Care Hospital In North-East India Research Articles

A single-center retrospective study of Vitamin D status and acute left ventricular heart failure from a super specialty tertiary care hospital in Northeast India

Introduction: Heart failure (HF) is a progressive clinical condition and is a major cause of mortality and morbidity. Various studies have shown the association of Vitamin D deficiency with HF. The present study aimed to investigate the Vitamin D status among acute left ventricular failure (LVF) patients admitted to our hospital. Materials and Methods: Medical records of 55 acute LVF patients were retrospectively assessed. Patients were categorized according to their Vitamin D status. Demographics, risk factors, clinical presentations, and biochemical data of the patients were analyzed and documented. Results: Patients were grouped based on their Vitamin D status as deficient (40%; n = 22), insufficient (32.7%; n = 18), optimal (23.6%; n = 13), and toxic (3.6%; n = 2). The overall cohort included 67.3% (n = 37) of males with a male/female ratio of 2.1:1. Ages ranged from 22 to 86 years with a mean age of 64.8 years ± 2.3. Rural/Urban was 1:0.9. Hypertension (63.6%; n = 35) was the predominant risk factor across all groups. Mortality was the highest in the Vitamin D deficient group (36.4%; n = 8). The most common symptom observed was dyspnea (76.4%; n = 42). A high incidence of HF with reduced ejection fraction (58.1%; n = 32) was seen in the entire cohort with the highest prevalence in the Vitamin D-deficient group (27.3%; n = 15). Conclusions: Our study revealed a high occurrence of Vitamin D deficiency and insufficiency among HF patients. Routine screening of Vitamin D levels should be done in patients with unexplained cardiac problems. Serious adverse events, including HF, can be prevented and/or reduced on early diagnosis and treatment of Vitamin D deficiency/insufficiency.

Plasma neutrophil gelatinase-associated lipocalin (NGAL)

Acute kidney injury (AKI) is a presentation of an underlying heterogeneous group of conditions that leads to impairment of filtration and excretion of nitrogenous waste products from the body. A prompt early diagnosis to detect AKI is a mandate due to the associated risk of high mortality and morbidity. We tested the sensitivity and specificity of plasma neutrophil gelatinase-associated lipocalin (NGAL), a potential biomarker of AKI, versus serum creatinine, the gold standard laboratory test. A cross-sectional diagnostic type study was conducted from February 2015 to January 2017 after obtaining the institutional ethics clearance certificate. Individuals admitted to the intensive care unit (ICU) of a tertiary care hospital of northeast India who were diagnosed with septicemia, heart failure, and ketoacidosis and individuals on nephrotoxic drugs such as aminoglycosides were included in the study. Serum creatinine and plasma NGAL of all individuals were estimated using suitable methods within 24 h of admissions. Considering all inclusion and exclusion criteria, 138 individuals were included in the study. The area under the curve (AUC) for plasma NGAL on day 1 of admission was 0.800 (95% confidence interval [CI]: 0.712-0.882). In the study, we estimated a plasma NGAL cut-off value of 391 ng/mL (with an odds ratio of 9.89) within the day of admission. Plasma NGAL is a candidate biomarker of AKI with acceptable sensitivity and specificity (AUC of 0.80) that can predict AKI in our setup before serum creatinine is raised, thereby asking for a prompt intervention to reduce the mortality and morbidity associated with AKI.

Self administration of topical steroids in face: A cross-sectional study from a tertiary care hospital in Northeast India

Topical steroid (TS) creams are easily available in pharmacies all over India, as OTC (over the counter) drugs. So are easily being misused even without the dermatologist’s prescription, which leads to side effects pertaining to the lack of awareness about the contraindications and adverse effects of the topical steroids. This was a cross-sectional, questionnaire-based study, conducted from July 2021 to December 2021, at the outpatient Department of Dermatology, Venereology and Leprosy, of a tertiary care hospital in North East India. Patients of both sexes (males and females), 15 years onwards were included in this study who presented with any kind of facial dermatoses resulting from use of topical steroid on face. Out of 300 patients who misused TS, majority were females (72%). The most common brand used was Betnovate C which contained betamethasone (0.1% w/w) & clioquinol (3% w/w). The average duration of use was less than 6 months (51%), shortest being 15 days and longest being 4 years. The most common reason for misuse was acne (38%) followed by fairness (22%) and the most common effect observed after misuse was acne form eruptions (25%) followed by dyspigmentation (16%). Most of the users had attained education till primary school. Abuse was commonly from purchase of the drug OTC or from pharmacists. As steroid abuse is increasing alarmingly, awareness about its various adverse effects becomes necessary.

