Care Institute In South India Research Articles

Immediate Skin to Skin Contact and Zero Separation of Mother Infant Dyads Among Healthy Term Infants Delivered Vaginally: A Quality Improvement Initiative in a Tertiary Care Institute in South India

Background The neonatal resuscitation program (NRP) recommends immediate skin-to-skin contact (SSC) of the neonate with the mother’s abdomen. Early establishment of SSC has increased the duration of breastfeeding and decreased neonatal morbidity significantly. Objective To achieve immediate SSC and zero separation of infant–mother dyads for a minimum of 30 min in vaginally born healthy term babies from 0% to 50% over 3 months by implementing a quality improvement (QI) initiative. Methods A QI initiative was undertaken at the maternity-newborn care unit of a tertiary-care hospital between March 2022 and December 2022. A team including neonatologists, obstetricians, pediatric postgraduates, and nurses (both neonatal and obstetric) in the concerned areas was identified. Using 5-why technique and fishbone analysis, the root cause analysis was done. Two plan-do-study-act (PDSA) cycles were undertaken. First, sensitization of healthcare personnel was done, and a written policy was made. Efforts were made to sustain the QI. Continuous surveillance, internal audits, and regular interprofessional team meetings were carried out. Results Prior to this QI, baseline data showed that no babies received SSC for 30 min. During the first PDSA cycle, 16.6% (4/24) of babies received SSC and zero separation for 30 min. During the II PDSA cycle, among 46 eligible neonates, 50% (23/46) received SSC >30 min. During the sustenance phase, among 262 eligible neonates, 75.2 % (197/262) received >30 min of SSC immediately after delivery. Conclusion Immediate SSC and zero separation for 30 min could be achieved by implementing simple measures through this QI initiative. The major hurdles, including the knowledge gap, fear, and safety of neonates, were tackled through simple strategies like education sessions, ergonomic modification, and sensitization of the healthcare team.

Clinico-Demographic Profile and Factors Affecting Duration of Hospital Stay Among Burn Patients in an Emergency Department of a Tertiary Care Center, South India: A Hospital-Based Cross-Sectional Study.

Background Burns continue to be a serious public health problem in India. It persists as an endemic disease in spite of implementing various preventive measures at the individual and community levels. Etiology and factors influencing burns are varied. There is a paucity of data regarding the clinico-demographic profile of burns disease, especially from emergency tertiary care settings in India. Objective To assess the proportion of burn patients having longer hospital stays (>1 week) and the influence of clinico-demographic factors associated with it among the burn patients presenting to the emergency department of a tertiary care institute in south India. Methodology An institution-based cross-sectional analytical study was conducted among burns patients attending the Emergency Medicine Department (EMD) of a tertiary care center between January 2017 and December 2017. Information on clinico-demographic profile and duration of hospital stay were captured using semi-structured data collection proforma. Results All the 327 burns injury patients who presented to our EMD during the study period were included. Among the 327 patients, 259 (79%) were admitted to the EMD. Among 259admitted patients, 142 (55%) patients were discharged home. Among these 142 patients, 106 (74.6%; 95%CI 66.8-81.2) had longer hospital stays (more than one week). Female gender and facial/inhalational burns were found to have an independent effect on the length of hospital stay even after adjusted analysis. Conclusion Length of hospital stay is independently influenced by female gender and facial/inhalational burns. This study also identified the need for better home safety, child-proofing, proper pre-hospital care, and dedicated burns units in the community.

Delays in Lung Cancer Diagnosis: Observations from a Tertiary Care Centre in Kerala, India.

