Care Hospital In Northern India Research Articles

Prevalence and correlates of relapse in adult male patients with alcohol dependence: a cross sectional study conducted in a tertiary care hospital in Northern India

Background: Relapse to alcohol dependence after successful detoxification and rehabilitation is a public health concern worldwide. Although the burden of alcohol dependence is massive in the Indian subcontinent, very little is known about the causes of relapse among patients treated for alcohol abuse. Hence, this study was designed to evaluate the prevalence and factors associated with relapse in patients of alcohol dependence disorder.Methods: 50 male patients diagnosed with alcohol dependence (according to ICD-10 criteria) who attended both in-patient and out-patient outpatient department (OPD) of a tertiary care hospital were included in our study. Severity of Alcohol Dependence Questionnaire (SADQ) for severity of alcohol dependence, Presumptive Stressful Life Events Scales (PSLES) and relapse precipitant inventory were used for correlation of factors responsible for relapse amongst these alcohol abusers after informed consent and acquiring socio-demographic details.Results: Out of 50 patients enrolled in the study as per the International Classification of Diseases 10th revision Diagnostic Criteria for Research (ICD-10 DCR), a majority (92%) were Hindus, 60% belonging to the rural background. Family history of alcohol dependence was found to be present among 46% patients, and a majority had moderate to severe alcohol dependence. Craving for alcohol was found to be the most common cause of relapse amongst these, and 72% patients showed moderate to severe stress on the PSLES scale.Conclusions: Alcohol consumption is emerging as a major public health problem in India. Regular follow up with family, peer and social support are essential along with vocational rehabilitation to prevent relapse. Multi-centric scientific community-based research studies have to be conducted in various individual states to understand the problem better. There is a dire need for various policymakers, media, professionals and society to come together and create awareness about the consequences of chronic alcohol through sensitization programmes and health education campaigns.

Exploring knowledge, attitude and practice regarding yoga among patients attending cardiology and neurology clinics in a tertiary care hospital in northern India

Background The use of complementary and alternative medicine, particularly yoga is increasing in non-communicable diseases (NCDs). We assessed the overall awareness regarding yoga among patients and their opinion about it as an adjunct therapy for NCDs. Methods We included 384 patients attending the cardiology and neurology clinics at a tertiary care centre in northern India. A questionnaire was developed to assess the knowledge, attitude and practice of yoga as a therapy. Results Ninety per cent of patients were aware of yoga, mainly through print and electronic media. Of the surveyed patients, 22% practised yoga. Lack of time and knowledge were cited as the main reasons for non-practice among the non-practising patients (88%), of which 82% believed that yoga could be practised along with modern medicine. In addition, 61% were ready to accept treatment if offered at the surveyed tertiary care centre. Conclusions Adequate knowledge, awareness and attitude towards yoga appears to be present in contrast to the low practice among the patient population surveyed. If implemented in an integrated fashion, the patients were willing to accept yoga as an adjunct therapy for their cardiac and neurological disorders-an encouraging sign given the burden of NCDs in India.

Serum kallistatin as a marker of severity of liver fibrosis in cirrhosis: A cross-sectional observational study.