Hepatitis D virus seroprevalence in HBsAg positive patients attending a tertiary care hospital in Northeast India

Background: Hepatitis D virus (HDV) infection is present worldwide. Around 18 million people are estimated to be infected with HDV and can infect individuals with active HBV infection and cause severe liver disease. There is lack of data on the prevalence of HDV infection in the state and also in the region. The aim of the study was to determine the seroprevalence of HDV in HBsAg positive patients attending Regional Institute of Medical Sciences Hospital, Imphal, Manipur, India.Methods: This study was carried out in a tertiary care hospital (Regional Institute of Medical Sciences, Imphal).The study was done for a period of 2 years from September 2016 to August 2018. A total of 119 HBsAg ELISA positive cases were included in the study.Results: Out of 119 HBsAg positive cases, 5 cases were positive for hepatitis D antibodies, of which 3 were positive for anti-Hepatitis D virus IgM and 2 were positive for anti-Hepatitis D virus IgG. Seroprevalence of HDV infection was found to be 4.2%.Conclusions: Seroprevalence of HDV infection was found to be 4.2% which is higher than the finding in some of the recent studies in the country.

Cervical cancer screening using liquid-based cytology (LBC) in a secondary care hospital in Northeast India

According to the latest National Cancer Registry Programme (NCRP 2020) report, India had the highest incidence rate of cervical cancer (27.7 per 100,000) in Asia and also cervix uteri was the leading anatomical site of cancer in women population of Nagaland (16.4%). Lack of access to healthcare and awareness has led to the increased cases of cervical cancer, in particularly the resource-limited areas. A retrospective study involving 711 samples of cervical smears of women collected in the Department of Gynaecology were analysed between May 2019-May 2021 at CIHSR hospital. The objective of this study was to address this preventable cancer burden and also to determine a fraction of pap cervical smear finding through LBC in a secondary level hospital in Dimapur, Nagaland. 711 Pap smears using LBC technique were processed in the Department of Pathology of which 20 samples (2.81%) yielded unsatisfactory result or were rejected. Of the remaining 691 samples, 16.35% (113/691) had abnormal results. The Bethesda System (TBS-2014) for cervical cancer screening was used for classifying the categories, of which ASC-US was 48.67% (55/113), LSIL 7.96% (9/113), ASC-H 22.12% (25/113), High grade squamous intraepithelial lesion (HSIL) 17.69% (20/113), Squamous cell carcinoma 2.65% (3/113) and adenocarcinoma 0.88% (1/113). The chief complaints among women with abnormal cytology were pain in the lower abdomen (27.4%), white discharge per vaginum (22.1%) and bleeding per vaginum (15.0%). This study determines the first retrospective analysis of Pap smear finding through LBC in the state and highlights the deficiency of effective screening programme and testing facilities.

Seroprevalence of SARS-CoV-2 among the Healthcare Workers of a Tertiary Care Hospital of Northeast India during First Wave of COVID-19 Pandemic: A Hospital-based Cross-sectional Study

