Care Hospital In Central India Research Articles

A Study of the Role of Magnetic Resonance Imaging in the Evaluation of T2-Weighted Hyperintensities in Spinal Cord in a Tertiary Care Hospital in Central India

A Study of the Role of Magnetic Resonance Imaging in the Evaluation of T2-Weighted Hyperintensities in Spinal Cord in a Tertiary Care Hospital in Central India

Factors associated with hospitalization and mortality in adult and pediatric extrapulmonary tuberculosis at a tertiary care hospital in Central India

Background Comorbidities complicate the management of tuberculosis (TB) and have become an essential part of the end TB strategy to eradicate TB. However, pulmonary TB has received the most attention, and little is known about the impact of comorbidities and other factors on outcomes in patients with extrapulmonary tuberculosis (EPTB). Objectives Our aim was to analyze the factors associated with hospitalization and mortality in EPTB at a hospital in Central India, using non-TB patients with similar clinical presentations as a comparison. Methods Patients with presumptive EPTB were prospectively enrolled and followed up until the end of treatment or for at least 6 months. Detailed demographic and clinical information was collected for all participants, and patients were categorized as TB or non-TB using a composite reference standard. Multivariate logistic regression was used to analyze the impact of various clinical findings and risk factors on hospitalization and mortality. Results A total of 276 patients were categorized as TB cases and 175 as non-TB cases. Factors associated with hospitalization in children were younger age and non-adenitis site of disease. In adults, factors associated with mortality were older age, non-adenitis site of disease and HIV infection regardless of TB diagnosis, while diabetes mellitus increased the odds of mortality in EPTB patients. Conclusion Our results show that comorbidities increase the odds of death in both TB and non-TB patients in low-resource settings. This argues for a shift away from the traditional vertical management of diseases in these areas and supports a continued focus on building robust healthcare systems.

Unmasking a looming crisis: Escalating MIC of last resort drugs against MRSA isolates from a tertiary care hospital in Central India

PurposeThe Centers for Disease Control and Prevention has classified methicillin-resistant S aureus (MRSA) as a serious public health threat. The escalating minimum inhibitory concentration (MIC) of standard anti-methicillin-resistant S aureus (MRSA) drugs within the susceptible range, known as "MIC creep," jeopardizes their effectiveness against MRSA infections, posing additional challenges in managing MRSA infections. This cross-sectional study was conducted in a tertiary care hospital in Central India to assess the susceptibility trends of clinical MRSA isolates against commonly used anti-MRSA drugs and to observe MIC creep, if any, over three years (2020–2022). MethodsThe study included 158 non-repetitive clinical MRSA isolates. The MICs of vancomycin, teicoplanin, and linezolid were determined in MRSA strains using agar dilution, while the MIC of daptomycin was performed by broth microdilution. MIC creep was assessed by calculating MIC50, MIC90, Modal MIC, G-mean MIC, and susceptible and resistant percentages for the fiscal years 2020, 2021, and 2022. ResultsOf the 158 MRSA isolates, none were resistant to vancomycin, teicoplanin, and daptomycin, but two showed resistance to linezolid (LRSA). However, fifteen isolates showed intermediate resistance to vancomycin (VISA), and five showed intermediate resistance to teicoplanin (TISA). MIC of these anti-MRSA drugs increased in 2021 and 2022 compared to 2020. G-mean MIC for vancomycin, teicoplanin, and linezolid in MRSA strains increased significantly over the study period, while daptomycin MIC remained relatively stable, with a slight increase in 2021 and 2022. There was a high resistance rate for clindamycin, doxycycline, and chloramphenicol among VISA, TISA, and LRSA isolates compared to MRSA. ConclusionsDuring the three years of the study, “MIC creep” was observed in vancomycin, teicoplanin, and linezolid and, to some extent, for daptomycin in MRSA strains. The recovery of VISA, TISA, and linezolid-resistant MRSAs is worrisome, suggesting possible MRSA treatment failure and being a forerunner of resistant strains.

