Care Hospital Of Odisha Research Articles

Short Communication: Analysis of the Spectrum of Glomerular Diseases in Chronic Filariasis Diagnosed in a Tertiary Care Hospital in India.

Introduction: The study presents renal manifestations in chronic filariasis, a substantial health concern in the eastern and north-eastern regions of India. Materials and Methods: The study is a retrospective analysis of a renal biopsy series of patients with chronic filariasis from a tertiary care hospital in Odisha. It involves eight cases of chronic filariasis. Results: Common indications of biopsy were nephrotic syndrome, chyluria, and unexplained renal failure. The mean duration from the diagnosis of filariasis to the onset of glomerular diseases was 15.75 years, SD ± 4.2 years. Patients were followed up for a minimum of 6 months. Renal histopathology revealed various patterns, including membranous nephropathy, minimal change disease, IGA nephropathy, and membranoproliferative glomerulonephritis. Conclusion: The study fills a critical gap in the literature by elucidating renal biopsy findings in chronic filariasis. The multifaceted nature of this disease underscores the need for continued research to understand kidney diseases due to filariasis, especially in endemic regions.

Patient Satisfaction in In-Patient Department in Tertiary care Hospital in Odisha

Patient satisfaction is a crucial factor in determining the overall Quality of services proved in the Hospital setting. It includes a collaborative and scientific inspection of the various departments associated with the patient that are being admitted to the Hospital. It gives an insight to the areas that need to be improved and increase the overall patient experience.

Analysis of real-time RT-PCR and rapid antigen test and its correlation with clinical characteristics, investigation profile, and imaging of SARI-suspected COVID-19 infections

Abstract Background: Coronavirus disease 2019 (COVID-19) continues to be a significant global public health issue. Aims and Objectives: This study aims to describe the demographic characteristics, comorbidities, clinical presentations, inflammatory biomarkers, and chest computed tomography (CT) findings of patients with severe acute respiratory infection (SARI) at a tertiary care hospital in Odisha, India. Additionally, the study aims to evaluate different COVID-19 diagnostic methods. Materials and Methods: A prospective observational study was conducted at a tertiary care hospital in Odisha, India. All admitted SARI patients underwent COVID-19 testing. Data on demographics, clinical presentations, laboratory investigations, and outcomes at 72 h were collected. COVID-19 diagnostic methods were also analyzed. Statistical Analysis: The statistical analysis was performed using GraphPad Prism 9.5. Results: Among the 830 patients studied, 305 tested positive for COVID-19. The rapid antigen test (RAT) demonstrated a sensitivity of 93.85% and a specificity of 97.43% compared to the real-time reverse transcriptase-polymerase chain reaction (RT-PCR) test. Discrepancies with RAT results were noted in cases with higher cycle threshold (Ct) values (>25). A male predominance was observed, with a mean age of 43.30 ± 15.19 years in the COVID-19-positive group and 40.95 ± 17.15 years in the COVID-19-negative group. Patients with multiple comorbidities (15.68%) had a higher susceptibility to COVID-19 infection. The COVID-19-positive group showed a significantly elevated neutrophil-to-lymphocyte ratio (NLR) (P = 0.0001) and thrombocytopenia (P = 0.001). Inflammatory biomarkers, including CRP, LDH, ferritin, D-dimer, and IL-6, were markedly elevated in swab-positive cases. Bilateral chest involvement and ground glass opacities were common radiological findings in both groups. Conclusion: In resource-limited settings, the RAT is considered an alternative screening tool for COVID-19. Initial laboratory and radiological investigations may aid clinicians in effective management of such patients.