Merin YohannanIntroduction Timely diagnosis of lung cancer is critical because treatment outcomes correspond to the stage of disease. This study identified patient and physician determined reasons for diagnostic delays. Materials and Method s This was an observational cross-sectional study, conducted at a tertiary care institution in South India, for 12 months. From 207 consecutively selected patients, with a presumptive lung cancer diagnosis, 150 were enrolled utilizing a prefixed questionnaire. The time intervals from appreciation of initial respiratory symptoms to a final tissue diagnosis were defined sequentially as approach interval, referral interval, and diagnostic interval and factors causing delay in each interval were identified. Results In a state with 100% literacy, the mean time to approach a doctor was 8 weeks (range: 0-336 days; SD: 7.95) with a delay seen in 52% of the study group. Referring a suspect lung cancer diagnosis to a specialist, took an average of 4.98 weeks (range: 1-26 weeks; SD: 5.64) with referral delays in 47.3% of patients. The mean diagnostic interval was 9.21 days (range: 3-41 days; SD: 7.18) and 16.7% of cases had diagnostic delays in spite of a definite procedure. Conclusion In a tuberculosis endemic location, empirical treatment with anti-tuberculosis therapy and prolonged antibiotic courses without serially monitoring the course of disease are responsible for referral delays. Also, 88.2% of the total females studied, presented late due to family and work pressures, fear of being stigmatized and being on prolonged home remedies. A wider dissemination and awareness on lung cancer are needed especially among females. A low threshold to reinvestigate and an early referral to a pulmonary or lung cancer specialist, when expected clinicoradiological improvement is lacking, in microbiologically negative tuberculosis should be highlighted.

Patterns of Occupational Exposure to Human Immunodeficiency Virus and Post-Exposure Prophylaxis Among Health Care Personnel in a Tertiary Care Institute in South India - A Retrospective Case Series.

Post-exposure prophylaxis (PEP) for occupational human immunodeficiency virus (HIV) exposure involves the comprehensive measures used to prevent transmission of blood-borne pathogens such as HIV, hepatitis B virus, and hepatitis C virus through various strategies such as first aid, counseling, risk assessment, relevant laboratory investigations with informed consent, the provision of short-term anti-retroviral drugs, and follow-up testing. We sought to investigate the patterns and causes of occupational exposure in health care workers (HCWs) in our institute and the usage of PEP in our center, a tertiary care hospital in south India. The study involved a retrospective analysis of data extracted from the records of PEP usage from the anti-retroviral treatment (ART) center attached to the dermatology, venereology and leprosy out-patient department of a tertiary care center in south India. The data were extracted into a pre-designed proforma and analyzed using descriptive statistics. A total of 352 health care professionals reported to the ART center for PEP from 2010 to 2020. One hundred and thirty-four patients took only the first dose as the source patient later tested to be HIV-negative. Among the 218 remaining patients, 84 were male and 134 were female patients. Only 56 health care workers started the regimen within 2 hours. One hundred and thirty-four patients completed the full course of PEP. Most HCWs (n = 68, 31%) sustained the exposure while doing a procedure on the patient followed by re-capping a needle (n = 64, 29%). Gastritis and drowsiness were the most common adverse effects. The study was limited by the retrospective nature of data collection and the lack of detailed interviews with HCWs. Knowledge about PEP, needle safety training, and training of early first aid measures should be increased among health care workers.

Stress and strategies in coping stress among the medical students of a south Indian city

Background: Stress is a personal experience brought on by complex interactions between a person and their environment, so it cannot be avoided. It typically happens when a person’s situational demand exceeds their available resources. Additionally, it has been noted that excessive stress can hurt self-esteem, academic performance, and both personal and professional development. This study sought to determine the stress level, different stressors, and coping mechanisms used by undergraduate medical students. Materials and Methods: A cross-sectional study was done among first to final-year medical undergraduate students between January and June 2022 at a tertiary care institution in South India. 450 students enrolled in the first year to last year were included in the study through the purposeful sampling method. The medical Student Stressor Questionnaire was used to assess the stress levels among the study participants. The coping strategies were considered using a brief coping orientation to problems experienced (COPE) inventory. Cluster analysis used the K-means method. Results: A total of 278 out of the 450 students completed the questionnaire and returned it, yielding an overall response rate of61.78%. Of which 175 (62.95%) women respondents made up the majority of the study participants. The mean age of the participants was 20.15 ± 2.8 years. 45.32% (n = 126) of the study participants belonged to the first year of their study, whereas 23.02% (n = 64) belonged to the second year of their research. Academic stress was the primary stressor. The predominant coping strategies used were problem-focused and emotion-focused coping with stress. Conclusion: A variety of stress management techniques should be offered to help the students in better handling of the demanding professional course.

