Charitable Hospital Research Articles

Lipoprotein(a) as a risk factor for atherosclerotic peripheral arterial occlusive disease

Background and Aim: Peripheral arterial occlusive disease (PAOD) commonly results from progressive narrowing of arteries in the lower extremities due to atherosclerosis. The objective of this study was to measure plasma levels of Lipoprotein (a) (Lp[a]) in patients with and without clinical evidence of PAOD and find an association (risk ratio) between Lp(a) and PAOD. Materials and Methods: This study was conducted in the Department of General Surgery at Justice K. S. Hegde Charitable Hospital, Mangalore. The age and sex of the patients, clinical symptoms were noted. The study included a total of 100 patients further divided into two groups: Fifty symptomatic patients with clinical evidence and 50 age and sex-matched asymptomatic patients without clinical evidence of PAOD. History of hypertension, diabetes mellitus, and ischemic heart disease were recorded. The diagnosis basically was made by clinical symptoms and signs. Arterial Doppler/computed tomography angiogram was done only if symptoms or signs of PAOD were present. Two ml of overnight fasting blood sample was collected, serum separated, and was analyzed for Lp(a) by immune turbidometry method. Results: In patients with PAOD, Lp(a) value was 90.06 ± 23.4 mg/dl, whereas among patients without PAOD, Lp(a) values was 48.02 ± 24.1 mg/dl and was statistically significant (P

Comparison of Manual, Semi-automatedand Fully-automated Enzymatic Methods for HighDensity Lipoprotein Estimation- A Cross-sectional Study

Introduction: Spherical particles with nonpolar neutral lipids at the center and more polar amphipathic lipids at their surface are called Lipoproteins. High Density Lipoprotein (HDL) aids in cholesterol homeostasis by removing it from cells by several different mechanisms. The results of HDL Cholesterol (HDL-C) should be accurate and reliable, especially for the patients with borderline values, where the variation resulting from the methodology used may interfere with the interpretation of clinical scenario by the doctors. Aim: To compare the results of HDL values obtained by using three different technical methods. Materials and Methods: The present study was conducted using 30 serum samples from the Biochemistry laboratory of KLE Society’s Dr. Prabhakar Kore Charitable Hospital and Medical Research Centre, Belagavi, Karnataka, India for HDL values, each for the three different technical methods (fully-automated, semi-automated and manual method). The data obtained was analysed statistically by computing descriptive statistics the mean, standard deviation and correlation coefficient. Results: Results of serum samples analysed for HDL-C values ranged from 31-79 mg/dL (mean 43.1) in fully-automated analyser, 28.06-75.18 (mean 39.6) in semi-automated and 27.06-62.7 mg/dL (mean 39.7) using manual method. There was significant difference in the mean values of HDL-C values obtained using the three different methods and positive correlation was established on comparing semi-automated and manual method (Semi-automated v/s manual method, r=0.827) and found to be statistically significant. Conclusion: As HDL estimation is routinely done in many of the clinical laboratories, a sound knowledge of the HDL values obtained using different techniques can help the clinicians while ordering for the test and also for diagnosing and monitoring of the cases with various lipid abnormalities.

Effect of UGT2B7 Gene Polymorphism with Clinical Pediatric Epileptic patients on Sodium Valproate Monotherapy

Background: Pediatric epilepsy comprises of a chronic neurological disorders characterized by recurrent seizure attack. Sodium valproate is one of the common anti-epileptic drugs used in the treatment. Glucuronide conjugation is the major metabolic pathway of sodium valproate, carried out by the enzyme Uridine 5’-diphospho (UDP) glucuronosyl transferase (UGT) whose genetic polymorphisms may alter clinical outcome. Aim: To find the association between UGT2B7 genetic polymorphism and clinical outcome in terms of efficacy and tolerability in pediatric epileptic patients on sodium valproate monotherapy. Methods and Materials: In this cohort study, 75 pediatric epileptic patients aged 2-18 years receiving sodium valproate monotherapy for past one month were included from Justice K S Hegde Charitable Hospital, Mangalore, India after obtaining informed consent. Genetic polymorphism patterns of UGT2B7 (C161T, A268G, G211T) was evaluated by PCR-RFLP. Clinical outcome was measured in terms of responders and non-responders based on seizure control during the 6 month observation period. Tolerability was measured by estimating the hepatic, renal and other lab parameters. Clinical outcome in different UGT genotypes was compared by Chi square test. P value <0.05 was considered as significant. Results: Out of 75 patients, CC (41.3%), CT (38.7%), TT (20%) pattern was observed in UGT2B7 (C161T) gene, AA(14.7%), AG(42.7%), GG(42.7%) in (A268G) gene and GG(80%), GT(18.7%), TT(1.3%) in (G211T) gene. It was found that there was no statistical difference in clinical outcome with different UGT2B7 genetic polymorphism patterns. Conclusion: We conclude from our study that genetic polymorphism of UGT2B7 doesn’t have any role on the clinical outcome of epilepsy.