Comparative Study of Anesthetic Agent Recovery Times in Outpatient Procedures: Insights from a Tertiary Care Hospital in Odisha

Comparative Study of Anesthetic Agent Recovery Times in Outpatient Procedures: Insights from a Tertiary Care Hospital in Odisha

IJCM_309A: Epidemiological Trends, Clinical Features, and Outcomes in Scrub typhus patients admitted to a tertiary care hospital in Odisha

Background: Scrub typhus is an emerging public health threat in South-Asian countries; with the growing number of cases in India, an understanding of local patterns of disease and factors that place individuals at risk is pivotal to future preventive measures. Objective: To analyze the epidemiological features- annual number of cases, age distribution, sex distribution, and seasonal distribution over the four years. To find out the clinical profile, laboratory features and outcomes of cases of scrub typhus, and to identify the predictors of disease severity. Methodology: A comprehensive retrospective review of scrub typhus cases reported over a 4-year period (2019-2023) was done, with a monthly trend of patients admitted. Data was collected from the case records of patients for demographic characteristics, clinical features, treatment, and outcomes, length of stay (LOS), complications, and mortality. Data was presented in frequencies and proportions, odds ratio (OR) was calculated and a p-value of Results: A total of 886 cases were reported over the four-years. There was a declining epidemiological trend in 2020-21 and then an increasing one. Scrub typhus cases exhibited seasonality, with a peak incidence during winter season. Males were more commonly affected (58.01%), and the age group most susceptible was 19-64 years (52.22%), followed by one-month to 18years (32.22%). Clinical presentations typically included fever (96%), eschar formation (8%) and rash (8%). Complications like pneumonia (13.88%) and AKI (11.73%), were observed in a significant proportion of cases. Mortality was reported in 4.40% of cases. Altered sensorium, deranged LFT, hypotension requiring ionotropic support, requirement of ventilatory support predicted poor outcome. Conclusion: Scrub typhus was seen to cause a multi-system infection among the studied population, causing significant morbidity and mortality. The conditions found associated with poor outcome and mortality can be used as risk factor predictors and help patient management.

Financial hardship of tuberculosis patients registered under National Tuberculosis Elimination Programme (NTEP) in rural India: A longitudinal study

BackgroundIndia shares a significant proportion of the Tuberculosis (TB) burden of the world. TB diagnosis, treatment, and success are complicated by the chronic nature of the disease as well as additional stressors including financial, psychological, and social hardships, adverse events associated with management, and poor compliance towards anti-tuberculosis medications. MethodsThis is a longitudinal study conducted in the Tuberculosis Units (TUs) of rural field practice areas of the Department of Community Medicine and Family Medicine in a tertiary care hospital in Odisha. 168 diagnosed TB patients from the TUs were enrolled after registration in NTEP and were followed up every month for 6 months or treatment completion. TB patient's cost estimate tool was used to collect data regarding the cost incurred by the patients before and during the diagnosis as well as in the post-diagnosis or treatment period. Results and conclusionOut-of-pocket expenditure was calculated as direct, indirect, and total cost in the pre and post-diagnostic phases of the disease. The median pre and post-diagnosis direct, indirect and total costs were ₹ 12,805, ₹ 16,960 and ₹ 31,192, respectively, with almost 62 % of participants spending more than 20 % of their annual income. In this study, 41 % of participants had to stop working for more than 60 days, and 53.1 % faced distress financing due to the disease. Through this study, we found that more than half of rural TB patients still visit private health facilities, and 20 % start anti-TB drugs by purchasing them from private pharmacies, which incur substantial out-of-pocket expenditure. Most participants faced catastrophic costs associated with hospitalisation, lower family income, and a delay in disease diagnosis.

Clinicopathological profile and survival analysis after pancreaticoduodenectomy for periampullary and pancreatic head malignancies: 7 year experience from Single Tertiary Care Hospital in Odisha, India

Clinicopathological profile and survival analysis after pancreaticoduodenectomy for periampullary and pancreatic head malignancies: 7 year experience from Single Tertiary Care Hospital in Odisha, India

EARLY DIAGNOSIS OF ANASTOMOTIC LEAKAGE AFTER ELECTIVE COLO-RECTAL SURGERY USING DUTCH LEAKAGE SCORE – A PROSPECTIVE OBSERVATIONAL STUDY