Association Between Glycated Hemoglobin (HbA1c) Levels in Patients With Iron Deficiency Anemia in a Tertiary Care Hospital in Central India

Association Between Glycated Hemoglobin (HbA1c) Levels in Patients With Iron Deficiency Anemia in a Tertiary Care Hospital in Central India

Role of Magnetic Resonance Imaging in evaluating T2-weighted hyperintensities in spinal cord in a tertiary care hospital in central India

Background Hyperintensities on T2-weighted images in the spinal cord are a complex and diagnostically challenging entity that can present with diverse clinical features. This study protocol outlines a comprehensive investigation to understand the causes, clinical and imaging characteristics, and correlation with pathological findings of hyperintensities on T2-weighted images in the spinal cord. By establishing a systematic assessment approach, this study seeks to provide valuable insights into these abnormalities’ diagnostic and prognostic implications. Methods The study will be conducted as a prospective observational design. Patients with clinically diagnosed or suspected spinal cord lesion presenting with intramedullary T2-weighted hyperintensity and referred for MRI evaluation will be included. Data collection will encompass patient demographics, clinical features, and extensive imaging parameters. Pathological data, when available, will be correlated with imaging findings. Various statistical methods will be employed to analyse the data, including frequency analysis, comparative tests, logistic regression, and survival analysis. Expected Results The study anticipates elucidating the spectrum of etiologies underlying hyperintensities on T2-weighted images in the spinal cord and their clinical and imaging profiles. The systematic approach will offer a structured diagnostic method, while correlations with pathological data will provide an enhanced understanding of these conditions. The results are expected to provide clinicians with valuable insights into diagnosing, treating, and prognosticating patients with spinal cord hyperintensities on T2-weighted images.

Role of squamous cell carcinoma antigen (SCC-Ag) in the management of carcinoma cervix in an Indian population: A pilot study

BackgroundEarly detection of recurrence in carcinoma cervix can be challenging but has the potential to improve survival in a subset of patients. Squamous cell carcinoma antigen (SCC-Ag) has been tested in multiple roles in the management of cervical cancer but the evidence from India is limited. MethodsThis was a prospective, cohort pilot study conducted in a tertiary care hospital in central India. Study subjects were patients with locally advanced carcinoma cervix treated with concurrent chemoradiotherapy between June 2017 and May 2018. All patients underwent pre and post-treatment SCC-Ag testing which was continued serially every 3 months for a total follow-up of 24 months. A cut-off value of 1.5 ng/ml or more was used to define a positive test. Chi–Square tests, Pearson's correlation testing and Kaplan Meier plots were used to study the association of different patient and tumour variables with the SCC-Ag levels. Test validity of serial measurements of SCC-Ag was also measured for detection of recurrence. ResultsA total of 45 patients were included. SCC-Ag levels were strongly correlated with tumour stage and presence of lymph nodal metastases. Post-treatment abnormal SCC-Ag levels were significantly associated with a poorer recurrence-free survival (RFS). Serial measurement of SCC-Ag levels proved to be a good screening tool for early detection of recurrences even before clinical symptoms or signs developed with a sensitivity of 90% and specificity of 91.8%. ConclusionOur study has highlighted the benefits of the use of this tumour marker in the management of cervical cancer and has generated useful evidence supporting its use in prognosticating patients, guiding investigations, determining risk for recurrence, assessing tumour response and for early detection of recurrences.

Clinical Profile and Outcomes of Heart Failure Patients: A Study Conducted in A Tertiary Care Hospital in Central India

Background: Heart failure (HF) is a major health problem with varying epidemiology and outcomes across different regions. This study aimed to investigate the clinical profile, risk factors, and outcomes of heart failure patients admitted to a tertiary care hospital in central India.

Role of Magnetic Resonance Imaging in evaluating T2-weighted hyperintensities in spinal cord in a tertiary care hospital in central India