Markers of atherosclerotic risk in patients with non-alcoholic fatty liver disease: A preliminary study

Introduction: The prevalence of Non-Alcoholic Fatty Liver Disease (NAFLD) is rising continuously. Cardiovascular disease is one among the leading causes of morbidity and premature mortality in patients with NAFLD. Aims and Objectives: To determine the risk of atherosclerosis in NAFLD subjects diagnosed by USG at K.S.Hegde Charitable hospital. Materials and Methods:A cross-sectional study involving 203 persons diagnosed with NAFLD were included in the study. Subjects with alcoholic liver disease, renal failure, tuberculosis, hepatitis B and/or C and those on lipid lowering drug were excluded from the study. Lipid profile was measured and Atherogenic Index of Plasma (AIP) was calculated as log (TG/HDL-c). Categorization of the subjects with respect to risk of atherosclerosis was done based on serum LDL-c, non HDL-c and AIP. Statistical analysis was done using Chi Square test and p value Results: More than normal values were observed for serum total cholesterol, LDL-c, triglyceride and non HDL-c in high percentage of NAFLD subjects (76.8%, 84.7%, 70.4% and 72.4% respectively). Serum HDL-c level was low in 53.2% subjects. 51.2% of subjects had high AIP and 23.6% had moderately high AIP. Conclusion: Results of categorization of the subjects with respect to risk of atherosclerosis based on serum LDL-c, non HDL-c and AIP showed that high percentages of subjects were in moderate and high risk categories. AIP is probably a better marker to determine the risk of atherosclerosis. Keywords: Atherogenic index of plasma, NAFLD, Non-alcoholic fatty liver disease, Lipids, Cardiovascular.

Relationship between ischemia modified albumin and lipid profile in type 2 diabetes mellitus

Introduction: Ischemia modified albumin (IMA), is new biomarker of oxidative stress and ischemia. IMA being increased in Diabetes Mellitus has been described in many studies. Diabetes Mellitus (DM) a metabolic disorder is characterised by hyperglycemia, hypertension and hyperlipidemia. So, our aim was to estimate the levels of IMA in type 2 DM subjects. Also to evaluate the relationship of IMA with all the parameters in lipid profile (TC, LDL, HDL, TG) in type 2 DM subjects. Materials and Methods: 120 subjects were selected from the medicine OPD of Justice K S Hegde Charitable Hospital, Mangalore for study. The subjects attending the hospital were from coastal areas of southern India. Out of which 60 subjects were type 2 DM patients as per the ADA guidelines and 60 subjects were age and sex matched controls. The biochemical parameters estimated were FPS, 2hr-PG, HbA1C, Lipid profile (TC, TG, LDL, VLDL, HDL) and IMA. The results were expressed in absorbance units (ABSU). Data obtained was analyzed using SPSS 20. Results: The Fasting and postprandial plasma glucose, HbA1c, serum TG, TC, LDL, HDL, IMA were significantly increased in type 2 DM patients than in control subjects with the p value Conclusion: The present study suggests that measuring IMA in dyslipidemic diabetic patients will provide an early index of ischemia and its severity. This would help in the better management and prognosis of DM. Keywords: Hyperglycemia, Hyperlipidemia, Type 2 Diabetes mellitus, IMA.

Lifestyle InterVention IN Gestational diabetes (LIVING) in India, Bangladesh and Sri Lanka: protocol for process evaluation of a randomised controlled trial

IntroductionThe development of type 2 diabetes mellitus disproportionately affects South Asian women with prior gestational diabetes mellitus (GDM). The Lifestyle InterVention IN Gestational diabetes (LIVING) Study is a randomised controlled...

Spectrum of disorders presenting as secondary Parkinsonism in a rural based medical teaching college in Western India

Objective: To evaluate the different etiologies amongst patients presenting with secondary parkinsonism in a rural medical charitable teaching hospital in Western India.