ABSTRACTBackground:Liver cirrhosis is among the leading causes of morbidity and mortality worldwide. Although liver biopsy is the gold standard for the assessment of liver fibrosis in cirrhosis, it has its own limitations. Therefore, noninvasive methods to detect liver fibrosis are widely preferred. However, they also have their own limitations. Thus, there is always a need to extend the battery of serum-based assays. Kallistatin is a protein synthesized primarily in the liver. As it is a negative acute-phase protein, its blood level decreases with a decline in liver function. In our study, we explored the relationship between serum kallistatin and radiological evidence of liver fibrosis by transient elastography to determine if kallistatin levels can be used as a diagnostic marker of liver fibrosis.Materials and Methods:A cross-sectional study of 1-year duration was conducted at a leading tertiary care hospital in northern India. Patients between 15 and 75 years of age having evidence of chronic liver disease were enrolled. All enrolled patients were evaluated by detailed history, physical examination, and relevant investigations. Serum kallistatin levels were quantified using the ELISA method. Grading of liver fibrosis was done using transient elastography. A FibroScan scoring card was used to convert FibroScan results measured in kPa into the Metavir scale F1–F4Results:A total of 128 subjects, including 64 patients with cirrhosis and 64 healthy controls, were enrolled. Our study suggested that FibroScan values were significantly higher in cases as compared to controls. The kallistatin level of cases was significantly lower than that of controls. An inverse correlation was found between FibroScan value and kallistatin level among casesConclusion:We conclude that serum kallistatin levels are low in patients with liver fibrosis and can be used as a potential marker of liver fibrosis.

Severity of Vitamin D Deficiency in Children with Nephrotic Syndrome: A Study from Tertiary Care Center in Northern India.

In nephrotic syndrome (NS) due to podocytopathies, loss of vitamin D binding globulin along with albumin in urine leads to Vitamin D deficient state. We aimed to study the severity of vitamin D deficiency and its clinical correlation in children with NS. We performed a cross-sectional study at a tertiary care hospital in Northern India. Enrolment of children aged 1-18 years was done. Patient's detailed history, numbers of relapse, treatment details, and data regarding various immunomodulatory drugs treatment. Vitamin D level was estimated, and its status was further classified as deficiency <20 ng/mL and insufficiency 20-30 ng/mL as per Global Consensus Recommendations on evaluation, treatment, and prevention of vitamin D deficiency. Continuous variables were compared using tests such as unpaired t-test, Kruskal-Wallis test, and Wilcoxon rank sum test depending on the distribution of parameters. Categorical variables were compared using Chi-squared tests or Fisher's exact test. A total of 96 children with NS were screened, of which 77.1% had vitamin D deficiency. The mean serum vitamin D level was 14.393 ± 8.52 ng/mL. Among the 48 children of the first episode of NS 36 were deficient (36/48 = 75%). Whereas in the relapse category, 30 patients had infrequently relapsing NS (deficient 24/30 = 80%). Eleven children had frequently relapsing NS; among them, 10 were vitamin D deficient (10/11 = 90.9%), and there was a negative correlation between vitamin D level and duration of illness. Vitamin D deficiency is a common comorbidity in children with NS. Given the putative immunomodulatory property of vitamin D, this deficiency should be identified and treated routinely in all cases of NS.

Microbial contamination on mobile phones of health-care workers at a tertiary care hospital of Northern India

Background: The use of mobile phones (MPs) in hospital halls, laboratories, intensive care units, and operating rooms is a common practice. There are no proper guidelines for the disinfection of MPs that meet hospital standards. This study investigated the bacterial contamination on MPs of health-care workers employed in tertiary healthcare Sher-i-Kashmir Institute of Medical Sciences (SKIMS) Srinagar, Jammu and Kashmir.” Materials and Methods: One-hundred and fifty-five health-care workers (57 doctors, 50 nurses, 35 technical staff, and 21 other employees) were included in a cross-sectional study performed from January 2018 to June 2018 at the SKIMS, Srinagar, Jammu and Kashmir. Social demographic characteristics (such as gender and occupation) and cell phone-related questions were gathered through a self-administered questionnaire (e.g., frequency of MP disinfection and use of the MP at work). Sample collection and processing were done correctly to avoid any bias. Results: Majority (79%) were working in different wards of the institute, followed by (51%) working in different laboratories and (8%) working in intensive care settings. The majority of the participants (42%) said they used their phone less than ten times per day; 33% said they used it 10–20 times/day. In terms of disinfection, 107 (69%) of the participants cleaned their MP occasionally, 31 (20%) never cleansed their phone, and just 17 (11%) regularly disinfected their phone. Out of 155 MPs sampled, 125 (80.6%) showed microbial growth, and 30 (19.4%) were free of microbial growth. Out of the total 125 positive samples, 51 (40.8%) were Gram-positive bacilli (which was considered as airborne contamination), 36 (28.8%) were Gram-positive cocci (GPC), 25 (20%) Gram-negative bacilli, 11 (8.8%) were mixed growth, and 2 (1.6%) were yeasts. Out of 36 GPC, Staphylococcus aureus was predominant, i.e., 15 (41.6%), followed by Enterococcus spp. 12 (33.3%), Coagulase-negative Staphylococci spp. 7 (19.4%), and Streptococci spp. 2 (5.5%). Conclusion: Almost all MPs were contaminated, with more than half of them harboring pathogenic microorganisms. It could pose a significant risk to both health-care personnel and patients in the form of nosocomial infections.