Introduction: During Coronavirus Disease-2019 (COVID19) pandemic, Healthcare Workers (HCWs) are the frontline personals who are engaged in different facilities of the health system. So they always remain at a greater risk of exposure and acquiring the disease. They may also become a potential source of infection to the other patients as well to the community. Aim: To estimate the seroprevalence of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-COV-2) specific Immunoglobulin G (IgG) antibodies among asymptomatic, COVID-19 negative HCWs of a tertiary care hospital. Materials and Methods: This hospital-based cross-sectional study was conducted in the Department of Microbiology in a tertiary care hospital of North-East India. A total of 215 HCWs were recruited from 15th October to 14th December 2020 after taking written and informed consent. Inclusion criteria were: a) >18 years of age and both genders, b) asymptomatic, negative for COVID19 either by Rapid Antigen Test (RAT) or Reverse Transcription Polymerase Chain Reaction (RT-PCR), c) working in the hospital for atleast last four months. Predesigned questionnaire was used for data collection. Serum samples were tested for SARSCoV-2 IgG antibodies by Enzyme Linked Fluorescence Assay (ELFA) using VIDAS (VITEK ImmunoDiagnostic Assay System) platform. Chi-square test was used (Epi Info version 7 software) for data analysis. Results: The prevalence of SARS-COV-2 IgG was 54 (25.12%) out of 215, which was highest in ≤30 years age group, 27 (32.14 %) out of 84 (p=0.0261). Significant seropositivity was found among cleaners 22 (61.11%) out of 36 (p<0.01) and participants who reported having COVID-19-related symptoms in the previous months (p<0.013). However gender, daily patient contact, close contact with COVID-19 cases and working in COVID-19 units showed no significance. Conclusion: The study highlighted a high burden of asymptomatic SARS-CoV-2 infection among HCWs. A proper surveillance system is needed for estimating the burden of COVID-19 among HCWs as well as in the community for better understanding of the dynamics of the infection.

A case control study of needlescopic herniotomy versus open herniotomy in children.

Since the inception of laparoscopy, it has been explored in many fields of surgery, like in the abdomen, hernia, thorax, etc., Laparoscopic hernioplasty in adults is being practiced by many surgeons nowadays. However, the role of laparoscopic inguinal hernia repair in pediatric patients is not well-established, even though it is being explored as an alternative to open herniotomy procedure. In the present study, laparoscopic needlescopic hernia repair was compared with the conventional open herniotomy procedure. The study was a case-control study conducted in a tertiary care hospital in northeast India during 2018-2021. A total of 25 patients underwent needlescopic hernia repair, the outcome of which was compared by collecting data of 25 more patients who earlier underwent open herniotomy repairs. The laparoscopic needlescopic repair took a longer operative time as compared to the open technique with a smaller-sized incision. Laparoscopic needlescopic hernia repair is a safe and feasible procedure with a similar outcome to open herniotomy but with a smaller scar.

C-reactive protein and its association with COVID-19: A preliminary study during the first wave of pandemic in a tertiary care hospital in North-East India

C-reactive protein and its association with COVID-19: A preliminary study during the first wave of pandemic in a tertiary care hospital in North-East India

The ethnic background of the prevalence of different rheumatological diseases in a tertiary care hospital of North-East India -a hospital-based observational study

The ethnic background of the prevalence of different rheumatological diseases in a tertiary care hospital of North-East India -a hospital-based observational study

Clinical and Demographic Profile of COVID-19 Patients: A Tertiary Level Hospital-Based Study From Northeast India.

Background and objectiveThe coronavirus disease 2019 (COVID-19) outbreak, which was first detected in Wuhan, China, has turned into a rapidly spreading global healthcare crisis. The clinical and laboratory features of COVID-19 are associated with significant regional variations. In this study, we aimed to describe the clinical and demographic profile of COVID-19 patients from a tertiary care hospital in Northeast India.Materials and methodsThis was a hospital-based cross-sectional study that included all laboratory-confirmed COVID-19 cases admitted to the institution from 1st July to 31st October 2020. The information was collected on a predesigned proforma, which included patients' demographic profiles, clinical presentations, and outcomes as per treatment by trained doctors.ResultsThe study included 180 laboratory-confirmed COVID-19 cases. A history of contact with laboratory-confirmed COVID-19-affected individuals was found in 92 (51.1%) patients. The median age of the patients was 37.17 years (range: 18-80 years), and there were 104 (57.78%) males in the cohort. Of the total enrolled patients, 102 (56.67%) were asymptomatic from the time of exposure till their admission. The common presenting complaints were fever (n=55, 70.51%), cough (n=42, 53.85%), and shortness of breath (n=32, 42.02%). The case fatality rate among the admitted cases was 15%. Comorbidities were found in 84 (46.67%) patients with the most common one being diabetes mellitus (n=31, 36.9%) followed by hypertension (n=29, 34.52%). Patients with advanced age (more than 60 years) and coexisting comorbidities were at higher risk of progression of disease and death.ConclusionThe COVID-19 pandemic is not only a huge burden on healthcare facilities but also a significant cause of disruption in societies globally. The majority of the patients with COVID-19 infection presenting to our hospital were young and asymptomatic. Patients of advanced age with comorbidities were found to have more complications. An analysis of the trends related to COVID-19 in different hospital and institutional settings will help to achieve better preparedness and lead to improved patient care to combat the COVID-19 pandemic in a more efficient manner.

