Care Hospital In Central India Research Articles

Complete coverage and covering completely: Breast feeding and complementary feeding: Knowledge, attitude, and practices of mothers

BackgroundKnowing current trends for timely comprehensive action for health promotion practices is an important prerequisite for medical practitioners and policy makers. MethodsA survey of mothers at a Tertiary Care Hospital in central India. ResultsOn the knowledge front >83.75% of the mothers studied showed good knowledge about breastfeeding and complementary feeding. Similar, but not as encouraging, were the results about attitude, with 76.25% of mothers having a positive attitude. The results of the practices part were varied. The WHO indicators assessed were ‘early initiation of breastfeeding’ (68.75%), ‘exclusive breastfeeding under 6 months’ (85%) (however exclusive breast feeding for first 6 months was carried out by only 36.25%), ‘introduction of solid, semi-solid or soft foods’ (48.75%), ‘continued breastfeeding at 1 year’ (63.75%) and ‘continued breastfeeding at 2 years’ (6.25%). ConclusionsThere is a discrepancy between knowledge and practices. The exclusive breast feeding rates are far from the ideal and there is a decline of continued breast feeding beyond 15 months. This calls for sustained efforts with the aim – ‘cover all and cover completely’. The ideal WHO indicator for exclusive breast feeding should be ‘exclusive breastfeeding for first 6 months’ which will provide information about the completeness of this ideal practice.

Prevalence and risk factors of osteoporosis in Chronic Obstructive Pulmonary Disease (COPD) patients from Central India.

The prevalence of osteoporosis in patients with COPD is high and potentially essential. To study prevalence and various risk factors contributing to osteoporosis in COPD patients. The present study is prospective cross sectional study carried out on 80 stable COPD patients attending tertiary care hospital in central India. After taking written consent & detailed clinical history consisting questionnaire about the risk factors, spirometry was done to stage the severity of COPD. DEXA scan of whole body was performed using fan beam X-ray bone densitometer to determine osteoporosis. Chi-square test was used to determine the association between COPD and osteoporosis. Univariate logistic regression was used to analyze the risk factors for developing osteoporosis. In the present study, the overall prevalence of low BMD was found to be 92.5% in COPD patients showing equal prevalence (46.25%) for osteoporosis and osteopenia. The duration & severity of disease along with steroid intake were found to be risk factors of osteoporosis in univariate analysis with risk ratio of 1.32 (95% CI 1.06-1.64), 1.75 (1.11-2.75) and 1.40 (1.00-1.97) respectively (p value <0.05). The prevalence of low BMD was very high in COPD patients at a tertiary care hospital of central India. Duration & severity of disease along with steroid intake were found to be risk factor for osteoporosis in univariate analysis.

Clinico-Pathological Spectrum of Ophthalmic Lesions: An Experience in Tertiary Care Hospital of Central India.

Ophthalmic lesions show varied distribution on the basis of geographical location. Eye being a unique sensory organ needs to be studied both clinically and pathologically. This study was aimed to evaluate the histomorphological and clinico-pathlological spectrum of ophthalmic lesions at a tertiary care hospital of Central India. We reviewed all the ophthalmic biopsies performed in the Department of Pathology of our institute between January 2008 and November 2014. Total 488 biopsies of the orbito-ocular region were obtained from patients attending the ophthalmology department. Ophthalmic biopsies were studied as per epidemiological and histomorphological data. The patients ranged in age from one month to 85 years with bimodal distribution. With a male to female ratio of 1:1. Ophthalmic lesions were highest (44.8%) in less than 20 years age group. Eyelid (33.6%) was the most commonly involved site. Clinical diagnosis was consistent with histopathological diagnosis in approximately 76% cases. The non-neoplastic, benign and malignant lesions were 61.1%, 7.8% and 31.1% respectively. Retinoblastoma formed 40.1% of all malignant lesions followed by sebaceous carcinoma (19.1%) and Squamous Cell Carcinoma (SCC) (10.5%). Rare lesions were primary neuroblastoma of orbit and rhabdomyosarcoma of eyelid. Findings suggest that among neoplastic lesions the most common ophthalmic malignancies were retinoblastoma in children and sebaceous carcinoma in adults. Among non-neoplastic lesions, 89% cases of infectious aetiology were of rhinosporidiosis in our study making it an important differential diagnosis among ophthalmic lesions.