Antifungal Susceptibility Testing of Five Antifungal Agents against Clinically Isolated Dermatophytes Species from a Tertiary Care Hospital in Northern India

Introduction: Dermatophytosis form approximately 15-75% of all the mycological infections. Dermatophytes are closely related keratinolytic fungi with ability to degrade keratin and invade the skin, hair and nails causing dermatophytosis. Aim: To evaluate the Minimum Inhibitory Concentration (MIC) of antifungal drug against the isolated dermatophytes by broth microdilution method. Materials and Methods: The present cross-sectional study was conducted in the Department of Microbiology, Muzaffarnagar Medical College, Muzaffarnagar, Uttar Pradesh, India. The duration of the study was August 2018-August 2020. A 10-20% KOH mount was prepared from the skin scrapings, nail clippings, and hair bits to look for fungal elements. The specimens were also inoculated on Mycosel media and Sabouraud Dextrose Agar (SDA) with chloramphenicol. The dermatophytes were identified on the basis of colony characteristics, Lacto Phenol Cotton Blue (LPCB) mount, nutritional requirement, temperature tolerance, urease production, and in-vitro hair perforation test. Antifungal susceptibility testing was done for all fungal isolates and performed by broth microdilution method. The descriptive statistics were reported as means with their Standard Deviation (SD). Data were statistically evaluated with International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) Statistics for Mac, Version 25.0., IBM Corp., Chicago IL. Results: In this study, the MIC range for all the 165 isolates for dermatophytes tested for antifungal susceptibility showed that itraconazole, terbinafine and voriconazole showed the lowest MIC range of 0.0019-0.5 μg/mL followed by griseofulvin and fluconazole at MIC range of 0.125-32 μg/mL. The MIC50 of itraconazole and terbinafine was seen lowest at 0.0313 μg/mL followed by voriconazole at 0.0625 μg/mL, griseofulvin at 0.25 μg/mL for all isolated dermatophytes. Highest MIC50 with 4 μg/ mL was found for fluconazole against T. mentagrophytes and T. violaceum. MIC90 of terbinafine, itraconazole and voriconazole was seen lowest at 0.25 μg/mL followed by griseofulvin at 1 μg/ mL for all isolated dermatophytes. Highest MIC90 of fluconazole was recorded at 16 μg/mL for all isolated dermatophytes. Conclusion: Highest MIC50 with 8 μg/mL was found for fluconazole against all isolated dermatophytes. MIC90 of terbinafine, itraconazole and voriconazole was seen lowest at 0.25 μg/mL followed by gresiofulvin at 1 μg/mL for all isolated dermatophytes. Highest MIC90 of fluconazole was recorded at 16 μg/mL for all isolated dermatophytes.

Patient Satisfaction Among the OPD Attendees at a Secondary Care Hospital in Northern India.