Evaluation of left ventricular dysfunction after single-chamber pacemaker implantation in patients with normal left ventricular function in a tertiary care institution in South India: An observational study

Evaluation of left ventricular dysfunction after single-chamber pacemaker implantation in patients with normal left ventricular function in a tertiary care institution in South India: An observational study

Evaluation of mean “R” wave amplitude in lead V1 of electrocardiogram among term newborn infants in tertiary care institution in South India

Evaluation of mean “R” wave amplitude in lead V₁ of electrocardiogram among term newborn infants in tertiary care institution in South India

Role of Low-Level Laser Therapy as an Adjuvant in Functional Rehabilitation of Patients with Joint Stiffness in Post-Burn Contracture

Introduction Post-burn contracture is a known sequelae of burn injuries involving neck, axilla, elbow, and hand. There are many methods which are used as adjuvant in rehabilitation of post-burn contracture patients. The low-level laser therapy (LLLT) is one of the methods that can be used as an adjuvant in rehabilitation of joint stiffness following burns and but with very few data available from India. In this article we share our experience of using LLLT for functional rehabilitation of a patient with joint stiffness following postburn contracture. Materials and Methods This study was conducted in a burns centre in a tertiary care institute in South India. Informed consent and departmental ethical committee clearance were obtained prior to study. The subject was a young boy with no known co-morbidities with stiffness of metacarpophalangeal and interphalangeal joint of index and middle finger of right hand. Patient was treated with contracture release with full thickness skin graft. The patient received low-level laser therapy to induce collagenolysis and to increase the movement of the joints. Each joint received laser therapy for duration of 125-second every time for 15-minutes for 2 sessions in a span of 4-days. Result LLLT has been found to be useful in early rehabilitation of post-burn contracture patients with joint stiffness. No side effects were observed during the study. Conclusion The LLLT is an effective, safe, and non-invasive adjuvant in functional rehabilitation of our patient with joint stiffness following post-burn contracture. We suggest further study including multiple subjects and a control group for validation of the result.

Quality improvement initiative approach to increase the duration of Kangaroo Mother Care in a neonatal intensive care unit of a tertiary care institute in South India during the COVID-19 pandemic

IntroductionKangaroo mother care (KMC) provided to stable babies in hospitals is associated with 40% relative risk reduction in death, 65% risk reduction in nosocomial infections. Despite clear existing evidence of advantages of KMC, its implementation remains limited.This study aimed to improve the median KMC practice hours in eligible preterm and low birth weight (LBW) neonates by 50% from the baseline practice. MethodsThis was a Quality Improvement study conducted at Neonatal unit of a tertiary care institute in South India. All stable preterm and LBW neonates were included after obtaining written informed consent from mother. Those who needed interruption in KMC due to medical reason were excluded. A team comprising of 2 principal investigators (UG students), 2 consultants and 2 in-charge nurses was formed. Baseline data were collected between January and February 2021 to find out the median duration of KMC practice and to identify limiting factors (barriers) and the facilitating ones through in-depth interviews and team meetings. The study was conducted over a 10 month period. Steps were taken to tackle these in two PDSA cycles, each lasting for 3 weeks (1st PDSA: Education of Mothers and Nurses; 2nd PDSA: KMC technique, orders by residents). The PDSA was followed by monitoring for 10 weeks for sustenance. ResultsThe baseline data showed that the median duration (in hours) of KMC practice was 2.6 which increased to 5.0 and 5.5 h by the end of first and second PDSA cycle, respectively and showed a lasting change, peaking at a median value of 6.1 h during the sustenance phase over the next 10 weeks. ConclusionThrough simple measures and closing the communication gap between health care workers and mothers, we were able to increase the duration of KMC, which remained high during the 10 week follow up period.

Surgical and anaesthetic outcomes of paediatric splenectomies at a tertiary care institution in South India: a retrospective cohort.