Introduction: Anastomotic leakage is a major complication after colorectal surgery, with reported incidence of 2–7%. To limit the clinical consequences, it should be detected and treated as soon as possible. Leak usually becomes apparent between 5 and 7 days postoperatively. A standardized post-operative score, Dutch Leakage Score (DLS) can be a useful clinical tool to reduce delay in diagnosis of anastomotic leak (AL) and reduce mortality. A score of <4 was considered negative while a score of 4 or more was considered positive. Methods: Total 110 patients were enrolled after written informed consent during March 2021–October 2022 at a tertiary care hospital in Odisha. DLS was measured before surgery and on POD2, POD3, and POD6. Results: Among the 110 patients, the AL rate was 16.4%. With respect to AL, DLS cutoff of 2.5 on POD2 had positive predictive value (PPV) of 53.10% and a negative predictive value (NPV) of 98.70%. DLS cutoff of 4.0 on POD3 had a PPV of 80.90% and a NPV 98.90%. DLS cutoff of 3.0 on POD6 had a PPV of 84.20% and a NPV of 96.70%.The most common day of AL was the fifth P.O.D (in seven patients) followed by sixth P.O.D (in five patients). Conclusion: DLS is a good positive and excellent negative predictor of AL. DLS is an easy bedside assessment to gauge the likelihood of AL in the early post-operative period.

Prevalence of target organ disease and its relation with HbA1c at the point of detection of type 2 diabetes mellitus – A cross sectional study from a tertiary care hospital in Odisha

Introduction and Aim: HbA1c is not only a valid indicator of chronic hyperglycaemia but also coincides with the increased risk of diabetic complications in the long term. This study focuses on the prevalence of target organ disease (TOD) and its relation with HbA1c at the point of detecting Type 2 Diabetes Mellitus(T2DM). Materials and Methods: This is a single-centre cross-sectional study done in the Department of General medicine at IMS and SUM Hospital, Odisha, between November 2020 and June 2022, including all newly diagnosed Type-2 Diabetes Mellitus patients aged > 30 years. Besides all the biochemical parameters, the demographic profile was noted in an excel sheet, and later on, using SPSS version 26, the data was analysed categorically. Results: 148 newly diagnosed Type 2 DM patients were enrolled in the study with male predominance (54.72%). The mean age was found as 52.49±9.40 years. There were 29 (19.5%) cases of diabetic retinopathy, 39 (26.3%) diabetic neuropathy, 32(21.6%) diabetic nephropathy and 23(15.54%) left ventricular diastolic dysfunction, with a minimal number of RWMA [7 (4.72%)], Concentric left ventricular hypertrophy [9 (6.08%)] and Ischemic DCM [1(0.67%)] found as complications of newly diagnosed Diabetes mellitus patients. The prevalence of coronary artery disease (CAD) is higher in our study than in other diabetic complications, i.e., 40 (27.02%).A statistically significant (p<0.05) correlation exists between newly diagnosed Diabetes patients with higher HbA1C and serum creatinine, serum urea, microalbuminuria, and positive monofilament test. Conclusion: This study underscores the significance of assessing target organ damage (TOD) prevalence for Type 2 Diabetes Mellitus (T2DM) detection, highlighting the utility of HbA1c testing. HbA1c, a rapid and precise diagnostic tool, holds promise, especially in resource-limited settings, aiding in timely T2DM diagnosis and improved patient care amid the global diabetes epidemic.

Cost-effective Analysis of Prescribed Oral Hypoglycemic Agents amongst Pre-obese and Obese Diabetic Patients in a Tertiary Care Hospital in Odisha

Objectives: Diabetes is more prevalent in middle- and higher-income groups and is spreading at an alarming rate. Drug therapy is compulsory because of the chronic and progressive nature of the disease. With such multifactorial background of high prevalence, progressive nature of the disease leading to various complications, increased healthcare cost, and availability of multiple therapeutic regimens prescribed, this study has been done to evaluate the cost-effective analysis of oral hypoglycemic agents. Materials and Methods: This is a prospective, parallel group, and comparative observational study conducted by the Department of Pharmacology in collaboration with the Department of Endocrinology at Kalinga Institute of Medical Sciences, Bhubaneswar. The duration of the study was of 2 years. A total number of 220 patients were selected and based on body mass index, patients were categorized into preobese (new and old diabetic patients) and obese (new and old diabetic patients) categories. In this study, cost-effectiveness analysis (CEA) was done to evaluate the cost differences between two or more medication groups, with a similar clinical effect. Results of CEA are expressed as an average cost-effectiveness ratio or as an incremental cost-effectiveness ratio. Results: From this study, it is observed that in terms of benefit, dual therapy of Metformin and Dapagliflozin was most efficacious followed by Metformin and Sitagliptin as well as Metformin and Glimepiride combinations. If cost is considered, Metformin montherapy and metformin and Glimepiride dual therapy was most cost-effective. In triple regimen, MET+VOG+GLIM combination was seen to be more cost effective than gliptin combination, both in terms of control of FBS as well as PPBS. The cost of treatment goes parallel with duration of disease, being higher in the old cases of long-standing duration. Conclusion: The present study shows that SGLT2 inhibitors are better class of oral hypoglycemics in terms of long-term benefits and this group is prescribed as dual therapy more frequently but cost of therapy is the greatest barrier. Metformin and Sulfonylureas remain the most beneficial combination, both in terms of efficacy and cost. The cost of treatment was varying, depending on the duration of disease, being higher in old cases and lower in new cases.

