD). A total of 100 PD patients, attending a tertiary care hospital in Mumbai were included. Prescriptions were analyzed and awareness was evaluated using a questionnaire. The mean number of anti-Parkinson agents (APA) prescribed was 1.52±0.65. Number of APA strongly correlated with disease duration (ρ =0.818; p<0.001). Many APA were underutilized (prescribed daily dose/defined daily dose < 1). There was no awareness of all items on symptoms and alternative therapeutic options. Awareness of disease impairments (32%), long-term complications (28%), dosing regimen (46%) and follow-up (36%) was poor. More than one APA is commonly prescribed in PD patients. Awareness of disease and treatment of PD is poor among the patients.

Drug resistance in intestinal tuberculosis: A reason to worry?

Background and AimEmergence of drug resistance in intestinal tuberculosis (ITB) makes the treatment of this condition challenging. While there is growing evidence of multiple and extensive drug resistance in pulmonary and glandular tuberculosis (TB), literature regarding susceptibility and resistance patterns in ITB is scarce. The aim of the current paper was to study the prevalence of drug resistance in patients with ITB.MethodsAmong patients presenting to a tertiary care hospital in Mumbai between 2008 and 2016, records of all patients with ITB, whose mucosal biopsy (obtained at ileocolonoscopy) tissue culture was positive for Mycobacterium tuberculosis and in whom drug sensitivity testing was performed, were retrospectively analyzed. Sensitivity and resistance to single or multiple anti‐TB drugs were noted.ResultsA total of 43 patients were included, of whom 10 (23.2%) patients were diagnosed to have resistance to at least one first‐line anti‐TB drug. Resistance to isoniazid was the most common (nine patients), followed by rifampicin (six), pyrazinamide (five), streptomycin and ethionamide (four each), ethambutol, moxifloxacin and ofloxacin (three each), and p‐amino salicylic acid (one). Six patients (13.9%) had multidrug‐resistant TB and needed second‐line anti‐TB therapy as per drug sensitivity pattern. There was no patient with extensive drug‐resistant TB.ConclusionTwenty‐three percent of our patients with ITB tested for drug resistance had drug resistance, 13.9% being multidrug resistant and needing second‐line anti‐TB therapy.

Outcome analysis of patients presenting with neurological manifestations of Plasmodium Vivax malaria in tertiary care hospital of Mumbai.

Objective: Plasmodium vivax (P. vivax) infection has been considered for a long time a benign and self-limited disease. Percentage of complicated cases of vivax malaria is on the increasing trend, cerebral malaria being the most dreaded and a potentially life-threatening complication. Material and Methods: A prospective observational study was done after institutional ethics committee approval from July 2011 to February 2012 at tertiary care hospital in Mumbai. We studied the clinical profile and outcome of all the 48 patients above the age of 12 years diagnosed with Cerebral Malaria. Results: Incidence of neurological manifestations of vivax malaria in our hospital was 14.15%, with 32(66.7%) out of 48 patients being males. The mean age of patients with neurological manifestations of vivax malaria was 29.66 years in discharged patients and 50.88 years in expired patients. Altered sensorium 37(77.1%) followed by convulsion 28(58.3%) were common findings, but focal neurological deficit, Bell’s palsy, ataxia, psychosis were also seen. Mortality was higher (62.5%) in patients with premorbid conditions (p value <0.05) and that of with other system involvements (87.5%) including hepatic, renal, hepatorenal, pulmonary involvement (p value<0.05). Association between outcome with older age & high parasite index patients is significant (p value<0.001), however no such significant association was found in terms of gender distribution. Conclusion: Plasmodium vivax, as has been traditionally believed, is no longer a benign species and is causing presentations akin to P. falciparum. It is imperative that clinicians are aware of and ready to handle the complications caused by Plasmodium vivax.

A case series of congenital ovarian cyst in a Tertiary Care Hospital in Mumbai, India

The congenital ovarian cysts are one of the most frequent lesions to be diagnosed antenatally. The manifestations postnatally determine the line of management of the cysts. These can manifest as abdominal lump, torsion or may be asymptomatic. We present a case series of four cases of congenital ovarian cyst presenting to our tertiary care hospital. DOI: 10.21276/APALM.1146

A Study of Maternal Outcome in Uterine Rupture in Pregnancy at a Tertiary Care Institute