Splenectomies though well-established in the successful management of several resistant haemoglobinopathies, have not been studied in detail in the paediatric population to assess the outcomes. We conducted this review to primarily assess the surgical and anaesthetic outcomes of paediatric splenectomies and secondarily highlight factors predictive for a high-risk splenectomy. A 5year retrospective chart review was made, and patient follow-up was done jointly using the hospital electronic medical records and telephonic calls. A p value of < 0.05 was considered significant. Among the 69 splenectomised children, 61% were male and the overall mean age was 10.2years. The cohort consisted of patients with thalassemia (46%), ITP (30%), haemolytic anemia (19%) and 1 child each with lymphoma, splenic cyst and Kassabach Meritt syndrome. Most (96%) were electively operated and 23% were performed laparoscopically. 61% received intravenous analgesia and the mean volume of fluid administered intra-operatively was 21ml/kg. There was no documented OPSI, and there was one mortality. The mean follow-up period was 43months and the overall survival rate was 98.5%. Splenectomy was associated with a promising overall outcome. A greater pre-operative transfusion requirement, a larger sized spleen and increased fluid administration intra-operatively, were associated with a worse outcome.

Study of Prevalence of Preoperative Corneal Astigmatism in Patients with Senile Cataract at a Tertiary Care Institute in South India

Study of Prevalence of Preoperative Corneal Astigmatism in Patients with Senile Cataract at a Tertiary Care Institute in South India

Ophthalmology practice in COVID-19 pandemic: Performance of rapid antigen test versus real time-reverse transcription polymerase chain reaction in a tertiary eye care institute in South India.

Purpose:To assess the rapid antigen test (RAT) against the gold standard reverse transcription-polymerase chain reaction (RT-PCR) to screen COVID-19 infection in asymptomatic patients undergoing ophthalmic procedures.Methods:This was a retrospective hospital-based study. Point-of-care (PoC) RAT was performed using nasopharyngeal swab, while RT-PCR for SARS-CoV-2 viral RNA was performed using both nasopharyngeal and throat swabs.Results:A total of 629 patients were tested for SARS-CoV-2 by using both RAT and RT-PCR. Only one patient had tested positive for SARS-CoV-2 with both RAT and RT-PCR, while two patients had tested positive with RT-PCR after an initial negative RAT. The positivity rate for RAT was 0.15% (1/629), and that for RT-PCR was 0.47%. Percent agreement or proportion of agreement observed between the two tests was 99.68%, while Cohen’s kappa coefficient value was 0.49. The sensitivity of RAT in comparison to RT-PCR was 33.33%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 99.68%.Conclusion:The sensitivity and Cohen’s kappa coefficient in our study were low but that can be attributed to the overall low positivity rates with both RAT and RT-PCR. However, percent agreement observed between the two tests was very high. Therefore, we recommend initial screening of all the patients for COVID-19 symptoms followed by RAT before performing any ophthalmic surgical procedure to ensure the safety of the health care professionals as well as the patients.

Factor assay in victims of snake bite: Experience from a tertiary care institute in South India.

Snake bites tend to cause a high mortality in those who develop coagulopathy. However, there is very limited literature on clotting factor assays in these patients, especially in the presence of clinical bleeding. The aim was to assess the coagulation profile and individual coagulation factors in patients with hematotoxic snake bites. This was a prospective observational study of clotting factor levels in victims of snake bites with hematotoxicity admitted to a single hospital in south India for 12 months. In 43 individuals who fulfilled the criteria, we measured platelet count, prothrombin time (PT), international normalized ratio, activated partial thromboplastin time (aPTT), fibrinogen levels, coagulation factors V, VII, VIII, IX, and X, and the qualitative factor XIII assay. Forty-three patients fulfilled the criteria and their samples were studied. There were 36 Russell's viper (Daboia russelli), 4 Hump-nosed pit viper (Hypnale hypnale), and 3 unknown snake bite victims samples, in which factor assays were done. All the Russell viper bite victims without a recordable clotting screen had deficiency of Factor V (0.5%-49.62%, Mean - 20.27%), Factor X (0.08%-92.3%, Mean - 70.73%), and qualitative factor XIII. Pit viper patients showed normal levels of Factor I, V, VII, VIII, IX, X, and XIII despite prolonged PT and aPTT. Early detection and treatment of envenomation remains the cornerstone of managing snake venom-induced consumptive coagulopathy. Anti-snake venom plays a major role in the reversal of coagulopathy. Blood and blood products would be useful when coagulopathy does not revert by ASV alone. Evidence-based transfusion can be implemented and cryoprecipitate may be used as many of the patients had factor XIII and fibrinogen deficiency as part of venom-induced coagulopathy. To improve patient management and thereby the outcome of patients CMEs and training programs for the treating physicians also has to be implemented so that guidelines are formulated and followed.

