Care Hospital In Central India Research Articles

Determinants of Maternal Mortality: In a Tertiary Care Hospital of Central India

Determinants of Maternal Mortality: In a Tertiary Care Hospital of Central India

Monitoring of adverse drug reactions in psychiatry outpatient department of a tertiary care hospital in Central India

Background: Adverse drug reactions (ADRs) are prevalent in patients taking psychotropic medications and can occur even at the normal doses used in the management of acute and maintenance phases of psychiatric disorders. Pharmacovigilance have cardinal role in alerting the healthcare providers from the possible ADRs and thus protecting the patients who are using psychotropic medications. To Monitor and estimate the incidence and nature of ADRs in psychiatry OPD of tertiary care hospital in central India and assess the causality, preventability and severity of documented ADRs.Methods: A prospective observational study was conducted in psychiatry out-patient department (OPD). Patients diagnosed with any psychiatric disorder and receiving psychotropic medications was included in the study. The recorded data were filled in the ADR form obtained from pharmacovigilance program of India (PvPI). Causality assessment was done using Naranjo scale and severity was assessed using Hartwig scale and preventability assessment using modified Schumock and Thornton’s scale.Results: The incidence rate of ADR was found to be 15.8%. A total of 61 ADRs were documented. Weight gain 14 (18.1%) followed by nausea 11 (14.2%) was the most commonly reported ADR. Atypical antipsychotics were the most common class of psychotropic drugs implicated in ADRs. Clonazepam 21 (27.2%) followed by amitriptyline 20 (25.9%) were associated with a maximum number of ADRs. Majority of the suspected ADRs were probable in nature (40.9%) followed by possible type (31%).Conclusions: Study revealed a moderate incidence of ADRs in patients attending the psychiatry OPD. Majority of the ADRs reported during the study were mild in nature and definitely preventable type.

Quality of Life in Children with Epilepsy

Abstract Objective The main aim of this study was to assess quality of life in children with epilepsy. Materials and Methods A prospective observational study was conducted in Regional Early Intervention Centre of the Department of Pediatrics Tertiary Care Hospital in central India. This study included 120 children with epilepsy aged between 2 and 18 years. In this study, we assessed the quality of life in children with epilepsy with the help of Pediatric Quality of Life Inventory (PedsQL). We further analyzed the quality of life in various dimensions. For the statistical analyses for SPSS version, 20 was used, chi-squared and Fisher's exact test was used for categorical variables, and Student's t-test was used for quantitative variables. Linear regression analysis was done for multivariate analysis. Result Mean total PedsQL score for total cohort was 70.96. The cognitive dimension of epileptic children was more affected than physical, social, and emotional dimensions. Factors associated with lower PedsQL scores in epilepsy patients were associated with long duration of epilepsy, polytherapy, male gender, low head circumference, presence of intellectual disability, and refractory epilepsy. Conclusion Epilepsy affects the quality of life in children across all age groups. Among epilepsy indicators, polytherapy, refractory epilepsy, and duration of epilepsy were the most important factors associated with poor quality of life. We can conclude that every effort should be made to decrease the duration of treatment and minimize the number of drugs for improving the quality of life in this patient cohort.

Follow up of growth, development and clinical outcome in neonates discharged from the NICU of tertiary care hospital in central India

Background: To assess the growth and neurodevelopmental outcome of all newborn discharged from the NICU of Netaji Subhash Chandra Bose Medical College, Jabalpur on follow up for 6 months.Methods: Prospective observational cohort study of 200 high risk newborn discharged from NICU. Babies were called for follow up at 1 month, 2 months, 4 month and 6 months of corrected age and detailed information was taken regarding NICU stay and morbidity with the help of data available from discharge card. Anthropometric parameters like weight, length, and head circumference were noted. Suitable screening tests like denver’s developmental screening test for Indian infants (DDSTII) for NDD (neurodevelopmental delay) and Amiel Tison scoring for tone assessment was done.Results: Among the 200 NICU graduates chosen, 40 lost during follow up. The neurodevelopmental delay in this study was 31.3%. Authors also analysed NDD according to gestational age wise groups. NDD in pre-terms was 39.6%. The developmental delay was more in babies with neonatal sepsis, perinatal asphyxia, prematurity, RDS, NEC etc.Conclusions: The morbidities like severe perinatal asphyxia, hypoglycaemia, seizures, shock, hypoxia, hypothermia, low gestational age have direct association with NDD.