Aim and Objective: The present research was carried out with an objective to determine the incidence, etiology, trend, and management, maternal and fetal outcome of ruptured uterus and to identify the preventive measures. Material and Methods: A prospective observational study was conducted over a period of 2 years from Nov 2012 – Nov 2014 in a tertiary care hospital of Mumbai, India. A total of 40 patients who came with rupture of uterus in pregnancy were studied. These cases were analyzed based on clinical features, etiology and risk factors of rupture uterus, the mode of management and the foetal and maternal outcome. Results: There were 40 cases of uterine rupture out of 32,200 deliveries giving an incidence of 1 in 805 i.e. 0.12%. Most common clinical features were those of classical signs of rupture with ill defined uterine contour, superficially felt foetal parts and absent foetal heart sounds. The commonest cause of rupture was due to separation of previous cesarean scar rupture (72.5%). The lower uterine segment was the commonest site of rupture. Rent repair was the commonest procedure done in the cases of ruptured uterus. Perinatal mortality of 77.5% and maternal mortality of 10% was observed in this study. Conclusion: Skilled attendance with accessible emergency obstetric care and focused antenatal care are key elements for the prevention and management of uterine rupture.

Validity of Broselow tape for estimating weight of Indian children.

Background & objectives:The Broselow tape has been validated in both ambulatory and simulated emergency situations in the United States and is believed to reduce complications arising from inaccurate drug dosing and equipment sizing in paediatric population. This study was conducted to determine the relationship between the actual weight and weight determined by Broselow tape in the Indian children and to derive an equation for determination of weight based on height in the Indian children.Methods:This cross-sectional study was conducted at a tertiary care hospital in Mumbai, India. The participants’ weights were divided into three groups <10 kg, 10-18 kg and >18 kg with a total sample size estimated to be 210 (70 in each group). Using the tape, the measured weight was compared to Broselow-predicted weight and percentage weight was calculated. Accuracy was defined as agreement on Broselow colour-coded zones, as well as agreement within 10 per cent between the measured and Broselow-predicted weights. The resulting data were compared with weights estimated by advanced paediatric life support (APLS) and updated APLS formulae using Pearson's correlation coefficient.Results:The mean percentage differences were −11.78, −17.09 and −14.27 per cent for <10, 10-18 and >18 kg weight-based groups, respectively. The Broselow colour-coded zone agreement was 33.3 per cent in children weighing <10 kg, but only 7.4 per cent in the 10-18 kg group and 33.9 per cent in the >18 kg group. Agreement within 10 per cent was 53.13 per cent for the <10 kg group, but only 21.08 per cent for the 10-18 kg group and 33.9 per cent for the >18 kg group. Application of 10 per cent weight correction factor improved the percentages to 79.2 per cent for the <10 kg category, to 55.70 per cent for the 10-18 kg group and to 61.0 per cent for the >18 kg group. The correlation coefficient between actual weight and weights estimated by Broselow tape (r=0.89) was higher than that between actual weight and weight estimated by APLS method or updated APLS formulae (r=0.68) in 12-60 months age group as well as in >60 months age group (r=0.76).Interpretation & conclusions:Broselow weight overestimated weight by >10 per cent in majority of Indian children. The weight overestimation was greater in children belonging to over 18 and 10-18 kg weight groups. Applying 10 per cent weight correction factor to the Broselow-predicted weight may provide a more accurate estimation of actual weight in children attending public hospital. Weights estimated using Broselow tape correlated better with actual weights than those calculated using APLS and updated APLS formulae.

A clinico-mycological study of onychomycosis at a tertiary care center

Background: Onychomycosis continues to be worldwide problem constituting a large bulk of cases attending the dermatology outpatient department. Fungal infections of nails have been partly studied,because it has been considered more of a cosmetic problem than a health problem. Although not life threatening, onychomycosis may have significant clinical consequences such as secondary bacterial infection, chronicity, therapeutic difficulties and disfigurement, in addition to serving as reservoir of infection. Aims and Objectives: To find out the prevalence, etiology and clinico-mycological correlation of onychomychosis among clinically suspected cases.To compare the microscopy findings using potassium hydroxide (KOH) preparation with potassium hydroxide- dimethyl sulfoxide (KOH-DMSO/DMSO) preparation.To compare demographic and clinical data inonychomycosis and fungus negative groupsMaterial and Methods: The study was conducted from October 2011 to October 2013, in the department of Microbiology of a tertiary care hospital in Mumbai, including 204 patients clinically suspected of onychomycosis. Nail scrapings were collected depending upon site, type of nail involvement and subjected for microscopic examination using 20% KOH and KOH DMSO (10-40%), followed by fungal culture.Results: Out of 204 patients, 78 (38.2 %) were diagnosed having onychomycosis, 72 (92.3%) patients were positive by direct microscopy and 45 (57.7%) by culture. DMSO preparation offered a faster clearing of background but in KOH preparation fungal morphology was better maintained even after 24 hours. In culture positive cases, isolation of dermatophytes was most common (42.2%), followed by Candida species (31.1%) and nondermatophytes (26.7%).Conclusion: This concludes that laboratory diagnosis of onychomycosis is essential as many conditions of nail mimic onychomycosis. Though commonest causative agents of onychomycosis are dermatophytes, number of cases caused by Candida species and nondermatophytesare on the rise.Asian Journal of Medical Sciences Vol.8(1) 2017 48-57

Linezolid-resistant Enterococcus (LRE) faecium from Blood Culture of an Adult Burns Patient: First Report of LRE from Mumbai.