Clinicopathological spectrum of teratomas: An 8-year retrospective study from a tertiary care institute.

Teratomas are tumors that contain tissues derived from three different germ cell layers and having a wider range of differentiation with different site and age at presentation. The aim of the present study was to know the frequency of teratomas in various sites and to analyze their clinicomorphological features. The present study is a retrospective study conducted in tertiary care hospital of Central India. All the cases diagnosed as teratoma in the period of 8 years were included and studied with reference to age, sex, site, size, gross, and microscopic features. A total of 92 cases were retrieved. The most common teratoma was ovarian (78.26%) followed by intracranial/intraspinal and sacrococcygeal in frequency of 7.61% each. Out of 92 cases, 89 were mature and benign, 2 cases were immature teratoma each in ovary and in sacrococcyx, and 1 case of teratocarcinoma in testis. Teratomas have much diversity in their age at presentation, location, gross features, and in degree of differentiation. The prognosis and treatment also depends on the histological grading of teratomas. Thus, pathologists have an important role in establishing a reliable prognostic profile.

Brought Dead Cases in Tertiary Care Hospital in Central India.

Brought Dead Cases in Tertiary Care Hospital in Central India.

A prospective study of epidemiology and clinical presentation of non-traumatic acute abdomen cases in a tertiary care hospital of central India

Background:Acute Abdomen is a term used to encompass a spectrum of surgical, medical and gynecological conditions ranging from trivial to life threatening conditions, which require hospital admission, investigations and treatment. The purpose of this study was to identify the epidemiological pattern and to determine the spectrum of disease causing “non-traumatic acute abdomen in central India”.Methods: This is a prospective study of 98 patients of non-traumatic acute abdominal cases conducted in the Department of Surgery, Sri Aurobindo Medical College and PG Institute, Indore, Madhya Pradesh, India. In this study, preoperative detailed history and thorough physical examination was done for all acute abdominal emergencies, to arrive at pre-operative diagnosis.Results:Amongst the study of 98 patients, males have higher incidence of acute abdomen with the young age group (21-30 years) most commonly affected. Perforation peritonitis constituted the most common cause of acute abdomen (39.7%), followed by acute appendicitis (37.7%), followed by intestinal obstruction (14.2%).Conclusions: This study was conducted to evaluate the epidemiology, etiology and differential diagnosis of non-traumatic acute abdomen. At the end of the study, we had a better insight of the spectrum of the condition and we concluded that there is more scope for further work in the same field for better understanding of this topic.

A Study of Prescription Pattern of Antibiotics in Paediatric In-Patients at a tertiary care hospital in central India

Introduction:- Rational antibiotic prescription is very important to prevent antimicrobial resistance. Widespread use of antimicrobials has facilitated the development of resistance. Aim:- The study was to assess the use of antimicrobials in tertiary care hospital in central India Material and methods:- A retrospective analysis of 200 case sheets of paediatric inpatients was done using medical records. Data was analysed for average number of drugs prescribed, antimicrobials prescribed by generic name or brand name, percentage of antibiotics among the prescribed drugs etc Statistical tests:- Data was expressed as number, percentage and Mean+SD. Results:- In our study, we found out that mean age of paediatric patients was 5.6 yrs. Our results showed tendency of polypharmacy with maximum number of prescriptions were having 3 drugs (39%). 2 antibiotics were prescribed to 79% of the patients. Cefexime was most commonly prescribed antibiotic. 48.92% drugs were prescribed in generic name. 96% of antibiotics were prescribed by Parenteral route. Conclusion:- Antibiotic resistance is an emerging problem worldwide which can be controlled by rational prescription, Restricting the number of antimicrobial prescription and appropriate selection of the drug.