Background Hyperintensities on T2-weighted images in the spinal cord are a complex and diagnostically challenging entity that can present with diverse clinical features. This study protocol outlines a comprehensive investigation to understand the causes, clinical and imaging characteristics, and correlation with pathological findings of hyperintensities on T2-weighted images in the spinal cord. By establishing a systematic assessment approach, this study seeks to provide valuable insights into these abnormalities’ diagnostic and prognostic implications. Methods The study will be conducted as a prospective observational design. Patients with clinically diagnosed or suspected spinal cord lesion presenting with intramedullary T2-weighted hyperintensity and referred for MRI evaluation will be included. Data collection will encompass patient demographics, clinical features, and extensive imaging parameters. Pathological data, when available, will be correlated with imaging findings. Various statistical methods will be employed to analyse the data, including frequency analysis, comparative tests, logistic regression, and survival analysis. Expected Results The study anticipates elucidating the spectrum of etiologies underlying hyperintensities on T2-weighted images in the spinal cord and their clinical and imaging profiles. The systematic approach will offer a structured diagnostic method, while correlations with pathological data will provide an enhanced understanding of these conditions. The results are expected to provide clinicians with valuable insights into diagnosing, treating, and prognosticating patients with spinal cord hyperintensities on T2-weighted images.

A prospective observational study on magnetic resonance imaging (MRI) based evaluation of pelvic masses in females in tertiary care hospital in central India

Background Pelvic masses in females often present a diagnostic challenge, necessitating accurate detection and characterization for appropriate clinical management. Magnetic Resonance Imaging (MRI) has emerged as a valuable tool in pelvic mass evaluation, offering superior soft tissue contrast and multiplanar imaging capabilities. This prospective observational study aims to assess the diagnostic accuracy of pelvic MRI, determine anatomic origin, classify masses, estimate local spread, and evaluate the impact of gadolinium contrast in a tertiary care hospital in Central India. Methods The study will be conducted over a two-year period, enrolling female patients with lower back pain and clinical suspicion or inconclusive ultrasonographic findings of pelvic masses. A systematic approach to participant identification, recruitment, and engagement will be employed, with both verbal and written informed consent obtained. The imaging protocol will involve T1 and T2 weighted images, and gadolinium contrast administration when necessary. Data collection will encompass demographic information, medical history, clinical details, and MRI findings. Statistical analyses, including sensitivity, specificity, prevalence estimates, and regression analyses, will be performed to evaluate the diagnostic accuracy of pelvic MRI. Expected outcome We anticipate that pelvic MRI will exhibit high diagnostic accuracy in detecting and characterizing pelvic masses, providing valuable information on anatomic origin and pelvic compartment localization. The study aims to contribute evidence on the impact of gadolinium contrast in enhancing diagnostic capabilities. The findings are expected to optimize clinical decision-making for effective management of females with pelvic masses, leading to timely interventions and improved patient outcomes.

Evaluation of ivabradine plus beta-blocker versus beta-blocker alone in addition to standard care in reducing hospitalization and major adverse cardiovascular event in patients with chronic heart failure: a prospective observational study in tertiary care hospital in central India

BackgroundIn recent years, there has been an increase in cases of heart failure, ultimately leading to an increase in hospitalization for heart failure (HF) and cardiovascular mortality. The aim of our study was to evaluate ivabradine combined with beta-blocker versus beta-blocker alone in addition to standard care for chronic heart failure, followed for a period of 6 months for the rate of hospitalization and major adverse cardiovascular event (MACE) in patients with reduced left ventricular ejection fraction (LVEF < 35%).ResultsA total of 64 patients were included in this observational study with 30 patients in the ivabradine + beta-blocker (IVA + BB) group and 34 in the beta-blocker (BB) group. The median (IQR) age of the study sample was 57 (50–62) and 58.5 (55–67) in IVA + BB and BB groups, respectively, with LVEF < 35%. The incidence of the primary endpoint of composite MACE (MI, stroke, death, worsening of HF) was 5 in both groups. The mean heart rate was significantly decreased (p < 0.001) at 3-month and 6-month follow-up from baseline in the ivabradine + beta-blocker group as compared to the beta-blocker group alone, while it significantly increased in the beta-blocker group at 3 months (p < 0.01) and also at sixth months (p < 0.05). Parameters such as the New York Heart Association (NYHA) class and the Minnesota Living with Heart Failure questionnaire (MLWHFQ) were also assessed but did not show significant change.ConclusionOverall, observations from the study results show that IVA + BB seems to be overall well tolerated in the study sample, with a somewhat smaller decrease in hospitalization and a delay in MACE events in the sample population enrolled in a tertiary care hospital in India. Further exploration in a larger sample is required concerning the Indian population.