Occurrence of Demodex infestation in chronic blepharitis in a tertiary care hospital in North-East India

Background: Chronic blepharitis is frequently encountered by ophthalmologists. Demodex mites (Demodex folliculorum and Demodex brevis) can play a role in its pathogenesis, especially in treatment-resistant cases. Demodex infestation often remains underdiagnosed and undertreated. Definitive diagnosis can be made with lash-sampling. Objective of the study was to find the association between Demodex infestation and chronic blepharitis.Methods: The study included 80 patients diagnosed with chronic blepharitis and 80 controls without blepharitis. Four eyelashes were epilated from each lower and upper lids of the right and left eye (a total of sixteen samples) of each participant. Eyelash samples were examined under a light microscope and Demodex species were identified and counted.Results: Demodex mites were detected in 45 cases (56.25%) and 14 controls (17.5%). Significant association was found between demodex infestation and blepharitis as odd’s ratio was found to be 6.0612 and p value <0.0001. D. folliculorum was detected in 42 cases, D. brevis in 2 cases while in one case, both were detected. The mean age for Demodex positive cases and controls were 49.78±13.25 and 64±7.86 years, respectively. Amongst the cases, Demodex was detected in 57.69% males (30 out of 52) and 53.55% females (15 out of 28).Conclusions: There is significant co-relation between Demodex infestation and chronic blepharitis. Demodex infestation should be part of the differential diagnosis of chronic blepharitis.

Syphilis on the rise-a retrospective study at a tertiary care hospital in Northeast India

<p><strong>Background:</strong> Syphilis is an important sexually transmitted disease known for quite a long time. Its recognition and efficient treatment have become all the more necessary in the era of HIV epidemic in many clinical situations.</p><p><strong>Methods:</strong> A retrospective observational study of 7 years (January 2013 to December 2019) in 43 patients of confirmed syphilis attending regional institute of medical sciences (RIMS), Imphal.</p><p><strong>Results:</strong> During 7-year study period a sharp rise in syphilis cases were present from 2018 till the end of the study. Out of 43 patients, 39 were males. The most common age group was 25-40 years. Half of them were married. Maximum were heterosexuals and only 8 were homosexuals. Premarital and extra marital exposures were seen in 18 and 3 patients respectively. Patients presented in different forms-primary (48.6%), latent (25.7%) and secondary syphilis (22.8%). No cases of congenital syphilis and neurosyphilis were seen. VDRL titres ranged from 1:4 to 1:32. Six patients had HIV co-infection. No atypical presentations were seen.</p><p><strong>Conclusions:</strong> Increasing cases of syphilis have been observed in recent years. Syphilis screening and prompt treatment amongst risk groups have become crucial along with proper surveillance and public health measures to prevent disease transmission.</p>

Use, Prevalence and People’s Attitude towards Traditional Medicine in Outpatient Department Setting of a Tertiary Care Hospital in Northeast India

Abstract: Objectives: Present study is aimed at reporting the use and people’s attitude towards the traditional system of medicine for their medical emergencies or common ailments. Methods: Study was done in outpatient departments of Guwahati Medical College, Assam. Study design was hospital based cross-sectional study, carried out for a period of 4 months. Patients attending outpatient departments were included in the study. A survey using openand close-ended questionnaire was used to collect the data. Questionnaire survey data was entered in Excel spreadsheets and summarized and reported in Figures and Tables. Results: Out of the 259 total participants, 172 (66.41%) respondents consulted allopathic practitioners more than 3 times for diseases they suffered last year. Minority population (18.9%) had consulted traditional medicine practitioners during the last year. Moreover, 62% never consulted a traditional system practitioner during the previous year. Study proved that easy improvement of physical health (25.86%), speedier actions of allopathic medicine (11.58%), lack of improvement of their health problems by using alternative medicinal system (7.72%) and availability of free medicines in the tertiary hospital they visit (1.93%) as the reasons for increased use of allopathic system. A very small percentage (8.88%) of people opinioned that traditional system is best, because of the lack of side effects and suitability of traditional medicinal system in treatment of common ailments. Conclusion: It is clear from the study that traditional system of medicine didn’t acquire its popularity among commoners in Assam even though many of the developed countries partially or fully support such medicinal systems. Key words: Complementary and alternative medicine, Prevalence, Traditional medicine use, World Health Organization, Outpatient department, Assam.