HEALTH RELATED QUALITY OF LIFE OF CHILDREN WITH THALA SSEMIAAT TERTIARY CARE HOSPITAL IN BELAGAVI.- A CROSS SECTIONAL STUDY

A study was conducted on 90 children suffering with thalassemia who are attending thalassemia unit of KLES Dr. Prabhakar Kore Charitable Hospital Belagavi. To assess the health related quality of life of children with thalassemia and to find out the association between health related quality of life of children with Thalassemia and selected demographic variables. Purposive sampling technique was used to select the samples. Data was collected using standardized paediatric inventory quality of life (PedsQL 4.0 Generic Core Scales) tool. Data obtained was tabulated and analysed in terms of objectives of the study using descriptive and inferential statistics. The study revealed that Majority 70 (77.78%) of thalassemia children had average level of quality of life where as minimum 10 (11.11%) of thalassemia children had low and high level of quality of life. The association between age groups and levels of QOL is found to be not statistically significant (Chi-square= 6.3530, p=0.1740) and the association between religions and levels of QOL is found to be not statistically significant.

Preparedness, administrative challenges for establishing obstetric services, and experience of delivering over 400 women at a tertiary care COVID-19 hospital in India.

ObjectiveTo provide a descriptive account of the challenges and administrative preparedness for establishing and sustaining safe obstetric services during the COVID‐19 pandemic at Topiwala National Medical College & BYL Nair Charitable Hospital (NH), Mumbai, India.MethodsThe management of pregnant women with COVID‐19 was implemented as per international (WHO, RCOG, ACOG) and national (Indian Council of Medical Research) recommendations and guidelines at an academic, tertiary care, COVID‐19 hospital in India.ResultsUsing a multidisciplinary approach and active engagement of a multispecialty team, obstetric services were provided to over 400 women with laboratory‐confirmed COVID‐19. A sustainable model is established for providing services to pregnant women with COVID‐19 in Mumbai Metropolitan Region, India.ConclusionWith limited resources, it is possible to set up dedicated maternity services, aligned to international guidelines, for safe pregnancy outcomes in COVID‐19 settings. This COVID‐19 hospital addressed the challenges and implemented several known and novel methods to establish and sustain obstetric services for women with COVID‐19. The model established in the present study can be replicated in other low‐ and middle‐income countries.

Knowledge of Antenatal Mothers Regarding Human Milk Banking

Introduction: Background: Breast milk is the perfect food and uniquely superior to, artificial baby milk. Giving a child breast milk from another woman is not a newer concept; wet nursing was a fairly common practice a few decades ago. Human milk banks are services which collect, screen, process and distribute donated breast milk. Current research evidences suggest that pasteurized donor human milk can provide many of the components and eliminate the risk of transmission of infectious agents. Method: Quantitative research approach was adopted to assess the knowledge on Human Milk Banking; a structured knowledge questionnaire was given to100 antenatal mothers. The study was conducted at Justice K.S Hegde charitable Hospital. Descriptive survey design was adopted to accomplish the objectives. Results: Findings revealed that 52% of mothers had good knowledge and remaining mothers had an average knowledge. The ‘p’ value of age with regards to knowledge on human milk banking is 0.099, whereas the ‘p’ value of parity is 0.718. Meanwhile the ‘p’ value of family is 0.213 and that of religion is 0.428. For education, occupation, income and any previous exposure with human milk banking the ‘p’ values were 0.284, 0.082, 0.104 and 0.750 respectively. The above results shows that for all the demographic characteristics, the ‘p’ value is &gt;0.05. Hence it was found that there was no significant association between knowledge of antenatal mothers with selected demographic variables. Conclusion: Providing knowledge to antenatal mothers on human milk banking serve as an investment for the future needs. The nurse practitioner has a primary responsibility of enhancing the knowledge and developing positive attitude, towards utilization of human milk banking.

The powers of masculinization in humanitarian storytelling: the case of the surgeon María Gómez Álvarez in the Varsovia Hospital (Toulouse, 1944–1950)

ABSTRACTThis contribution is focused on analysing the power of ‘masculinization’ through which traditional humanitarian storytelling has been shaped. Strongly marked by a patriarchal vision, humanitarian accounts have traditionally hidden the work of women while stressing that performed by men, who appeared represented as true protagonists and, even, as heroes. In particular, this article analyses the professional career of a Spanish female surgeon named María Gómez (1914–1975) between 1944 and 1950, when she worked in a small charitable hospital based in Toulouse (France) for improving the health-care conditions of Spanish Republican refugees. Known as Hospital Varsovia or as Walter B. Cannon Memorial Hospital in the United States, it was supported by several humanitarian agencies, such as the Unitarian Service Committee (USC) and the Joint Anti-Fascist Refugee Committee (JAFRC). In order to get funds, both entities filmed a propaganda documentary in 1946, Spain in Exile, which deliberately ignored Gómez’s work as a surgeon in this hospital. By examining this visual record, this article attempts to reconstruct the life and the professional career of this female physician, which was at the crossroads of the Spanish Civil War, the Second World War and the ideological polarization emerging in the Cold War period.