Patient satisfaction reflects the quality and effectiveness of healthcare. Healthcare services have become more patient-centric in today’s era as patients are viewed as active consumers of healthcare services rather than passive recipients. Measuring patient satisfaction level has become an objective criterion for defining the effectiveness of these services. Feedback from patients makes healthcare services more responsive to the expectations of patients. We conducted a cross-sectional study among 200 OPD attendees of a secondary-care hospital to assess the level of satisfaction. A 5-point Likert scale was used to record the responses. For overall satisfaction with the OPD services, most common responses were “good” or “very-good”, with mean (SD) score of 3.8 (0.77). Majority of the patients were satisfied with facilities such as drinking water and toilets, and with consultation time provided by the doctors. The patients were not satisfied with the time taken at the registration window and behavior of other hospital employees. This highlights the importance of reorientation training on communication and interpersonal skills for all categories of healthcare staff.

Analysis of clinical presentation, biochemical profile, and management of liver abscess in North India

<br><b>Objectives:</b> Liver abscess is a common disease in tropics with high morbidity and mortality if left untreated. It is quite prevalent among low socioeconomic population. In this study, we have analyzed the clinical and biochemical profile with management options for cases of liver abscess presented at a tertiary care hospital of Northern India.<br><b>Materials and Methods:</b> This was an observational prospective study conducted at Santosh Medical College and Hospital from March 2019 to March 2021. All patients underwent extensive clinical, biochemical evaluation and radiological examination, followed by treatment as per reports and requirement. All results were formulated in tabular form and analyzed accordingly.<br><b>Results:</b> Liver abscess is commonly seen in the Indian subcontinent. Middle-aged males are predominantly affected. Alcohol intake and diabetes are the significant risk factors. Pain abdomen and fever were the most frequent complaints. <i>Escherichia coli</i> was the most common organism causing pyogenic liver abscess. More than 75% of the cases can be treated with antibiotics and ultrasound-guided single needle aspiration.<br><b>Conclusion:</b> Hepatic abscess is a common disease of Indian subcontinent. Early diagnosis and treatment is essential to prevent mortality. Ultrasound has emerged as a cheaper and effective diagnostic modality. The incidence of tubercular hepatic abscess is not uncommon.<br>

A study on parental attitudes in patients with personality disorders and healthy controls from a tertiary care hospital in Northern India

A study on parental attitudes in patients with personality disorders and healthy controls from a tertiary care hospital in Northern India

Tessier cranio-facial clefts presenting to a tertiary eye care center in Northern India: Ophthalmic features and a review of management.

Purpose:Tessier classification is used to classify congenital facial cleft disorders utilizing the anatomical location of the cleft and its extension. The orbital and ocular morbidities associated with the birth disorder are numerous. The authors decided to perform a retrospective analysis of the clinical features of the patients who presented to a tertiary care hospital with orbito-cranial clefts.Methods: The authors retrospectively evaluated the records of patients with craniofacial clefts who had presented to a tertiary eye care hospital in northern India in the last 2 years (January 2019–December 2020). The clinical features were studied, entered in MS Excel, and the data were evaluated.Results: The data of 40 patients with Tessier cleft were found. The majority of the patients were male and presented in the pediatric age group. Unilateral involvement was more common, with maxillary hypoplasia being the most common facial anomaly associated. Eyelid coloboma and euryblepharon was the most common periocular finding; lateral epibulbar dermoid and corneal opacity were the most common ocular surface anomaly. The majority of patients had presented for cosmetic correction. The syndromic association was with Goldenhar syndrome (n = 13), Fraser (n = 2), and one each of Treacher Collins, blepharocheilodontic, organoid nevus, and oculo-dento-digital syndrome. Combined clefts were also seen.Conclusion: Tessier cleft classification is a useful tool to classify cranio-facial left anomalies. Multitudes of ocular and orbital anomalies can be associated with their different forms. Better knowledge and understanding of the classification will aid immensely in predicting the ocular defects and planning their management.