Group B Streptococcal Colonisation among Pregnant Women Attending a Tertiary Care Hospital of Northeast India

Introduction: Group B Streptococcus (GBS) is an important cause of maternal as well as neonatal morbidity and mortality worldwide. Early identification of colonisation of GBS among pregnant women plays an important role in preventing neonatal disease by taking measures such as antibiotic prophylaxis. In India, the spectrum of disease caused due to GBS is largely unrecognised due to lack of screening practices and also there is no specific guideline to prevent the disease. Aim: To determine the group B streptococcal colonisation and their antibiotic susceptibility profile among pregnant women of North-east India. Materials and Methods: The study was a hospital based cross- sectional survey conducted from April to June 2019. A total of 295 pregnant women with gestational age more than 35 weeks attending the Outpatient and Inpatient Departments were included in the study. Two vaginal swabs and two rectal swabs were collected from each participant and were processed according to standard laboratory protocol. Identification of GBS was done on the basis of Christie-Atkins-Munch-Peterson (CAMP) test and Lancefield grouping by latex agglutination test. Antibiotic susceptibility profile was also obtained for these isolates for certain antibiotics. Chi-square test was applied to determine the association of isolation among different types of cases. Results: Out of 295 pregnant women, 15(5.1%) showed GBS colonisation. There was no significant association found with age or socioeconomic status. However, GBS colonisation was found to be significantly associated with increasing gravidity (p-value=0.03). GBS colonisation of vaginal flora is siginficantly associated with rectal colonisation (p-value <0.01). Although certain isolates were found to be resistant to macrolide antibiotics (66.7%), all strains were uniformly sensitive (100%) to penicillin, levofloxacin, quinupristin-dalfopristin, vancomycin and linezolid. Conclusion: A low rate of colonisation was determined among the pregnant women and it is not associated with age and socioeconomic status. However, it is suggested that routine screening of pregnant women especially multigravida women should be done to prevent the transmission to the newborn.

Histological patterns of renal diseases in children: A 12-year experience from a single Tertiary Care Center in North-East India.

This study was conducted to retrospectively investigate the indications for renal biopsy in the native kidneys of children and to analyze the pathological findings in a single tertiary care hospital in North-East India for the past 12 years. All children (≤18 years) who underwent renal biopsy at our hospital from March 2007 to April 2018 were included. Renal tissue specimens were studied under light and immunofluorescence microscopy. The study group included 254 patients (female 57%). The median age was 15 years (range 6-18 years). The most frequent indications for renal biopsy were nephrotic syndrome (NS) (53.9%), urinary abnormality in systemic disease (22.1%), nephritic syndrome (15.4%), asymptomatic hematuria (4.7%), significant proteinuria (3.1%), and unexplained renal failure (0.8%). On histopathological examination, primary glomerular diseases were the most frequent (68.9%) followed by secondary glomerular diseases (30.3%) and tubulointerstitial diseases (0.8%). The most common primary glomerular diseases were minimal change disease (26.8%), focal segmental glomerular sclerosis (12.2%), diffuse proliferative glomerulonephritis (9.1%), membranous nephropathy (8.7%), IgA nephropathy (8.3%), membranoproliferative glomerulonephritis (2%), and mesangioproliferative glomerulonephritis (2%). Lupus nephritis (LN) (29.5%) was the most common secondary glomerular disease. NS was the most common indication of renal biopsy, and LN was the most common histopathological diagnosis in children ≤18 years.