Profile of patients with severe chronic obstructive pulmonary disease in a tertiary care hospital in central India

Chronic obstructive pulmonary disease (COPD) is a public health problem. Tobacco smoking is the major cause, but not the only one. Air pollution, exposure to chemicals, environmental smoke exposure, and passive smoking are among other contributing causes; viral and bacterial infections also being risk factors. Gender and weight are associated with the severity of the disease. Co-morbidity is frequent. Objective: To characterize a population of COPD patients. Methods: Questionnaires were applied to patients with COPD. The data included gender, age, weight, body mass index (BMI), oxygen delivery users, and FEV1, exposure to tobacco smoke, exposure to wood smoke, history of tuberculosis and co-morbid diseases. Results: Of the 110 patients enrolled in the study, 70% (77) were men with an average age of 64 ± 10 years, average weight of 63 ± 16 kg and average BMI of 22 ± 5 kg/m 2. Mean FEV 1 was 35 ± 14% and 45.7% were oxygen dependent. Sixteen (17.6%) patients never smoked, while 16.3% had quit tobacco smoking). Eighteen (19.8%) were exposed to wood smoke. Eight (8.8%) patients had tuberculosis, Five (4.5%) complained of asthma symptoms, 2 (1.8%) had bronchiectasis, Thirteen (11.8%) diabetes mellitus, Sixty two (56.3%) hypertension, and Fourteen (12.7%) Corpulmonale. Conclusion: Other possible COPD etiologies must be investigated. Determinants of the pulmonary injury could be environmental smoke exposure associated to former infections. Men with low BMI are typically representative of this severe patient population. Hypertension and Cor Pulmonale are frequent co-morbidity factors.

Ceftriaxone induced anaphylaxis in a tertiary care hospital in central India

Anaphylaxis is a life threatening emergency condition which can be prevented by simple precautionary diagnostic test. Penicillin allergy can occur frequently and it shows cross resisistance with cephalosporins. Sensitivity test should be routinely performed before administration of the cephalosporins.

Screening of Nasal Carriage of Mupirocin Resistant Staphylococcus aureus among Health Care Providers of Tertiary Care Hospital in Central India

Introduction: Nasal carriage of Mupirocin resistant Staphylococcus aureus amongst Health Care Providers (HCP) is a matter of concern for Hospital acquired infection due to Methicillin resistant stains of S. aureus. CDC recommends use of Mupirocin for decolonization only in outbreaks or other high prevalence situations. This Cross-sectional Analytical study was carried out to assess the burden of Mupirocin resistance in nasal carriage isolates of Staphylococcus aureus in Health care providers form Tertiary care hospital in central India. Methods: Thirty non repetitive samples each from four groups of health care provider i.e. Consultants, Residents, Nursing staff & Cleaning Staff were collected after informed consent and ethical clearance. Samples from anterior nares were processed for isolation of S. aureus and screened for Methicillin resistance with MIC of Mupirocin. Data maintained in Microsoft office Excel was analyzed with statistical tools like tests of proportion & Chi Square test for significance. Results: Thirty five S. aureus strains were isolated of 120 samples collected of which 15 were MRSA. A total of 11 strains were found to be having High level Mupirocin resistant (MupH) of which 9 were Methicillin resistant while 2 were Methicillin sensitive. MupH strain colonization was more in Residents group but Low level Mupirocin Resistant was not found in any group. Statistically no difference was found between Clinical & Non Clinical Groups for MupH. Conclusion: MupH is on rise in MRSA as well as MSSA strains. Regular screening of HCP for nasal carriage of MRSA & use of Mupirocin only in outbreaks or critical areas in view of developing Mupirocin resistance is of prime importance. Key-words: Mupirocin resistance, Nasal colonization, MRSA, MIC, Health care provider, Hospital Acquired Infections Key Messages: The control and prevention of the infection ascribed to MRSA can only be achieved when there is a regular screening of carriers among healthcare provid

Pattern of refractive error in paediatric patients coming to rural tertiary care hospital of Central India