Assessment of anemia in cases of acute myocardial infarction in a tertiary care hospital in central India

Assessment of anemia in cases of acute myocardial infarction in a tertiary care hospital in central India

A prospective observational role of magnetic resonance imaging and magnetic resonance spectroscopy in evaluation of choline levels in gall bladder carcinoma in tertiary care hospital in central India

Background Gall bladder carcinoma (GBC) is a challenging malignancy characterized by late-stage diagnosis and poor prognosis. Early detection and accurate staging are crucial for improving patient outcomes. Magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) offer non-invasive imaging modalities that may aid in the evaluation of GBC. Choline, a metabolite detected by MRS, has been implicated in tumor growth and may serve as a potential biomarker for GBC. This study aims to investigate the role of MRI and MRS in evaluating choline levels as biomarkers for GBC. Method A prospective observational study will be conducted involving patients with suspected or confirmed GBC referred to the Department of Radiology, AVBRH, Sawangi. Patients meeting inclusion criteria will undergo MRI scans and MRS examinations to assess tumor characteristics and choline levels. Data collected will include MRI images, MRS spectra, histopathological results, and clinical outcomes. Statistical analysis will be performed to examine correlations between MRI findings, choline levels, and histopathological characteristics. Expected Outcome It is anticipated that MRI and MRS will demonstrate utility in evaluating choline levels as imaging biomarkers for GBC. Correlations between choline levels, tumor characteristics, and clinical outcomes are expected to provide valuable insights into the role of choline in GBC pathogenesis and prognosis. If successful, MRI and MRS could serve as non-invasive tools for early detection, staging, and treatment response monitoring in GBC, ultimately leading to improved patient outcomes and management strategies.

Analytical observational study of salmonella PCR and its comparison with routine laboratory parameters in cases of enteric fever in tertiary care hospital in central India

Background Enteric fever, predominantly caused by Salmonella enterica serotype Typhi, remains a significant global health concern, particularly in resource-limited settings. The diagnostic landscape for enteric fever relies on traditional methods such as the Widal test and blood culture, each with inherent limitations regarding sensitivity and turnaround time. Methods The study will employ an Analytical Observational Study design conducted at Acharya Vinoba Bhave Rural Hospital in central India over a two-year period. Participants will include adults above 18 years admitted to the ward or Intensive Care Unit (ICU) with acute febrile illnesses. Inclusion criteria encompass a wide age range, ensuring a diverse study population. Peripheral blood samples will be collected for Salmonella PCR, Widal testing, and blood culture. Dot-PCR for Typhi will be employed, and DNA extraction will follow strict protocols. Data will be systematically recorded, and statistical analyses, including sensitivity, specificity, and comparative assessments, will be conducted to evaluate diagnostic performance. Expected Outcome It is anticipated that Salmonella PCR will exhibit superior sensitivity and specificity compared to traditional diagnostic methods, offering a more rapid and accurate identification of enteric fever cases. The study aims to contribute valuable evidence supporting the incorporation of Salmonella PCR into routine diagnostic algorithms, potentially revolutionizing the approach to enteric fever diagnosis. Moreover, insights gained from the study are expected to inform clinical practices, enhance patient management, and potentially reduce the economic burden associated with misdiagnosis or delayed diagnosis of enteric fever. The outcomes of this research are poised to impact public health strategies, providing a foundation for more effective and efficient diagnostic protocols in the context of enteric fever.

A prospective observational comparative study to compare the diagnostic efficacy of the Fenyo Lindberg scoring system and Yash scoring system in patients of acute appendicitis in tertiary care hospitals in central India