Incidence and characterization of early- and late-onset skin diseases in neonates – A hospital-based cross-sectional study

Background: Neonatal skin diseases occur in almost every newborn baby. Many are transient, involute rapidly and require no management. Objective: The objective of the study was to study the incidence and characterization of early and late onset of various skin diseases in the neonates. Methods: A cross-sectional observational study was carried out among 200 neonates in a tertiary care hospital in Central India. Skin lesions which appeared on or before 48 h before birth were categorized as early onset and skin lesion appearing after 48 h were considered as late onset and the characteristics of lesions were highlighted. Results: The most common skin lesions identified within 48 h of birth were Epstein pearl’s (77.0%), followed by Mongolian spot (45.5%), desquamation of skin (35%), sebaceous gland hypertrophy (31.5%), and milia (28.4%), respectively. Less incidence of salmon patch, erythema toxicum neonatorum, impetigo, miliaria rubra, accessory auricles, pigmented nevi, port-wine stain, and lamellar ichthyosis also was recorded. Impetigo (11.2%) and candidiasis (11.2%) were commonly seen after 48 h of birth followed by dermatitis 6.4% and a few cases of birthmarks. Conclusion: Along with increasing awareness of neonatal diseases, our study results also aid in better identification and diagnosis of these diseases.

Incremental Prognostic Value of Anemia in Acute Coronary Syndrome from A Rural Hospital in India.

Background:Anemia is highly prevalent in low- and middle-income countries, where prevalence of acute coronary syndrome (ACS) is also rising. Evidence indicates that baseline anemia status can prognosticate ACS. However, the Global Registry of Acute Coronary Events (GRACE) score that is popularly used all over the world does not include information on anemia.Objectives:Our objective was to investigate if anemia at admission, along with the GRACE score, improves the prediction of adverse outcomes within 6 months in rural Indian patients of ACS.Methods:We enrolled 200 ACS patients at the Acharya Vinoba Bhave Rural Hospital—a rural, tertiary care hospital in central India. Patients were followed for 6 months for death and major adverse cardiac event (MACE). Improvement in the prediction of adverse events by including anemia in addition to the GRACE score was quantified using area under the receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI) and the net reclassification index (NRI).Results:There were 31 deaths due to MACE and an additional 28 non-fatal MACE events during follow-up. Baseline hemoglobin was strongly and independently associated with both outcomes even after adjusting for a multivariable propensity score. For the outcome of death and death/MACE there was a moderate improvement in the AUC of 1% and 6%, respectively. However, for these outcomes the IDI for baseline hemoglobin was 6% (p = 0.03) and 12% (p << 0.0001), respectively, while the NRI was 0.50 (p = 0.01) and 0.78 (p << 0.0001), respectively.Conclusions:Inclusion of baseline anemia in addition to the GRACE score improves prognostication of ACS patients.

Impact of Educational Intervention on Knowledge, Attitudes, and Practices of Laboratory Technicians regarding Universal Work Precautions at a Tertiary Health Care Center in Central India

Introduction: Laboratory technicians are routinely exposed to occupational health hazards that can be a serious threat to their health. To safeguard themselves against laboratory-acquired infections, they must be aware of universal work precautions. A targeted educational intervention to increase awareness about universal precautions was designed to result in behavioral changes in attitudes and practices to help reduce the incidence of laboratory-acquired infections. This study was planned to assess the preexisting levels of knowledge, attitudes, and practices of laboratory technicians regarding universal work precautions at a tertiary care hospital in central India and to evaluate the effectiveness of educational interventions on the same. Method: The 40 lab technicians participating in the study were subjected to educational interventions in the form of training on universal precautions. Pretest and posttest evaluations using questionnaires were conducted to evaluate the learning gain. Pretest and posttest responses to each question were compared using the Pearson chi-square test. The subjects’ mean pretest and posttest scores were compared using paired t tests, and the significance level was set at .05. Results: There was remarkably significant improvement in knowledge, attitudes, and practices of laboratory technicians regarding universal work precautions after the educational intervention/training sessions. Conclusion: On the basis of the findings, it was suggested that such training sessions should be conducted regularly for laboratory technicians to help in better retention of knowledge and to instill a positive attitude toward universal precautions.