Seroprevalence of Transfusion Transmitted Diseases in a Tertiary Care Hospital of Northern India: A Five Year Retrospective Study

Introduction: Although transfusion of blood and its components is life saving but it may also pose a threat to life as with every unit of blood there is 1% chance of transfusion associated problems which include the transfusion of transmitted diseases as well. The Ministry of Health and Family Welfare (Government of India) under The Drug and Cosmetic Act, 1945 (amended from time to time) mandates the screening of blood donations against five major infections- Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Syphilis and Malaria. Aim: To estimate the prevalence of Transfusion Transmitted Infections (TTIs) among blood donors in a tertiary care hospital. Materials and Methods: This is a retrospective five year study from February 2016 to January 2021. The study was undertaken at TS Misra Medical College and Hospital, Lucknow, Uttar Pradesh, India. The sample size included 5420 blood donors. The data concerning type of donors, gender and results of screening tests were obtained from blood bank register/records. Donor selection was based on history of present and past illness and also included a pre-donation questionnaire. Serum samples were screened for Hepatitis B Surface Antigen (HBsAg), antibodies to HIV Type 1 and 2 and antibodies to HCV using Microwell Enzyme Linked Immuno Sorbent Assay (ELISA) Test. For syphilis and malaria detection, membrane based immunoassay and sandwich immunoassay techniques were used respectively. Results: Out of a total of 5420 blood donations over a period of five years, there were 5298 male donors and 122 female donors. There were 5368 replacement donors and 52 voluntary donors. The prevalence of HIV, HBsAg, HCV, syphilis and malaria was 0.16%, 0.77%, 0.11%, 0.53% and 0%, respectively. Conclusion: Voluntary blood donations, stringent screening measures, advanced screening techniques, strict donor selection are essential features for decreasing the prevalence further and also would ensure blood safety.

Metabolic bone disease in ulcerative colitis: A cross-sectional study in a tertiary care hospital of Northern India

Background: Metabolic bone disease (MBD), including osteomalacia, osteopenia, and osteoporosis, is common in patients with inflammatory bowel disease (IBD) and is considered to be an extraintestinal manifestation. There is a paucity of reports on MBD in patients with IBDs from India. We aimed to investigate the prevalence of MBD in adult patients with ulcerative colitis (UC). Materials and Methods: In this single–center, hospital–based, cross-sectional observational study, 161 consecutive patients of UC, between 18 and 70 years of age, were assessed for MBD with blood investigation (corrected serum calcium, phosphorus, alkaline phosphatase, serum 25-hydroxy Vitamin D3, and parathyroid hormone levels) and dual-energy X-ray absorptiometry (DEXA). Results: Out of 161 UC patients, 74 (46.0%) had Vitamin D deficiency. Osteopenia and osteoporosis of the neck of the femur on DEXA were seen in 39.7% and 11.2% of the patients, respectively. Osteopenia and osteoporosis of the lumbar spine on DEXA were seen in 33.5% and 15.5% of the patients, respectively. Conclusion: MBD is common in UC.

Clinical features and orbital anomalies in Fraser syndrome and a review of management options.

Purpose:Fraser syndrome is a rare congenital disorder comprising cryptophthalmos, syndactyly, and many times, urogenital anomalies. Herein, the authors aimed to study and report the clinical features and orbital anomalies in cases diagnosed with Fraser syndrome.Methods: The authors retrospectively evaluated the records of patients with Fraser syndrome who had presented to a tertiary eye care hospital in northern India in the last 2 years (from January 2019 to December 2020). The clinical features were studied, entered in MS Excel, and the data was evaluated.Results: Data of 15 patients with Fraser syndrome were found. Majority of the patients were males and presented in the pediatric age group. Bilateral involvement was more common, and the most common variant of cryptophthalmos was abortive. Complete and medial madarosis of the eyebrows was the most common periocular finding. Complete cryptophthalmos was associated with cystic globes, whereas abortive forms had superior symblepharon. Common systemic features included syndactyly, bifid nose, and urogenital anomaly.Conclusion: Fraser syndrome is an extremely rare developmental disorder; it encompasses a wide range of ocular, periocular, and orbital anomalies, along with multiple pre-existing systemic anomalies. The treating ophthalmologist should always be careful in examining these patients