A Retrospective Study of Demographic Profile and Management Appraisal Non-Gonococcal Urethritis in Male Patients Attending a Tertiary Care Hospital in Odisha.

Male urethritis is primarily sexually transmitted in India and has also shown a high rate. Urethritis or inflammation of the urethra is a multifactorial condition. It is called gonococcal urethritis (GU) when Neisseria gonorrhoeae is detected in a urethral smear of the patient and non-gonococcal urethritis (NGU) when this organism cannot be visualized. To study the demographic profile and management pattern of NGU retrospectively in male patients. Urethritis cases were identified from the dermatology outpatient record. A retrospective study of data of patients diagnosed with NGU was done for 5 years from August 2015 to July 2020. We included only male patients more than 10 years of age. Chlamydia trachomatis (CT, 48%) was the most common causative organism found. The diagnosis was confirmed by demonstrating ≥5 polymorphonuclear lymphocytes (PMNLs) from the anterior urethra using a Gram-stained urethral smear followed by the polymerase chain reaction (PCR.) of urine. The most common age group affected was 21-30, (30, 46%) years with a mean ± standard deviation (SD) of 30.32 ± 10.80. Most patients were from low socioeconomic status, labourers (36, 55%). A history of heterosexual behaviour, (57, 88%) was the most common and it had been seen that sexual exposure was more common in unmarried patients (38, 59%). Associated features were seen in 18 patients. Among recommended initial therapies for NGU, doxycycline and azithromycin might be improved by the addition of antimicrobial coverage for Trichomonas vaginalis (T. vaginalis). Further, it was seen that response to doxycycline therapy was better than azithromycin. Though there is an increased incidence of Herpes infections, we found Chlamydia infection to be the most common cause of NGU. Doxycycline showed better results in NGU due to Chlamydia infection.

Experience of performing Hepatic Interventional Radiological Procedures in a Tertiary Care Hospital in Odisha

Experience of performing Hepatic Interventional Radiological Procedures in a Tertiary Care Hospital in Odisha

Comparison Of Artificial Neural Network and Decision Tree Methods for Predicting the Maternal Outcome in A Tertiary Care Hospital in Odisha, India

Background: This study used an artificial neural network (ANN) and a decision tree to predict maternal outcomes and their major determinants. An artificial neural network (ANN) and a decision tree were used in this study to determine maternal outcomes and their significant determinants. Methods: Data was gathered from 955 pregnant women at a tertiary care hospital in Bhubaneswar, Odisha. A popular machine learning algorithm, artificial neural networks (ANN), was used to predict maternal outcomes and their determinants. Results: in the bivariate analysis, we found gestational age is significantly associated with maternal outcome (p=<0.001). The accuracy of the ANN model and decision tree was 0.882 and 0.823, respectively. Based on the variable importance of ANN, the significant determinants of maternal outcome were birth weight, systolic blood pressure, hemoglobin, gestational age, age of mother, diastolic blood pressure etc. Conclusion: This model can be utilized in future for Proper precautions and medical checkups required during the maternal period to avoid a negative maternal outcome.