Assessment of blood donor selection and deferral pattern in a tertiary care hospital in Central India

Introduction:Safety and efficacy of blood donations depends on selection of suitable donors. Understanding the prevalent reasons of non-suitability of donors can help understanding the donor pool demographics to develop better donor recruitment and screening strategies. Material and Methods: This is across sectional retrospective study conducted in a tertiary care hospital in central India over a period of two years from January 2017 to December 2018. The donor registry from in hospital donation as well as the blood donation camps were analyzed for the pattern of deferral. Results: Total 18,025 people donated blood during the study period. During this period the number of deferrals was 681. The overall deferral rate was 3.77%.Males constituted the majority of donors (17586, 97.56%), and expectedly majority of deferrals were in males (626, 3.47%). The most common reason of temporary deferral in donors was recent alcohol intake is 197(28.93%) potential donors which was exclusively in the males. The most common reason of permanent deferral was hypertension (59, 8.66%). The common reason for deferral among deferred females was low hemoglobin (26, 47.27%) and that in deferred males was alcohol intake (197, 31.46%). Conclusion: Donor deferral is essential to ensure the safety of both the donor and recipient of the blood; however, it can also lead to non-return of temporarily deferred donors. A pattern and trend in donor deferral could be used as a reference for developing policy and future initiatives in donor education, encouragement and retention.

Seroprevalence and trends in transfusion transmitted infections in blood donors: a 6-year experience in a tertiary care hospital

Introduction: Blood transfusion continues to be a possible source of pathogens in transfused patients. The pattern of transfusion-transmitted infections (TTI) varies between regions. Knowledge of prevalence of TTIs is essential to monitor safety of blood transfusion by ensuring better practices of collection and processing of blood components. The aim of the study was to determine the prevalence of TTI in blood donors in a tertiary care hospital in central India. Materials and Methods: A retrospective cross sectional study was performed from 2012 to 2017 in a tertiary care government hospital in central region of India. The study analyzes all voluntary and replacement blood donations received through the hospital in its blood bank and blood donation camps organized by the hospital. Results:A total of 54,831 units of blood was collected over a period of 6 years. Prevalence of TTI in the blood donors was 1.45%. Prevalence of seroprevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis and malaria were 0.31 %, 0.75%, 0.065%, 0.22% and 0.1% respectively. Among all the potential donors, the most common TTI prevalence was that of Hepatitis B followed by HIV and syphilis. Conclusion:Public awareness, careful donor selection,vigilant screening and adoption of newer techniques for inactivation of pathogens are needed to ensure safety of blood products and their transfusion.The public outreach programs such as blood donation camps could be used as a way of spreading awareness to improve the safety and efficacy of a blood donation program.

Knowledge, attitude, and practice of adverse drug reaction, and adverse drug reaction reporting among practising dermatologists in Maharashtra: A questionnaire-based survey

Introduction: Adverse drug reactions (ADRs) are common in a dermatological practice. Underreporting of ADR is a concern for dermatologists across the world. Aim: This survey aims to assess the attitudes and current reporting practices of ADRs and to understand possible causes for underreporting of ADRs amongst practising dermatologists of Maharashtra This will help to better understand, which steps will be effective to increase the reporting of ADRs. Study Design: Descriptive cross sectional questionnaire based study. Materials and Methods: The descriptive cross sectional questionnaire based study was conducted in Department of Dermatology of tertiary care hospital in central India from a period of April 2017 to September 2018.The target population was all practising dermatologists across Maharashtra. All practising dermatologists willing to participate in the survey were included while postgraduate students in dermatology and other fields, those not willing to participate in the study, doctors of non-allopathic disciplines practicing dermatology were excluded. Results: A total of 49% of the surveyed dermatologists see cases of ADRs often in their practice. Of these, the most common cutaneous adverse reaction is to topical corticosteroids. 30% of surveyed dermatologists had heard of the ADR reporting system but did not know how it is done while 27% had reported ADRs. Conclusion: The current trend of underreporting of ADRs is alarming as many dermatologists are not even aware that ADR in their practice needs to be reported.