A Retrospective Study on Adverse Drug Reactions of Anticancer Drugs in a Tertiary Care Hospital in Northeast India

Introduction: Anticancer drugs account to high susceptibility towards Adverse Drug Reactions (ADRs) due to their narrow therapeutic window and increased toxicity, which makes pharmacovigilance studies essential. Aim: To determine the nature and severity of ADRs in cancer patients based on the reports received from the Department of Radiation Oncology to the Pharmacovigilance centre of a tertiary care hospital. Materials and Methods: A retrospective, descriptive study was conducted in the Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, India on the patients who developed ADRs due to anticancer drugs during the period from January 2018 to December 2020. These ADRs were assessed for causality using World Health Organisation- Uppsala Monitoring Centre (WHO-UMC) criteria. The data was analysed using Statistical Package for the Social Sciences (SPSS) version 21.0 and frequencies and percentages were determined for each variable. Results: A total of 913 ADRs were reported from 334 patients. Total 62.57% females developed ADRs and age group of 51-60 years (31.14%) were affected the most. Bronchogenic carcinoma (20.9%) was found to be the most common cancer and haematological system (31.11%) was mostly affected. Most common ADRs observed were alopecia (16.32%) followed by anorexia and anaemia. Carboplatin (23.21%) followed by Cisplatin, Paclitaxel, Docetaxel were the most common drugs causing different ADRs. On causality assessment, as per WHO-UMC criteria 67.25% ADRs were ‘probable’ and 32.75% were ‘possible’. Severity assessment using modified Hartwig and Siegel scale showed 56.41% ADRs as mild, 41.95% moderate and 1.64% severe reaction. Preventability assessment using Schumock-Thornton scale showed 44.69% ADRs were ‘not preventable’ whereas 41.62% ADRs were ‘definitely preventable’ and 13.69% were ‘probably preventable’. Conclusion: The use of anticancer drugs is associated with various adverse effects. However, early detection of the ADRs may help to modify the doses or the drug regimen to minimise the adverse effects.

Clinical outcome and cost analysis of negative pressure wound therapy in extremity wounds: a comparison to conventional wound management

<p><strong>Background:</strong> Open fractures and traumatic wounds constitute a major health problem. Amongst the armamentarium of wound care products available, negative pressure wound therapy (NPWT) is a modality that has transformed wound care and has been recommended for treating all kinds of acute and chronic wounds.</p><p><strong>Methods:</strong> This prospective randomised comparative study was conducted at a tertiary care hospital in Northeast India. 30 patients were included in this study over a period of 24 months commencing from January 2018. The patients consisted of two groups of 15 each, the first group comprised patients who underwent treatment using NPWT and the second group was treated using standard wound therapy (SWT). The endpoint taken was a granulated wound or a wound ready for split skin grafting (SSG).</p><p><strong>Results:</strong> The mean wound size difference between the NPWT group and the SWT group on day nine was 13±7.17 mm and 4.53±0.99 mm, respectively. Likewise, on day nine, 11 (73.3%) patients in the group treated using NPWT had no positive bacterial cultures compared to 8(53.3%) patients on SWT. The estimated cost of materials for each NPWT dressing change was roughly INR₹ 3446 (US$ 45.57).</p><p><strong>Conclusions:</strong> NPWT is not a magic bullet and will not replace the basic methods of wound treatment such as wound debridement, infection control and ensuring adequate blood supply. Nevertheless, NPWT remains an integral part of the current scenario in wound care management and is cost effective under the condition that it accelerates wound healing when compared to traditional treatment.</p>

High Prevalence of Antibiotic-Resistant Gram-Negative Bacteria Causing Surgical Site Infection in a Tertiary Care Hospital of Northeast India.