Factor assay in victims of snake bite: Experience from a tertiary care institute in South India

Factor assay in victims of snake bite: Experience from a tertiary care institute in South India

A study on ocular symptomatology and clinical profile of coronavirus disease-19 positive patients admitted at a tertiary care institute in South India

Purpose: To study the ocular symptomatology and clinical profile of coronavirus disease-19 (COVID-19) positive patients admitted at a tertiary care institute. Methods: This cross-sectional, observational, and descriptive study was conducted on 200 reverse transcriptase-polymerase chain reaction positive confirmed COVID-19 patients in a tertiary care institute from September 2020 to October 2020. Ocular and systemic history was collected from the patients, clinical findings and investigation values were noted and analyzed. Results: Out of 200 COVID-19 positive patients in our study, 54% of the patients were graded as mild COVID-19 cases, 34% of the patients were graded as moderate, and 12% of the patients were graded as severe COVID-19 cases. The prevalence of ocular symptoms was 10.5%. Burning sensation of the eyes was the most common ocular symptom. A higher occurrence of ocular symptoms was observed in febrile patients and it was found to be statistically significant. The ocular symptoms worsened with a rise in temperature. Conclusion: Our study reveals that in COVID-19 positive patients, the most common systemic symptom was fever and the most common ocular symptom was burning sensation. In most of the cases, ocular symptoms appeared before or with the appearance of systemic symptoms. Most ocular symptoms were either mild or moderate grade. Ocular symptoms were higher in febrile patients with the severity increasing during febrile period in most patients. With this, we need to consider all patients coming to the outpatient department with complaints of burning sensation of eyes, eye pain and red eye as possible COVID-19 cases, and do due diligent workup.

Diagnostic Utility of Bronchoalveolar Lavage in Chronic respiratory diseases-A cross sectional study on patients from Tertiary Care Institute in South India

Diagnostic Utility of Bronchoalveolar Lavage in Chronic respiratory diseases-A cross sectional study on patients from Tertiary Care Institute in South India

Proportion of diabetic retinopathy among diabetics presenting for the first time to a tertiary eye institute in South India.

To detect the proportion of diabetic retinopathy (DR) among diabetics visiting a tertiary eye care institute and correlate presenting symptoms to clinical diagnosis. The study recruited 1000 eyes of 1000 diabetics visiting a tertiary eye care institute in South India for the first time. Along with basic demographic data and systemic history, details of presenting complaints and clinical diagnosis were noted. Data from 956 cases were analyzed. There were 29 (3%) newly diagnosed diabetics and 927 (97%) known diabetics. The commonest reason for the hospital visit was diminution of vision (66%) followed by "visiting for a routine checkup" (22.3%). Diabetic retinopathy was seen in 492 (51.5%), cataract in 161(17%) and refractive error in 240 patients (79.2%). Vision-threatening DR was present in 216 cases (22.59%) and clinically significant macular edema in 73 cases (7.63%) at first presentation itself. The cohort from a tertiary eye care institute has higher proportion of diabetic retinopathy, with vision-threatening DR at presentation. These data emphasize the need for more robust screening for DR, along with population awareness programs.

Outcome of Induction of Labor with Foley's Catheter in Women with Previous One Cesarean Section with Unfavorable Cervix: An Experience From a Tertiary Care Institute in South India.