Effect of artificial sweeteners on insulin resistance among type-2 diabetes mellitus patients.

Introduction:Incidence of diabetes mellitus has increased over the past few years, mainly due to our eating habits and physical inactivity. This also includes the use of artificial sweetening agents which have broadly replaced other forms of sugars and have shown a paradoxical, negative effect on blood glucose. Ingestion of these artificial sweeteners (AS) results in the release of insulin from pancreas which is mistaken for glucose (due to their sweet taste). This increases the levels of insulin in blood eventually leading to decreased receptor activity due to insulin resistance.Methodology:It is a crosssectional study that was conducted on patients diagnosed with type-2 diabetes mellitus of a tertiary care hospital in Central India. All the diabetics that presented in the OPD were divided into 2 groups based on whether they use AS (group A) or not (group B). Insulin resistance was calculated for each group using HOMA-IR and graphs were plotted.Results:The HOMAIR values for Group A and B ranged from 0.9–24.33 and 0.12–10.83 with mean values 7.39 and 2.6, respectively, showing that the ones who used AS had a higher insulin resistance. The study also showed that the duration of use of artificial sweeteners had a direct impact on insulin resistance.

Practice patterns in the management of congestive heart failure and post-discharge quality of life: A hospital-based cross-sectional study.

Objective:The objective of the study is to identify the etiology, risk factors, frequency of major and minor components of the Framingham criteria for heart failure, discharge medications, mortality, and quality of life after discharge from the hospital, for patients who were admitted to the in-patient unit of a tertiary care hospital in central India, with a diagnosis of congestive heart failure (CHF).Methods:This hospital-based cross-sectional study involved retrospective chart review of patients who were admitted to the in-patient unit with a diagnosis of CHF. These patients were then attempted to reach via their telephone numbers listed in the medical records and their current quality of life was assessed using Euro-QoL 5D questionnaire.Results:In the 69 patients who were admitted to the hospital with congestive cardiac failure during the pre-defined period, ischemic heart disease was the most common etiology and smoking was the most common risk factor for the development of CHF. The most common findings based on Framingham criteria were dyspnea on mild exertion, rales and bilateral ankle edema. It was determined that one-fourth of the individuals were non-compliant to the medical treatment and more than half of the patients had a poor health score.Conclusion:Smoking remains to be a major risk factor for patients to develop ischemic heart disease and subsequent CHF. Patients with congestive cardiac failure also had severe deterioration in their quality of life after discharge from the hospital, implying the need for improving efforts toward prevention and better management.

A Clinicohistopathological Correlation of Hansen's Disease in a Rural Tertiary Care Hospital of Central India.

Background:Leprosy is an ancient, chronic granulomatous infectious disease caused by Mycobacterium leprae, principally affecting the skin and peripheral nerves. The clinical manifestations of leprosy are variable and can mimic a variety of other skin diseases. Thus, histopathological examination plays an important role in early diagnosis and management.Aim:The aim was to study the clinicohistopathological correlation of all suspected cases of Hansen's disease.Materials and Methods:A retrospective study was conducted on 207 skin biopsies obtained from patients clinically diagnosed as new lesion of leprosy in the department of pathology from 2016 to 2019. Demographic, clinical details of the patients were retrieved from hospital information system. Hematoxylin–eosin- and Fite–Faraco-stained sections were evaluated for features confirming leprosy and further categorized as per Ridley–Jopling system. Sensitivity, specificity, and concordance rates were studied.Results:The male-to-female ratio was 1.5:1. The agreement between histopathological and clinical diagnoses was more than 90% in all the subclasses except for borderline tuberculoid leprosy (BT) and tuberculoid leprosy (TT) which showed an agreement of 86.5% and 88.4%, respectively. The sensitivity of clinical diagnosis ranged from 69.70% for indeterminate to 100% for histoid and neuritic types. The specificity ranged from 90% for BT and TT to 100% for neuritic leprosy.Conclusion:Clinical diagnosis of early leprosy lesions offers difficulties even to experienced dermatologists as a patient presents in different clinicopathological forms, depending on host immune status. Thus, the correlation between clinical, histopathological, and bacteriological features is required for diagnosis and classification of leprosy. Nerve damage is irreversible; therefore, early detection and treatment is important to prevent Grade 2 disabilities.