Causes, frequencies, and predictors of relapse in patients with ulcerative colitis on long-term follow-up in a tertiary care hospital of Northern India

Context: Ulcerative colitis (UC) initially thought to be a disease of developed world is equally common in India. Surprisingly, there are very scant data from India. The study was undertaken to find the frequency of relapse and to determine factors predictor of relapse in Indian population. Subjects and Methods: This study was conducted at a tertiary care center of New Delhi for a period of 1 year. Patients were included if they had a diagnosis of UC based on accepted historical, endoscopic, histological, and/or radiologic criteria. Detailed past/present history, baseline clinical examination, dietary details, and psychological analysis using shortened Depression Anxiety Stress Scale score, biochemical tests, inflammatory markers, endoscopic, and histopathological analysis were done at baseline and regular intervals. The outcome was clinical relapse or continued remission. Results: Out of 86 patients screened, 50 patients were included in the study according to inclusion criteria and were followed up. The frequency of relapse was 32%. Univariate analysis showed higher relapse frequency, frequency of steroid received in past, patients on immunomodulator therapy, presence of acute or chronic inflammatory cells on histology, and disease activity at baseline as predictors of relapse. There was no significant difference between anxiety, stress, and depression relapsers and those who maintained remission. On multivariate analysis, disease activity at baseline was the only independent predictor of relapse. Conclusions: Stringent control of disease activity with mucosal healing should be the aim, as mucosal healing is the only predictor for prolonged remission.

Evaluating Thyroid Function in Paediatric Nephrotic Syndrome in a Tertiary Care Hospital of Northern India: A Case-control Study

Introduction: Nephrotic Syndrome (NS) is a glomerular disease characterised by oedema, hypoalbuminaemia and substantial proteinuria, which includes loss of thyroxine binding globulin and thyroid hormones, often resulting in subclinical or overt hypothyroidism. Studies reporting on the relationship between NS and thyroid dysfunction elude consensus. Aim: To evaluate Triiodothyronine (T3), Thyroxine (T4) and Thyroid Stimulating Hormone (TSH), and lipid levels to identify clinical predictors of thyroid dysfunction in paediatric cases of NS. Materials and Methods: A hospital based case-control study was undertaken on 100 children, attending Paediatric Nephrology Clinic, from October 2020 to March 2021.Patients were divided into two groups: 50 cases under various stages of nephrotic syndrome, and 50 healthy controls in the age group of 1 to 18 years, of either gender. Investigations on serum creatinine, Haemoglobin (Hb), white blood cell count, platelet count, serum T3, T4, TSH, and blood lipids like: Triglyceride (TG), Total Cholesterol (TC) and Low Density Lipoprotein (LDL), were performed on all the children, and compared for analysis of corresponding data of cases and controls. Statistical analysis was carried out using ANOVA test. Results: The mean age of the cases and controls was 12.6±4.2 and 11.8±4.0 years, respectively. Mean T3 value in the case group was 117±63 ng/dL, and in control was 176±95 ng/ dL (p=0.104). Mean T4 value among the case group (9.9±5.1 μg/dL) was significantly lower than that of controls (14.2±8.4 μg/dL) (p=0.016). The difference of TSH levels in the case group was 3.8±2.9 μIU/mL, and control was 2.5±2.2 μIU/mL (p&lt;0.001). Hypothyroidism was observed in 9 (45%) children with first episode, 7 (53.84%) in remission, and 6 (60%) relapsed patients. Conclusion: Urinary losses of binding proteins such as Thyroxine Binding Globulin (TBG), transthyretin or prealbumin and albumin, may have caused lower levels of T3 and T4 and higher value of TSH. T3, T4 and TSH are important clinical predictors of thyroid dysfunction in patients with NS, therefore hypothyroidism should be investigated in all children with NS.