Induction of labor in women with previous cesarean section is associated by the fear of scar rupture, resulting in high rates of repeat scheduled cesarean section. Mechanical methods are being advocated as a safe method. We present our experience of vaginal birth rates and safety profile with single-balloon Foley's catheter for induction of labor in women with previous one cesarean section. We studied 96 women admitted in Women and Children Hospital JIPMER, India, with a previous cesarean section at term having unfavorable cervix and undergoing induction of labor. Foley's catheter inflated to 60ml was used for cervical ripening for 24h followed by strict oxytocin infusion protocol. The mean Bishop score before induction of labor was 3.3 ± 0.88. Ripening with Foley's catheter resulted in mean improvement in the Bishop score by 2.56 ± 0.67. Forty-seven percent women spontaneously expelled the Foley's catheter, and 53.1% achieved contractions spontaneously. The successful vaginal birth rate was 40%. Emergency caesarean section was more likely in women with poor post ripening Bishop score, meconium stained liquor and abnormal fetal heart rate pattern during labour. There was one scar dehiscence, one neonate with low Apgar score. There was no rupture uterus. Induction of labor with Foley's catheter resulted in a 40% successful vaginal birth rate and was found to be safe with only one scar dehiscence and no perinatal or maternal mortality. There was no perinatal or maternal mortality.

Clinical profile of patients with intussusception in a tertiary care institution in South India

Background: Intussusception is a common abdominal emergency in children. It is the most common cause of intestinal obstruction in children less than 2 years. Awareness about the clinical presentation vomiting, abdominal pain, blood in stools, abdominal mass helps in early diagnosis. This study describes the demographics and clinical profile of patients with intussusception in a tertiary care institute in South India.Methods: This was a prospective case series study conducted in the pediatric surgery department in a tertiary care hospital in South India. Children upto 12 years with clinically and radiologically confirmed intussusception were enrolled over 12 months study period. Demographic and clinical data was collected and recorded.Results: Eighty two children with clinical and radiological picture suggestive of intussusception were studied. 57 patients (75%) were below 1 year of age. Male:female ratio was 1.7:1. The classical triad of abdominal colic, palpable abdominal mass and rectal bleeding was seen in 39 patients (50%). Most common signs were rectal bleed and abdominal mass.Conclusions: Awareness about the clinical presentation of intussusception helps in early diagnosis and prompt treatment of this common pediatric emergency and helps to prevent mortality.

Lessons from healthcare personnel screening and management during H1N1 pandemic in preparation for the impending COVID-19 pandemic in a tertiary care hospital in India

BackgroundIn the wake of the COVID-19 pandemic caused by a novel corona virus, health care personnel are at increased risk of acquiring the infection. In preparation for the management of health care personnel that are likely to be infected, we looked in to the data collected during the Influenza pandemic in 2009, caused by a novel strain of H1N1 influenza called swine flu. The care of healthcare personnel in our institution, who had an acute febrile respiratory illness (AFRI) during that period was routed through a single channel using a uniform protocol. We retrospectively analysed the available data, during the initial four months of the pandemic, to draw lessons from it. ObjectiveTo study the prevalence, clinical profile and risk factors of swine flu among health care personnel during the pandemic of 2009 in a tertiary care hospital in South India. MethodologyThis retrospective study enrolled all the health care personnel including students of a tertiary care institution in South India, who presented with an AFRI between June to August, the initial four months of the swine flu pandemic of 2009. The clinical profile and risk factors were extracted. The results of the RT PCR for swine flu was obtained. Prevalence in each demographic group was calculated and compared. Characteristics of those with swine flu were compared with those who turned negative for the swine flu. ResultsThe prevalence of all AFRI and only swine flu among health care personnel during the study period was 18 per thousand and 8.7 per thousand respectively. Highest prevalence of swine flu was found among students and office staff. After adjusting for confounding factors, hyperthermia at presentation was significantly higher {OR = 1.97; 95% CI (1.01–3.76)} among those who tested positive for swine flu as compared with those with other AFRI's. Only 2.5% of the entire AFRI group required admission and there was no mortality. ConclusionHealth care personnel are at increased risk of acquiring infection. Our study demonstrated that students and office staff were the most susceptible. Unprotected exposure to unknown infectious patients and relatives is likely to have been an important factor. Though the mode of transmission is similar, compared to H1N1, COVID-19 is associated with different comorbidities and has significantly higher mortality. Therefore, in preparation for the COVID-19 pandemic, the personal protective equipment of the healthcare personnel need to be escalated.