Spectrum of ovarian masses at a tertiary care hospital of Central India

Background: Carcinoma of the ovary is among the most common cancers in the world. It is also a significant cause of mortality. The present study was initiated to analyze ovarian tumors with respect to age, presentation, diagnosis, and treatment, and to correlate the duration of symptoms and stage of disease. Materials and Methods: The present study was a retrospective observational study, done at NKP Salve Institute of Medical Sciences, Nagpur, Maharashtra. The study duration was of 10 months, carried out from July 2018 to April 2019. The total sample size for the present study was fifty. Results: In the present study population, out of the total ovarian masses, 52% had neoplastic and 48% had nonneoplastic ovarian masses. Majorly affected age group was 36–45 years, which comprised 26% of the nonneoplastic and 20% of the neoplastic masses, including 10% each of benign and malignant masses. On analyzing the malignant ovarian masses, it was found that serous cystadenocarcinoma/surface epithelial tumor was most commonly encountered, accounting for 70% of the total malignant ovarian masses. Conclusion: Epidemiological studies analyzing economically feasible screening tools should be identified, which will help screen risky population, to detect the disease at early stage and improve the prognosis.

Our experience with gastrointestinal stromal tumors at tertiary care hospital in central India: A retrospective observational study

Gastrointestinal stromal tumors (GISTs) are the commonest mesenchymal tumor of gastrointestinal tract. Commonly found in Stomach and Small intestine, may present as E GIST. A case series of 30 patients over a period of 3 years managed at Government medical college and hospital. A Retrospective study of the GIST cases. Around 30 patients who were diagnosed having GIST, there records were compiled. Data analysis of all patients in terms of demographics, clinical presentation, location of the tumor, management has been done. Presented with varied complaints such as pain in abdomen, lump in abdomen, upper/lower GI bleeding, weight loss, obstruction perforation, hematuria and retention of urine depending upon the site involved. Sites involved were small bowel (16), Stomach (10), Colon (1), Rectosigmoid (1), retroperitoneum (1) and omentum (1). Half the cases took imatinib including neoadjuvant and post operative cases and rest lost to follow up. Surgery being the main stay of treatment.

Awareness and knowledge of diabetes mellitus in rural population visiting a tertiary care hospital of Central India

The worldwide prevalence of Diabetes mellitus (DM) has risen dramatically in developing countries over the past 2 decades reaching level of almost 70% of all cases. The ICMR-INDIAN Diabetes study showed that by 2030 projected No. of people with DM will be around 101.2million. This study focuses on the level of awareness and knowledge about DM in the general rural population of central India by using a pre-validated questionnaire. A cross-sectional study was conducted in the rural population of central India in a tertiary care hospital of central India. The duration of study was of 2 months. A total of 200 individuals whose aged above 20 years were screened by using a pre-validated questionnaire regarding awareness and knowledge of DM, associated risk factors, complications and it’s relation to pregnancy (Gestational Diabetes mellitus-GDM). 84% of the population reported that they knew about diabetes, 58.5% population knew that it could causes complications while 65.5% of the populations were aware of the fact that it is preventable and also its preventive factors. The questions related to DM and pregnancy revealed that 50% of the population was not aware of its complications in pregnancy, its effect on later life and on the children born to diabetic mother. This study reveals that knowledge about the basic understanding of DM (like its incidence, symptoms and its prevention) is quite satisfactory: but there is lack of awareness about the complications of diabetes and its effect on pregnancy and children born to diabetic mother. This emphasizes the need for carrying out awareness programs down to masses in rural area. Keywords: Diabetes mellitus, Gestational diabetes mellitus (GDM), Awareness, Rural population, Complication.

Bacterial profile and antimicrobial susceptibility pattern of asymptomatic urinary tract infections among pregnant women attending antenatal clinic at tertiary care hospital in central India

Bacterial profile and antimicrobial susceptibility pattern of asymptomatic urinary tract infections among pregnant women attending antenatal clinic at tertiary care hospital in central India

Viral hepatitis among acute hepatitis patients attending tertiary care hospital in central India.