Background: Refractive error is a important cause of low vision in paediatric age group. If uncorrected it can lead to severe visual impairment in paediatric age group. Around 12.8 million children in age group range of 5-15 years have undiagnosed refractive error or under corrected refractive error. In India, refractive error as social health problem not yet defined. The untreated refractive error can cause amblyopia and poor school performance, which in long run can lead to financial and social loss for the rest of life. The purpose of the present study is to know the different types of refractive errors in a tertiary care rural hospital. Materials and methods: A cross sectional study to know the different types of refractive error in paediatric patients in a tertiary care rural hospital of central India from January 2015 to June 2015. The patients of birth to upto the age of 15 years were included. The patient particular were noted. The patient name, age, sex ,residence, visual acuity, refractive error were noted. Results: The total number of 848 patients enrolled in the present study from eye OPD of UPRIMS &R, Saifai, UP from January 2015 to June 2015. The age of patients ranges from birth to 15 years of age. Out of these refractive error is seen in 260 patients (31.37%, 168 male, 92 female). So, refractive error was the cause of hospital consultation in around 1/3rd of the patients.The most common refractive error noted was myopia in 160 patients (61.53%, 95 males, 65 females), followed by astigmatism in 40 patients (23.85%, 32 males, 6 females) and hypermetropia in 38 patients (14.61%, 32males, 6 females). The common age of presentation was from 11-15 years ( 130 patients, 50%), followed by 6-10 years age( 70 patients, 26.92%) and lastly less than 5 years age group (60 patients.23.08%). Conclusion: In India, refractive error as public health problem is not yet defined. The untreated refractive error can cause amblyopia and poor school performance, which in lon

Prevalence and Correlates of Metabolic Syndrome in Young Population: A Cross Sectional Study

Background: The Metabolic Syndrome (MS) is emerging as one of the major public health problem all over the world including India. It confers increased risk of Cardiovascular Disease (CVD) and Diabetes Mellitus (DM), both of which pose a huge burden over the society and economics. This study was conducted to assess the prevalence and correlates of MS in young population. Settings and design: A cross-sectional study was performed in Department of Medicine of a rural teaching tertiary care hospital in central India. Materials and methods: In all consecutive study subjects, a National Cholesterol Education Programme Adult Treatment Panel (NCEP ATP – III) criteria was applied to assess the magnitude of MS. Statistical analysis: Prevalence of MS was expressed in percentage. For determining the association of risk factors with MS, we used Student’s t-test to test for continuous variables Chi square for categorical variables and Fisher exact test in the case of small cell sizes (expected value<5). Association was considered statistical significant when P value was ≤ 0.05. Results: The magnitude of MS was 11.2%. Conclusion: Metabolic syndrome exists in significant number of young student population. The early identification of MS and associated risk factors can help to prevent or delay MS, diabetes and CVD by modifying their lifestyle.

Assessment of socio-demographic determinants of psychiatric patients attending psychiatry outpatient department of a tertiary care hospital of Central India

BACKGROUND: Mental disorders are among the most burdensome in the world, and their burden will increase over the next decades. The mental and behavioral disorders account for about 12% of the global burden of disease. By 2020, it is likely to increase to 15%. Depression, OCD, schizophrenia, anxiety, phobia and bipolar disorders constitute the top 10 conditions contributing to the global burden of disease among mainly the age group of 15-44 years. In India, little is known about the extent, severity and unmet need of treatment of mental disorders. The objective of the study was to assess the socio-demographic determinants of psychiatric patients. Methods: This was an observational cross sectional study which was undertaken in a psychiatric outpatient department (OPD) of a tertiary care hospital (S.G.M.H) affiliated to S. S. Medical College Rewa, MP, India. The total sample size was 108; it was collected randomly by face to face interviews with the help of pre-designed questionnaire based proforma. All new cases were selected in the study. Duration of study was three months i.e. from 1st November 2014 to 30 January 2015. Data were analysed by using EPI info 2000. Results: Out of total 108 interviewed patients, 59.25% were males 40.74% were female; most of them (45.37%) were belong to age group of 21-40 years. Mental disorders (78.70%) were more common in un-married or separated patients. In case of educational status most of them (87.96%), belong to low education status. Depression was most common mental illness 43 (39.81%) among of all types of disorders. Conclusions: As per the findings of the present study it can be concluded that there must be a kin observation for prevention and control of mental disorders over particularly low educational status group and unmarried/separated group of people hence mental disorders are more common among of those group. Infact we need more studies for validate our findings. Key words: Psychiatric illness, OPD, Patients Language: en

Study of referred cases in Obstetric and Gynecological practise at a tertiary care hospital in Central India