Background Acute appendicitis is a typical surgical emergency requiring prompt and accurate diagnosis for timely intervention. This prospective observational comparative study aims to assess the diagnostic efficacy of two scoring systems, the Yash scoring system and the Fenyo-Lindberg scoring system, compared to the gold standard of histopathological diagnosis. The study is conducted at A.V.B.R.H., a tertiary care hospital in Central India, focusing on providing valuable insights into the comparative performance of these scoring systems in the local patient population. Methods The study adopts a prospective observational comparative design, enrolling clinically diagnosed cases of acute appendicitis from the outpatient and inpatient departments of the Surgery department at A.V.B.R.H. Patients willing to undergo surgery are included. At the same time, those with complicating factors or contraindications are excluded. Data collection involves thorough clinical evaluations, scoring system assessments, and comprehensive investigations, with histopathology as the reference standard. Statistical analyses include descriptive statistics, comparative analyses, primary outcome assessments, and regression analyses, ensuring a robust evaluation of the diagnostic efficacy of the scoring systems. Expected Outcome Anticipated outcomes include a comprehensive understanding of the diagnostic efficacy of the Yash and Fenyo-Lindberg scoring systems in acute appendicitis. The study aims to identify which scoring system demonstrates superior accuracy, sensitivity, and specificity, providing valuable information for clinical decision-making. The results will contribute to optimizing diagnostic protocols for acute appendicitis, potentially influencing patient management and surgical interventions. This study’s findings are expected to be relevant to the local setting and broader contexts, enhancing the knowledge surrounding acute appendicitis diagnosis.

An observational prospective cross-sectional study on extravascular lung water by lung ultrasound as a guide to fluid resuscitation therapy in adult septic shock in tertiary care hospital in central India

Background Septic shock is a life-threatening condition characterized by systemic inflammation and organ dysfunction, with fluid resuscitation being a cornerstone of management. However, indiscriminate fluid administration can lead to fluid overload and worsen outcomes. Extravascular lung water (EVLW) estimation by lung ultrasound has emerged as a promising tool for guiding fluid therapy in septic shock, allowing clinicians to assess pulmonary edema and tailor resuscitation strategies accordingly. Methods This prospective observational study aims to evaluate the utility of EVLW estimation by lung ultrasound in guiding fluid resuscitation therapy in adult patients with septic shock admitted to a rural tertiary care teaching hospital. Eligible patients admitted to the intensive care unit (ICU) will undergo baseline demographic and clinical assessments, including lung ultrasound, to quantify EVLW using B-line analysis. Fluid resuscitation therapy will be initiated based on EVLW findings, with subsequent adjustments guided by repeat lung ultrasound examinations at 6, 12, 24, and 48 hours post-initiation. Outcome measures include changes in mean PaO2/FiO2 ratios, respiratory parameters, renal function, fluid balance, and mortality rates. Expected Outcome We anticipate that EVLW-guided fluid resuscitation therapy will lead to more precise and tailored management of septic shock, potentially reducing the incidence of fluid overload, ARDS, and renal dysfunction. By optimizing fluid management strategies based on individual patient characteristics and responses, we aim to improve clinical outcomes and enhance the delivery of care for patients with septic shock.

Knowledge, Attitude and Practice of Lifestyle Modifications Among Hypertensive Patients Visiting A Tertiary Care Hospital in Central India

Background: Globally, hypertension is a major problem. The cornerstone of the strategy for preventing hypertension is making appropriate lifestyle modifications. The present study was carried out to assess knowledge, attitude and practice of lifestyle modifications among hypertensive patients.Methods: This cross-sectional questionnaire-based study carried out among 343 hypertensive patients visiting a tertiary care hospital.Results: We observed that although majority of hypertensive had good knowledge and attitude about lifestyle changes in hypertension, least were adherent to those. Conclusion: The treatment of hypertension is greatly aided by preventive medication. In order to lower the prevalence of hypertension in a nation, assessments of knowledge, attitudes, and practices regarding lifestyle change are fundamentally necessary.International Journal of Human and Health Sciences Vol. 08 No. 02 Apr’24 Page: 140-146

Observational and cross-sectional study on clinical profile of nontuberculous mycobacterial (NTM) disease in patients at tertiary care hospital of central India

Background Nontuberculous Mycobacterial (NTM) diseases present unique clinical challenges and are increasingly recognised as significant contributors to respiratory and extrapulmonary morbidity. This study protocol outlines an observational and cross-sectional investigation aiming to comprehensively understand the clinical profile of NTM disease, including its prevalence, risk factors, and clinical features, in patients at a tertiary care hospital in central India. Methods Over two years, from July 2022 to June 2024, a convenience sample size will be recruited from TB suspects meeting inclusion criteria. Comprehensive data collection will be conducted, including demographic information, clinical history, radiological findings, microbiological test results, and risk factor assessments. Statistical methods will be applied to the collected data, including descriptive statistics, comparative analysis, risk factor assessments, and multivariate analyses. Expected Results The study aims to provide valuable insights into the prevalence and clinical manifestations of NTM disease, shedding light on the risk factors contributing to its occurrence. The statistical analyses will identify key factors associated with NTM disease and characterise its clinical and radiological features.