Coverage of Hepatitis-B Vaccination among the Healthcare Providers of a Tertiary Care Hospital in Odisha

Background: Hepatitis B (Hep-B) infection is the major cause of acute and chronic liver disease, cirrhosis, and hepatocellular carcinoma worldwide and has long been recognized as an occupational hazard among healthcare workers (HCWs). Thus, this study was planned to evaluate the coverage of Hep-B vaccine among healthcare providers (HCPs) in a tertiary care hospital in Odisha. Material and Methods: A cross-sectional study was conducted among HCPs of Hi-Tech Medical College and Hospital. A total of 300 HCPs were selected for the study by a stratified random sampling technique. A proportionate sampling of 26.2% from the doctor population of 280, i.e., 73, and 26.2% of the paramedic population of 865, i.e. 227, were selected by using a random number table to meet the sample size of 300. A self-designed, semi-structured questionnaire was used to collect data from the participants. Data on demographics and knowledge regarding Hep-B aspects were also collected. Results: One hundred and two (34%) participants had adequate knowledge and 198 (66%) participants had poor knowledge of Hep-B. The overall prevalence of Hep-B vaccination acceptance was 71.3%. 70% of the health workers had received the full three-dose vaccination schedule, while 6% had received two doses, 3.7% had received one dose, and 20% were unvaccinated. Conclusion: Coverage of complete immunization was low. The level of knowledge regarding the disease was also not satisfactory. Education programs should focus on increasing HCWs' perceived severity of occupational exposure to the Hep-B virus.

Maternal and neonatal outcomes among women with and without severe acute respiratory syndrome corona virus-2 infection: A retrospective analytical study.

BackgroundCorona virus disease (COVID-19) is an infectious disease caused by the novel corona virus known as severe acute respiratory syndrome corona virus 2 (SARS Cov-2). Physiological changes occurring during pregnancy can have a positive or negative effect on the disease progression. The objective of the study was to evaluate the maternal and neonatal outcomes in pregnant women with COVID-19 compared to pregnant women without COVID-19 and to determine its influence on the healthcare system.Material and methodsThis was a retrospective analytical study conducted at a tertiary care hospital in Odisha, India, over 3 months, from 1 September 2020 until 30 November 2020. Results were compared in both groups.ResultsThree hundred and three (303) women delivered, out of whom 92 were COVID-19 positive. Incidence of COVID-19 positivity was 30.3% with 93.47% asymptomatic patients. The majority of the patients were 26–35years of age. Average gestational age at delivery for both groups was 37–40 weeks. COVID-19 positivity was seen more in primigravidas than in multigravidas. Comorbidities such as GDM/type 2 DM, PIH, PROM, APH and jaundice were similar in both groups and statistically non-significant, whereas association of anaemia and hypothyroidism were statistically significant (p<0.05) in the positive group. A single maternal death was reported in the positive group. There was an increase in Caesarean section (p=0.002) with higher incidence of preterm births and lowbirth weights in the positive group. Only 3 babies tested positive for COVID-19, so vertical transmission probability was low. Overall, all babies were healthy and the majority of women were discharged without any complications.ConclusionThere was no significant effect of the infection on maternal and fetal outcomes, but further studies and long-term follow-up is needed to look for any delayed effects on the babies and mothers.

Nonfermenting, Gram-Negative Bacilli Causing Neonatal Sepsis in Odisha, India: Four-Year Surveillance.

IntroductionIn India, blood culture-positive sepsis results in mortality in 33%-35% of affected neonates. Nonfermenting Gram-negative bacilli (NFGNB), particularly Acinetobacter baumannii and Burkholderia cepacia commonly cause hospital-acquired infection.Materials and methodsWe performed a subgroup analysis as part of a prospective study conducted in a neonatal intensive care unit in a tertiary care hospital in Odisha, India, between January 2017 and December 2020. Neonates with blood culture-positive sepsis caused by NFGNB were enrolled in this study. Demographic characteristics of the neonates, clinical features of sepsis, complications, need for supportive care, and blood culture sensitivity patterns were recorded and analyzed.ResultsA total of 168 organisms were isolated in blood cultures during our study period, of which 48 (29%) were NFGNB species. Among these 48 species, A. baumannii (37.5%) and B. cepacia (33.3%) were the most common NFGNB in our study. Neonates with sepsis commonly exhibited feeding intolerance (64.5%), circulatory insufficiency that necessitated vasopressor treatment (54.1%), disseminated intravascular coagulopathy (35.4%), seizures (33.3%), and the need for respiratory support (56.2%). NFGNB were multidrug-resistant (MDR) in 70.8% of cases, and 93.7% of B. cepacia and 55.5% of A. baumannii were MDR.ConclusionsA. baumannii and B. cepacia are NFGNB commonly isolated in neonatal cases of blood culture-positive sepsis. The prevalence of MDR NFGNB sepsis is gradually increasing, which poses a threat to neonates. Strict aseptic precautions and antibiotic stewardship are thus mandatory in perinatal practice.