Background: Referral services for identification & referral of high risk pregnancies are an integral part of maternal and child health services. This study was aimed to incidence of referral cases of obstetrics/gynaecology analyze and to analyse the availability of adequate essential care for obstetric and gynaecological emergencies at health centers at periphery level. Methods: 156 consecutively referred cases at Sri Aurobindo Medical College and PGI, Indore from various peripheral and private hospitals were included in the study and prospectively analysed for the cause of obstetric/gynaecological treatment referral, treatment obtained before arrival, delays during various points of treatment. Results: Out of 156 cases studied, 118 cases (75.64%) were of obstetrics and 38 cases (24.35 %) were of gynaecology. Neonatal ICU care post delivery (n=28, 23.7%) was the most common cause of referral, followed by cases due to obstructed labour (n=27, 22.8 %). Out of 38 cases of gynaecology, maximum cases were of Ca Ovary (n=15, 39.4%), followed by those of uterire prolapsed (n= 14, 36%). Neonatal mortality in referred cases was observed in 8 cases, while obstetrics deaths were observed in 3 cases. Lack of facilities at peripheral health centre and lack of blood bank facilities were dominant reasons for referring the cases. Conclusion: In view of the above findings, there is need for social and clinical interventions to fill the gaps in the current referring practices, to strengthen and improve quality of services, infrastructure and availability of trained manpower at peripheral health centres. Key words: Referral cases, Obstetrics, Gynaecology, Obstructed labour

In vitro study of the antimicrobial property of Green tea extract against standard (ATCC) bacterial strains and clinical isolates of Methicillin Resistant Staphylococcus aureus &amp; Multidrug Resistant Pseudomonas aeruginosa

Objective: To evaluate the antimicrobial activity of Aqueous Green Tea extract against Standard ATCC Strains (Staphylococcus aureus ATCC 25923, Escherichia coli 25922, Pseudomonas aeruginosa 27853) & Clinical Isolates of Methicillin Resistant Staphylococcus aureus (MRSA) & Multidrug Resistant Pseudomonas aeruginosa (MDRPA). Methods: This Cross-sectional Analytical study was conducted in the Department of Microbiology of a Teaching Tertiary care hospital of Central India over a period of two months after obtaining Ethical clearance. Antimicrobial activity of green tea extract was determined by Agar well diffusion method. Results & Interpretation: The results of this study has shown that the aqueous extract of Green tea exhibits a potent antibacterial activity. Inhibition Zone diameter of green tea extract at lowest concentration (12.5 mg/ml) was 8mm, 10mm & 10mm respectively for ATCC strains of E.coli, Pseudomonas aeruginosa & Staphylococcus aureus. However at highest concentration (200mg/ml) it was 20mm, 22mm & 26mm respectively. Amongst six MRSA isolates tested aqueous green tea extract exhibited significant antibacterial activity against five isolates. Amongst six MDRPA isolates tested even at lowest concentration of 12.5 mg/ml aqueous green tea extract showed appreciable antimicrobial activity against four isolates. Conclusion: Aqueous extract of Green tea (Camellia sinensis) prepared by cold extraction method do have a significant antibacterial activity not only against standard ATCC bacterial strains but also against highly resistant clinical isolates of MRSA & MDRPA. Keywords: Camellia sinensis, Green Tea extract, Methicillin Resistant Staphylococcus aureus (MRSA), Multidrug Resistant Pseudomonas aeruginosa (MDRPA), Agar well diffusion, Inhibition zone diameter

Importance of identification of lactose nonfermenting Escherichia coli and their prevalence in urinary isolates

Introduction: Escherichia coli is one of the most common bacteria causing urinary tract infection. Accurate identification of urinary isolates is highly desirable and frequently challenging. Our study aims at identifying the “atypical” phenotype of E. coli by conventional, automated, and molecular methods and studying its prevalence among all the urinary isolates of E. coli. Materials and Methods: The present prospective study was conducted in the Department of Microbiology of a teaching tertiary care hospital of Central India for 6 months during the year 2014–2015. A total of 592 urine samples were processed. Identification of different urinary isolates was done by conventional and automated methods and by molecular method in special cases. Results: Two hundred and sixty-one uropathogens were isolated during the study. Among these, 110 (42.1%) isolates were E. coli, of which 4 (3.6%) isolates were confirmed as “atypical” E. coli by automated and molecular method. Conclusions: Our study highlights the challenges in the identification of atypical urinary isolates of E. coli. Accurate identification is essential for implicating proper antibiotic treatment.