An interventional cross-sectional study of electrolyte levels in newborns with hyperbilirubinemia before and after phototherapy in a tertiary care hospital in central India

Introduction This study protocol outlines a comprehensive investigation into the impact of phototherapy on electrolyte levels in newborns with hyperbilirubinemia. With a focus on neonates admitted to the Neonatal Intensive Care Unit (NICU) at Jawaharlal Nehru Medical College and AVBR Hospital, Sawangi, Wardha, Central India, the research aims to contribute valuable insights into the physiological changes associated with this common neonatal condition. The study’s introduction highlights the rationale, significance, and gaps in current knowledge, emphasising the need for a detailed exploration of electrolyte dynamics before and after phototherapy. Method The methodology involves a descriptive, interventional cross-sectional design with a calculated sample size of 264 neonates. Standardised protocols for data collection, including serum electrolyte analysis and urine-specific gravity assessment, will be employed. Inclusion and exclusion criteria are clearly defined to ensure a homogenous study population. Statistical analyses, utilising R Studio 4.3.1 will encompass descriptive statistics, comparative analysis, correlation analysis, and multivariate analysis to explore the nuanced relationships between variables. Rigorous ethical considerations and transparency in reporting will guide the data collection process. Expected Result Anticipated outcomes include a nuanced understanding of changes in serum electrolyte levels following phototherapy and the correlation of these changes with the treatment duration. The study is poised to shed light on the impact of gestational age and birth weight on electrolyte responses. Through rigorous statistical analysis, the research aims to provide evidence-based insights that can inform neonatal care protocols. The anticipated findings hold the potential to influence clinical practices, enhancing the quality of care provided to newborns with hyperbilirubinemia undergoing phototherapy.

A parallel-arm randomised control trial to study the effects of risk communication methods for prevention of cardiovascular diseases: EFFRICO trial.

Cardiovascular diseases (CVDs) have many risk factors; few can be modified through health education. Traditional patient counselling methods fail to impact health behaviours to prevent or reduce the risk of CVDs. This study was conducted to estimate the effect of various risk communication methods on CVD risk reduction and medication adherence. An open-label superiority randomised control trial was conducted where 159 patients were randomised into three groups: Communication of 10-year Framingham CVD risk score, heart age, and routine care. Follow-up was done 3 months after recruitment. The primary outcome was a difference in excess 10-year Framingham CVD risk score in the end-line compared to baseline. The status of modifiable behavioural risk factors at baseline was expressed as 'yes' and 'no', and follow-up was defined as 'action', 'positive maintenance', 'negative maintenance', and 'defaulter'. The trial was registered with the Clinical Trials Registry India (CTRI NO. CTRI/2020/10/028614). The study setting was screening outpatient department (OPD), General Medicine OPD, and Cardiology OPD of a tertiary care hospital in Central India. Participants aged >30 years, residing in Bhopal for more than 6 months, diagnosed with hypertension or diabetes mellitus or both, and having any of the four CVD behavioural risk factors: tobacco use, alcohol use, physical inactivity, or unhealthy diet. Median excess 10-year Framingham CVD risk scores were 0.945% (CI: 1.275-4.297), -0.850% (-3.932-2.075), and -1.300% (-5.100-0.900) (10-year Framingham CVD risk score vs Heart age vs Routine care) and 0.000% (-3.125-5.925), -1.600% (-3.760-1.475), and -1.400% (-6.600-5.900) before and after intervention, respectively (P > 0.05). Positive maintenance was higher in both intervention groups concerning all modifiable behaviours, with a higher proportion reported in the 10-year Framingham risk score. The action phase was reported higher in intervention groups for medication adherence, addiction, and dietary changes. Systematic risk communication methods reduced the probability of contracting CVD in the future, though this finding was statistically insignificant.

Co-expression of ESBL, AmpC and MBL in Pseudomonas Isolates from a Tertiary Care Hospital in Central India

Co-expression of ESBL, AmpC and MBL in Pseudomonas Isolates from a Tertiary Care Hospital in Central India