Awareness and Compliance to International Patient Safety Goals among Healthcare Personnel of a Tertiary Care Hospital in Northern India

Introduction: Advances and commitment to patient safety worldwide have grown since the late 1990s which have led to a remarkable transformation in the way patient safety is viewed. Having begun as a subject of minor academic interest, it is now embedded in most healthcare systems worldwide. The International Patient Safety Goals (IPSG) are important guidelines developed by Joint Commission International to promote safe and high-quality patient care. Patient safety is the responsibility of every healthcare personnel who is directly or indirectly involved in patient care. Aim: To determine the level of awareness amongst doctors, nurses, and technicians and their compliance to IPSG in a tertiary care hospital. Materials and Methods: This observational cross-sectional study was conducted from March to May 2021, in a tertiary care teaching hospital. Stratified sampling technique was used in determining the number of doctors, nurses, and technicians required for this study. A validated questionnaire was used to assess the awareness level of healthcare personnel to IPSG. ‘1’ mark was assigned to each correct answer and ‘0’ were awarded to wrong answers. Results: A total of 394 patient records/documents were audited for patient safety compliance. It was observed that 339 (86%) documents revealed compliance to all six IPSG. Out of the six goals of IPSG, the best compliance was observed for the 4th goal of IPSG (ensure safe surgery) for which the compliance was 100%. The lowest compliance was observed for 2nd, 5th and 6th goal (improve effective communication, reduce the risk of healthcare associated infection and reduce the patient harm resulting from fall) which was 81%, 80% and 78%, respectively. The awareness questionnaire was given to doctors (n=60), nurses (n=86) and technicians (n=76). The findings revealed that awareness was highest in nurses (84.8%) followed by doctors (81.7%) and technicians (80.2%). Conclusion: The study has found out that the awareness level of doctors, nurses, and technicians towards patient safety goals is good. Further quality improvement in this field can be achieved by conducting on the job-training, workshops, lectures, and seminars.

Clinicoetiological profile of acute ischemic stroke patients in the therapeutic window in a tertiary care hospital in Northern India

Background: A stroke is defined by the rapid emergence of clinical symptoms and focuses on evidence (applicable to individuals in a deep coma and those with subarachnoid hemorrhage) or widespread brain damage. The study aimed to evaluate the clinical characteristics of patients with acute ischemic stroke in a tertiary care hospital in North India. Methods: By analyzing case files and conducting patient interviews, information on the patients was gathered and evaluated. The study's inclusion and exclusion criteria were based on the 2018 American Heart Association and American Stroke Association (AHA/ASA) thrombolysis guidelines for acute ischemic stroke. Recent major trauma or major surgery within 14 days not involving the head, seizure at the onset of stroke, systemic malignancy, and pregnancy were excluded. Results: The study enlisted the participation of 76 patients who were divided into two groups. Patients in the one group were given tenecteplase, whereas the other group were given alteplase. Patients in the tenecteplase and alteplase groups were of different ages and had various other risk factors for hypertension, atrial fibrillation, diabetes, smoking, and previous stroke or transient ischemic attack. The risk factor distribution in both the groups was statistically significant for variables such as hypertension and diastolic blood pressure (P < 0.05). Stroke in internal carotid artery territory was present in 3 out of 42 in the tenecteplase group and 2 out of 32 in the alteplase group. Most patients in both the groups had a stroke of undetermined cause. Small vessel and large vessel strokes were found in 9.5% and 14.7%, respectively. Conclusion: In the development of stroke, there is a definite relationship between age and gender. A sedentary lifestyle, food, and obesity are risk factors for stroke. According to an AHA/ASA drug utilization analysis, most medicines were appropriate for stroke patients.

Retrospective review of severe acute respiratory syndrome coronavirus-2 infection in children with acute leukemia from a tertiary care hospital in Northern India.