Awareness of cervical cancer and Pap smear among nursing staff at a rural tertiary care hospital in Central India.

Cancer cervix is the leading cause of cancer deaths in females in developing countries and one in five women suffering from cervical cancer lives in India. The aim of this study is to determine the awareness about cervical cancer and Pap smear among nurses working in a tertiary care institute. Study Setting and Design: Cross-sectional survey in a tertiary care institute. Nurses working at our institute excluding those who have worked or working in the Obstetrics and Gynecology department were provided with a pre-designed questionnaire testing their knowledge about cervical cancer. Approximately, 86% were aware about cancer cervix and 69% were aware of a pre-cancerous stage. 42.3% were not aware of any risk factor and 27.6% were not aware of any symptom of cancer cervix. 86.2% were aware about Pap smear, but only 58.6% were aware that facilities of Pap smear were available at our hospital. Knowledge about cervical cancer and awareness of Pap smear as screening test was inadequate in nursing staff. Awareness programs about cervical cancer and screening are needed to increase awareness for this preventable condition. There is a need to arrange reorientation programs to sensitize nurses and establish cytology clinics to offer facilities for easily accessible and affordable screening.

Co-morbidities associated with Non Alcoholic Fatty Liver Disease in Tertiary Care Hospital of central India

Co-morbidities associated with Non Alcoholic Fatty Liver Disease in Tertiary Care Hospital of central India

Predicting the conversion of laparoscopic to open cholecystectomy: an experience in a tertiary care hospital of central India

Background: Laparoscopic cholecystectomy is the gold standard procedure for symptomatic cholelithiasis. However some laparoscopic cholecystectomies need to be converted into an open cholecystectomy for various reasons. So it will be very helpful if criteria can be developed for the prediction of difficult laparoscopic cholecystectomies. The objective of this study was to evaluate pre-operative risk factors amounting to the conversion of laparoscopic cholecystectomy into an open cholecystectomy. Methods: This is a prospective study in which 255 patients presenting with definitive diagnosis of cholelithiasis meeting the inclusion criteria, undergoing laparoscopic cholecystectomy were included in the study. Their demographic data, symptomatology and associated illness were documented. Results: Out of 255 patients 19 (7.4%) patients required conversion to open cholecystectomy. In converted group of patients, 73.33% patients were more than 50 years , 52.63% had BMI more than 30, 68.42% had >2 episodes of cholecystitis, 63.16% had leukocytosis, 68.42% had gallbladder wall thickness >3 mm, 63.16% had pericholecystic collection. Conclusions: Clinical and ultrasonographic factors can help to predict difficult laparoscopic cholecystectomy and likelihood of conversion of laparoscopic cholecystectomy to open surgery.

Diagnostic Accuracy of Fine Needle Aspiration Cytology in Benign and Malignant Breast Lesions

Background: Fine needle aspiration cytology (FNAC) or core biopsy form an integral component of the triple test which is being performed as a pre-operative test to evaluate breast lump. Aim: To study the cytomorphological pattern of breast lesions in a tertiary care hospital of Central India and to find out the accuracy of FNAC in diagnosing benign and malignant lesions of breast. Method: 200 patients presenting as breast lumps were evaluated by FNAC and correlated with histology. Result: Fibroadenoma was most common benign lesion while Infiltrating duct carcinoma was most common malignant lesion reported. Sensitivity of FNAC was 99.25% for benign lesions and 95% for malignant lesions. Specificity and PPV of FNAC in diagnosing benign lesions were 95% and 97.79% respectively while that for malignant cases were 99.25% and 98.27% respectively. The diagnostic accuracy of FNAC was 97.94% in the present study. Conclusion: FNAC serves as a rapid, economical and reliable tool for the evaluation of breast lumps. Key words: Fine needle aspiration cytology, Benign breast lesions, Malignant breast lesions, FNAC