Antibiotic resistance pattern and clonal relationship of Enterobacter spp isolates from different clinical samples in Odisha, India

Bacteria with increase antibiotics resistant caused serious health treat worldwide. Regular surveillance of resistance spectra and clonal relationship of infectious bacteria are important for appropriate use of antibiotics. In this study, we investigated the antibiotic resistant pattern and clonal relationship of Enterobacter spp isolated from different clinical samples of a tertiary care hospital of Odisha, India. The results of this study indicated the presence of multidrug resistant Enterobacter spp with multiple β-lactamases production. The phylogenetic tree showed three unique clusters of ERIC within the nineteen Enterobacter spp. isolates.

Health profile of security personnel in a tertiary care hospital in Odisha

Health profile of security personnel in a tertiary care hospital in Odisha

Intrapartum respectful maternity care practices and its barriers in Eastern India.

Respectful maternal care (RMC) is increasingly recognized globally as critical to improving the quality of maternity care as women deserve respectful and dignified care. Numerous women face disrespectful maternal care during labor and delivery, especially in low- and middle-income countries, which dissuades them from seeking institutional care. Women, the consumers of care, are better positioned to report on the level of respectful care they receive. Health care workers' perspectives on barriers to delivering respective maternity care are seldom explored. Thus, this study aims to assess the levels of respectful maternity care and its barriers. This cross-sectional study assesses the level of RMC and its barriers in the labor room of tertiary care hospital in Odisha among 246 women selected by consecutive sampling technique by a questionnaire. More than one-third of women reported good RMC. Although women rated high in domains of environment, resources, dignified care, and non-discrimination, non-consented care and non-confidential care were poorly rated. Barriers that adversely affect the delivery of RMC perceived by health care workers were lack of resources, staffing, uncooperative mother, communication issues, privacy issues, lack of policies, workload, and language problems. There was a significant association of RMC with age, education, occupation, and income. In contrast, residence, marital status, number of children, antenatal visit, type of institute of antenatal care, mode of delivery, and gender of health care provider were not associated with RMC. Given the above findings, we recommend vigorous efforts to improve the institutional policies, resources, training, and supervision of health care professionals on women's rights during childbirth to strengthen the quality of care for positive birth experiences.

Determinants of Inpatient Satisfaction on Hospital Services in a Government Tertiary Care Center

Introduction: Patient satisfaction is a psychological concept which is considered as a judgment of individuals regarding any object or event after gathering some experiences over time. It is one of the established yardsticks to measure the success of the services. Objectives: 1. To assess the level of inpatient satisfaction on hospital services. 2. To find out the determinants of inpatient satisfaction on hospital services. Method: It was a cross-sectional study conducted over a period of four months at VIMSAR, a tertiary care hospital in Odisha in eastern India. A total of 164 patients were enrolled in the study from the five most occupied indoor departments who were administered a pre-tested semi-structured standardised questionnaire by face to face interview method. Results: Majority (77.44%) of respondents were in the age group of 21-60 years. The sample consisted of 65.24 % males and 43.9% were from lower socio-economic class. Patient satisfaction level was found to be relatively low (~80%) for the service domains like housekeeping, general services and ancillary services. Fields like front desk services, medical care, nursing care and laboratory services enjoyed a better satisfaction score (~90%). Binary logistic regression analysis reflected age and socio-economic class to be the negative determinants of the level of satisfaction. Conclusion: About two thirds of the inpatients were satisfied with the services availed at the tertiary care hospital in the five specialities. There is scope of improvement in the areas like housekeeping, ancillary care and general care. Socio-demographic characteristics like age and socioeconomic class inversely related to inpatient satisfaction on hospital services.