Sir, Linezolid is an oxazolidone antibiotic used for treating infections due to Gram-positive cocci. There have been reports of emerging linezolid resistance in complicated enterococcal infections.[1] The first report of nosocomial transmission of linezolid-resistant Enterococcus (LRE) faecium was from Mayo Clinic, USA.[2] We reported the first documented case of LRE from Mumbai. A 36-year-old male was admitted to a tertiary care hospital in Mumbai with history of electric burns. Extensive debridement of both upper and lower limbs was done. He was started on injection meropenem and metronidazole. After 10 days of admission, the patient developed intermittent spikes of fever, and his blood was sent for culture. The blood culture grew E. faecium, resistant to both vancomycin and linezolid. Minimum inhibitory concentration (MIC) of vancomycin was >32 µg/ml and linezolid MIC >8 µg/ml. It also exhibited high-level aminoglycoside resistance. The first and only reported case of LRE faecium from India was from Kolkata in 2015, with no history of prior linezolid medication.[3] LRE has been reported even without prior exposure, and asymptomatic colonization has also been documented.[4] A nosocomial transmission of LRE may be a possibility in our patient. Resistance to linezolid is a matter of grave concern. Indiscriminate use of linezolid and its availability as an oral preparation may contribute to the development of resistance. Rational use of linezolid and avoiding long-term therapy with linezolid should be the objective of every treating physician. Sincere efforts are also needed for specific infection control measures for LRE. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Effects of seasonal variations on the trends of H1N1 cases in a tertiary care hospital of Mumbai

Effects of seasonal variations on the trends of H1N1 cases in a tertiary care hospital of Mumbai

Health Status and Stress Levels of Nurses Working In a Tertiary Care Hospital in Mumbai

Health Status and Stress Levels of Nurses Working In a Tertiary Care Hospital in Mumbai

Cancer early detection program based on awareness and clinical breast examination: Interim results from an urban community in Mumbai, India

Indian women with breast cancer are usually diagnosed in advanced stages leading to poor survival. Improving breast awareness and increasing access to early diagnosis and adequate treatment has been advocated for breast cancer control. We implemented a program to increase awareness on breast cancer and access to its early detection in an occupational health care scheme in Mumbai, India. Breast awareness brochures were mailed annually between June 2013 and June 2016 to a cohort of 22,500 eligible women aged 30–69 years old receiving universal health care from an occupational health care scheme comprising of primary health centres and a referral secondary care hospital in Mumbai. Women with suspected breast cancers were provided with diagnostic investigations and treatment. Socio-demographic information and tumour characteristics were compared between the breast awareness pre-intervention period (Jan 2005–May 2013) and the breast awareness intervention period after four rounds of mailers (June 2013–June 2016). The proportion of women with early tumours and axillary lymph node negative cancers increased from 74% to 81% and 46% to 53% respectively, between the two periods. While the proportion of patients receiving breast conserving surgery increased from 39% to 51%, the proportion receiving chemotherapy decreased from 84% to 56%. Interim results following efforts to improve breast awareness and access to care in a cohort of women in an occupational health care scheme indicate early detection and more conservative treatment of breast cancers. Creating awareness and improving access to care may result in cancer down-staging.

Phenotypic and antibiogram pattern of V. cholerae isolates from a tertiary care hospital in Mumbai during 2004–2013: a retrospective cross-sectional study

ObjectivesCholera is a major gastroenteric disease with reports on fluctuation and resistance. Hence, the objective is to determine the trend in seasonality, resistance pattern, prevalent biotypes, serotypes and phage types...

Severe Hallux Varus; an Uncommon Deformity —A Case Report and Review of Literature

Hallux varus is relatively uncommon and few cases have been reported in the orthopedic literature. In this article, we report the case of a 63 years old, female patient with severe hallux varus deformity, associated with deformity of other toes. Here we describe the case report of hallux varus managed by surgical intervention at our tertiary care hospital in Mumbai, India.