Viral hepatitis is a considerable public health burden affecting millions of people throughout the world. The incidence of viral hepatitis varies greatly depending upon geographic locations, age and gender. Exploring the etiological spectrum and clinic-epidemiological profile of acute viral hepatitis (AVH) becomes essential for strategizing the preventive measures to control the diseases. An epidemiological data depicting AVH situation and its etiologies is missing from central India. With the aim of fulfilling this lacuna, the present analysis was done on samples tested over a period of 2years from July 2015 to June 2017. Of the 1901 hepatitis cases, 597 individuals (31.4%) were positive for AVH infection and HEV was the predominant cause followed by HBV, HAV and HCV. Co-infections of hepatitis viruses were detected in 42 cases. Co-infection of HEV with HBV was the commonest pattern. Male preponderance was observed among AVH positive cases and the age group of 26-45years was the most susceptible to the viral hepatitis infections, except hepatitis A, which was the most frequent among children. Two hundred patients (33.45%) required hospitalization and 51 deaths were attributed to AVH infections. The analysis for the first time reports intricacies and viral etiologies of AVH in central India. Regular diagnosis of AVH etiology and monitoring of cases will help in patient management and assist disease control programs to take policy decisions.

A rare case of blood stream infection due to Candida ciferii in an immuno-compromised patient

Invasive infections related to yeast are increasingly observed in immune-compromised patients in hospitals.Fungal infections have increased morbidity and mortality and prolonged hospital stay which can lead to rise in medical care costs. Non-albicans Candida species have been increasingly found as causative agents in human infections with important therapeutic implications. We present a case of a 37-year-old, female patient, known case of B cell Acute Lymphoblastic Leukaemia admitted in a tertiary care hospital in central India for supportive care and chemotherapy. Patient was responding well to chemotherapy. On post induction day 20, she complained of high-grade fever with abdominal pain.Two sets of blood culture were sent to Microbiology Diagnostic Laboratory for diagnosis. She was started on Injection Magnex Forte (Cefoperazone-Sulbactum) empirically.The Gram stain of positive blood culture showed Gram positive budding yeast like cells in all four bottles.The organism was identified as C. ciferrii on Vitek 2 with 95% identification.Antibiotic susceptibility testing showed sensitive to Amphotericin B MIC ≤0.25 and voriconazole MIC ≤0.12. It was resistant to fluconazole MIC ≥64 μg/ml.

Low-Dose Paclitaxel-Coated Balloon Angioplasty versus Uncoated Percutaneous Transluminal Balloon Angioplasty for Femoropopliteal Peripheral Artery Disease: 6-Month Results in a Tertiary Care Hospital of Central India

Abstract Introduction Superficial femoral and popliteal arteries are the most common locations of peripheral vascular disease (PVD). Endovascular interventional therapy including drug-coated balloon (DEB) angioplasty or percutaneous transluminal angioplasty (PTA) and stenting are important options for treatment of PVD. Aims and Objectives The main objective is to compare the efficacy of DEB over PTA with optional stenting in management of obstructive femoropopliteal lesions in terms of 6-month patency rate. Materials and Methods The clinical experimental study was carried out in a tertiary care center over duration of 2 years. All symptomatic patients having lower limb PVD in femoropopliteal segment were included. Total 37 patients were included in this study in which 16 underwent plain balloon angioplasty (with 3 patients undergoing bare metal stenting [BMS]) and 21 additional underwent DEB angioplasty. Patients with previously intervened lesions, primary lesion failure, major ischemic tissue loss, poor aortoiliac or common femoral inflow, or end-stage kidney disorders were excluded. Result At 1-month follow-up, patency rates in DEB and conventional PTA ± BMS were 85.71% and 87.5%, respectively. On 6-month follow-up, patency rates were found to be 71.4% versus 37.5%, respectively (p = 0.039; significant). In case of occluded lesions, on 6-month follow-up, patency rate in DEB group was higher than that in plain balloon group (66.7% vs. 25%). In both the cohorts, success rate, i.e., patency rates were more in short and intermediate length lesions than long segment lesions. DEB was found to be superior to plain angioplasty with optional stenting in terms of 6-month patency rate.