Retrospective review of severe acute respiratory syndrome coronavirus-2 infection in children with acute leukemia from a tertiary care hospital in Northern India.

Neonatal outcomes following prophylactic administration of phenylephrine or noradrenaline in women undergoing scheduled caesarean delivery: A randomised clinical trial.

There is limited evidence to support the use of noradrenaline over phenylephrine during elective caesarean section with regards to its impact on foetal acidosis. Concerns regarding a deleterious effect of noradrenaline on foetal blood gas analysis because of its β-mimetic activity cannot currently be ruled out by data from randomised controlled trials. We hypothesised that noradrenaline would be associated with higher umbilical artery base excess values and less foetal acidosis compared with phenylephrine. This study aimed to observe the effect of prophylactic infusions of phenylephrine or noradrenaline in low-risk elective caesarean delivery on umbilical artery blood gas analysis. A prospective, randomised, double-blind trial. Labour room operating theatre of tertiary care hospital in Northern India from April 2020 to November 2020. Full-term, nonlabouring pregnant women, scheduled for elective caesarean delivery under spinal anaesthesia. Equipotent prophylactic infusions of either phenylephrine 100 μg min-1 or noradrenaline 5 μg min-1 were administered to maintain maternal SBP between 90 and 110% of baseline using a predefined algorithm. The primary outcome was umbilical artery base excess in noradrenaline versus the phenylephrine group. The incidence of foetal acidosis defined as umbilical artery base excess less than -6 mmol l-1 was also assessed for noradrenaline versus phenylephrine. Median [IQR] umbilical artery base excess was significantly higher in the noradrenaline group: -5.4 [-6.6 to -4.03] versus -6.95 [-9.02 to -4.53] in the phenylephrine group (P = 0.014). No significant difference in the incidence of foetal acidosis was observed between noradrenaline and phenylephrine groups: 36 versus 54% (P 0.07); difference 18% (95% CI, -1.4 to 35.6%). Prophylactic noradrenaline 5 μg min-1 infusion resulted in higher base excess values compared with phenylephrine 100 μg min-1 infusion. A comparable incidence of foetal acidosis was observed in women receiving either noradrenaline or phenylephrine. Maternal bradycardia was more pronounced with phenylephrine while targeting blood pressure goals. CTRI/2020/03/023986.

Irregular erythrocyte antibodies among antenatal women and their neonatal outcome at a tertiary care hospital in Northern India.

Red blood cell alloimmunisation during the pregnancy is a significant cause for neonatal mortality and morbidity. This study was planned to determine the prevalence and specificity of irregular erythrocyte antibodies in antenatal mothers and their neonatal outcome. In this observational study, blood grouping and red cell antibody screening of mothers were performed at first visit and after 28 weeks of gestation and positive cases were identified and followed up monthly till delivery by repeating antibody titre and middle cerebral artery-peak systolic velocity. After delivery of alloimmunised mothers, cord blood haemoglobin, bilirubin and direct antiglobulin tests (DAT) were analysed and further outcome of neonate was recorded. Among 652 registered antenatal cases, 18 multigravida women were found to be alloimmunised, accounting to prevalence of 2.8%. Most common alloantibody identified was anti D (>70%) followed by anti-Lea, anti-C, anti-Leb, anti-E and anti-Jka. Only 47.7% Rh D negative women received anti-D prophylaxis during previous pregnancies or whenever indicated. DAT was positive in 56.2% of neonates. Among nine DAT positive neonates, two early neonatal deaths due to severe anaemia were observed following birth resuscitation. Four antenatal mothers required intrauterine transfusion in view of fetal anaemia while three neonates received double volume exchange transfusion and top up transfusions after birth. This study emphasises importance of red cell antibody screening for all multigravida antenatal women at registration of pregnancy and additionally at 28 weeks or later in high-risk cases irrespective of RhD status.