Background and objectiveSurgical site infections (SSI) are the most common healthcare-associated infections in low- and middle-income countries associated with substantial morbidity and mortality and impose heavy demands on healthcare resources. We aimed to study the microbiological profile of SSI pathogens and their antibiotic-resistant patterns in a tertiary care teaching hospital serving mostly rural populationMethodsA prospective, hospital-based cross-sectional study on pathogen profile and drug resistance was conducted from January 2015 to December 2016. Study subjects were the patients who developed signs of SSI after undergoing surgical procedures at three surgical wards (General Surgery, Orthopedics, and Obstetrics & Gynecology). The selection of the patients was based on CDC Module. Standard bacteriological methods were applied for isolation of pathogens and antibiotic-susceptibility testing based on CLSI (Clinical Laboratory Standard Institute) guidelines.ResultsOut of 518 enrolled subjects, 197 showed growth after aerobic culture yielding 228 pathogen isolates; 12.2% of samples showed polymicrobial growth. Escherichia coli (22.4%) and Klebsiella species (20.6%) were the predominant isolated bacteria followed by Staphylococcus species (18.4%), Pseudomonas species (12.3%), and Enterococcus species (6.6%). Gram-negative bacteria (GNB) were highly resistant to ampicillin (90.1%) and cefazolin (85.9%). High resistance was also observed to mainstay drugs like ceftriaxone (48.4%), cefepime (61%), amoxycillin-clavulanic acid (43.4%), and ciprofloxacin/levofloxacin (37.7%). Among the Gram-positive cocci, Staphylococcus aureus showed 85-96% resistance to penicillin and 65-74% to ampicillin. But GPCs were relatively less resistant to quinolones (16-18%) and macrolides (21.5%). S. aureus was 100% sensitive to vancomycin and clindamycin but vancomycin-resistant Enterococci was encountered in 3/15 (20%) isolates.ConclusionGNBs were responsible for more than two-thirds of aerobic-culture positive SSI and showed high resistance to the commonly used antibiotics thus leaving clinicians with few choices. This necessitates periodic surveillance of causative organisms and their antibiotic-susceptibility pattern to help in formulating hospital antibiotic policy. The antibiotic stewardship program is yet to be adopted in our hospital.

Drug utilization among diabetes mellitus patients in a tertiary care hospital in North-East India

Diabetes mellitus (DM) is a spectrum of common metabolic disorders, arising from a variety of pathogenic mechanisms, all resulting in hyperglycemias. Drug utilization study of anti-diabetic agent is of paramount importance to promote rational drug use and also to make available valuable information for health planning.The present study was taken up to explore into the drug-utilization pattern among diabetic patients. A cross-sectional study was carried out in the Department of Pharmacology in collaboration with Medicine Department, JNIMS, Porompat during May 2018 – April 2020. A total of 100 patients aged 18 years or more with the clinical diagnosis of type II DM and admitted in the Medicine Ward were the study-subjects. Patients with co-morbid conditions were excluded from the study. Information on the medical compliance profile was collected by using the Medical Compliance Questionnaire. Females outnumbered males in the ratio of 1.2:1. The mean age of the patients is 55.03 years with a standard deviation (SD) of 8.58 years. The proportion of patients who took the prescribed drugs without any interruption was 66%. 64% of the patients never thought of giving up the medicationsin any circumstance, even though they started feeling better. 63% of the patients always carried the medications with them when they are away from home.The treatment adherence to medications among the study-subjects was found to be 66%. This variation might be because of inadequate counseling during starting of the therapy and also during the follow-up periods. This issue needs to be focused while initiating diabetic medications.

Clinical presentation and subtypes of spondyloarthritis patients in North East India

Aim of the workTo describe the clinical profile and subtypes of spondyloarthritis (SpA) patients from a tertiary care center in North-Eastern India. Patients and methodThis cross-sectional study was conducted from a tertiary care hospital in Northeast India including 34 patients. Diagnosis of SpA was based on the European Spondyloarthropathy Study group (ESSG) criteria. Results34 cases were 26 (76.5%) males and 8 (23.5%) females. The male to female ratio was 3.2:1. The mean age of the patients was 45 ± 20.2 years. 21 (61.8%) belonged to the age group 21–40 years. The mean age at onset was 28.4 ± 11.4 years while the disease duration was 5.4 ± 5.1 years. Ankylosing spondylitis (AS) was the most common subtype (n = 19,56%), followed by reactive arthritis (ReA)(n = 5,15%) and undifferentiated (UdSpA)(n = 5,15%). Psoriatic arthritis (PsA)(n = 4,12%) and juvenile SpA (n = 1,3%) made up rest of the cases. The most common articular manifestations were peripheral arthritis (88.2%) followed by low back pain (73.5%) and enthesitis (50%). There was evidence of sacroiliitis in 20 (58.8%) patients of which 19 had AS and 17 (85%) were bilateral. The HLAB27 was done in 14 with AS and one with Juvenile SpA; 10(73.7%) were positive. ConclusionThe commonest SpA encountered was AS with a notable male preponderance among patients. Peripheral arthritis was a common clinical presentation in all subtypes of patients. As diagnosing SpA can be challenging, it is recommended that the physicians have a high index of suspicion. Early diagnosis and knowledge of the pattern of the disease might contribute to more favorable treatment outcomes.