Pharmacoeconomic Evaluation on Treatment of Diabetic Patients in a Charitable Hospital

This study aimed to conduct a pharmacoeconomic evaluation of the treatment of diabetic patients in a charitable hospital. A retrospective study was carried out for a period of 8 months from August 2016-March 2017. Patients admitted in general medicine with age above 18 years diagnosed with diabetes and on at least one antidiabetic medication. Patient’s data was collected by referring patient’s treatment charts and case notes, hospital billing system, medical record department and hospital pharmacy department. In this study, the direct medical cost was analysed. A total number of 212 diabetic patients were enrolled in the study of which 131 (61.8 %) were males, and 81 (38.2 %) were females. It was found that 67 % of patients had comorbid conditions and 33 % without any complications. One hundred and eleven (52.35 %) patients were prescribed a combination of insulin and oral hypoglycaemic agents, 66 (31.13 %) patients received insulin alone and 35 (16.50 %) patients received only oral hypoglycaemic agents. The annual median cost incurred for the management of diabetes with and without complications per patient was INR 14 959.60 and INR 8619.90, respectively. The study revealed that the costs for males with and without diabetes complications were INR 21 095 and INR 11 644.70, respectively. The corresponding figure for females was INR 12 030 and INR 8515. The cost incurred for nephropathy and peripheral circulatory co-morbidities was the highest (INR 53 795.50), whereas the cost for managing diabetes with nephropathy, neuropathy, retinopathy and peripheral circulatory comorbidities was INR 37 888.00. The study concluded that the cost of treatment could be drastically reduced by early identification and treatment of diabetes thereby preventing the development of diabetes-associated comorbidities.

A pharmaco-epidemiological study of psoriasis

Background: Psoriasis is a chronic relapsing disease necessitates long-term therapy. The disease severity, comorbidities, and access to health care determine the choice of therapy for psoriasis. The main aim of the treatment of psoriasis is to induce prolonged remission and suppress the disease as there is no cure. It is only palliative and symptomatic treatment, and the choice of treatment modality is according to the type of presentation. The various modalities of treatment available include topical therapies, systemic therapies, phototherapy, and biologics. The difference includes among clinical varieties in their presenting features, severity, natural course, and response to the treatment are responsible for variation in choice of therapy.Methods: In this descriptive study, data collected from patients diagnosed with psoriasis who were admitted in a K.S. Hegde Charitable hospital from January 2017 to January 2019 were analysed for demographic features, disease pattern and drug use pattern in patients.Results: Psoriasis vulgaris/plaque type of psoriasis was commonly observed type of psoriasis in our patients with fourth and fifth decade patients getting more affected. Diabetes was the most commonly associated comorbid disorder. The patients were treated both with systemic and topical modalities of treatment, antihistaminic and methotrexate were most commonly most commonly used systemic drug and moisturizers and glucocorticoids were used topical drugs.Conclusions: Psoriasis needs a multimodality treatment with careful monitoring for the comorbid disorder. Treatment choice is individualised depending on the severity and body parts affected.

Noncommunicable diseases among nursing professionals at a charitable hospital in Southern Brazil.

to describe the prevalence of noncommunicable diseases (NCDs), long term (current) drug therapy, blood pressure levels and capillary glycemia among a nursing team at a charitable hospital in Pelotas/RS. This was a cross-sectional study. The questions were adapted from the Vigitel system questionnaire (Telephone Surveillance of Chronic Disease Risk and Protection Factors). All participants had their blood pressure and blood glucose measured. Of the 272 staff assessed, 29.4% reported having NCDs, 48.9% were on long term (current) drug therapy and 73.9% reported a family history of NCDs. Among those interviewed, 20.6% reported using antihypertensive drugs, of these 27.7% had high blood pressure levels, and 2.6% reported using antihypoglycemic agents, 42.9% of whom had high blood glucose. Among those professionals who stated they had high blood pressure and diabetes, those who were on medication had higher blood pressure and glucose levels than those who were not on medication.

Prevalence of Potential Drug-Drug Interactions in the Intensive Care Unit of a Tertiary Care Hospital: A Cross-Sectional Study

Objective: To analyze the various Potential Drug-Drug Interactions in ICU patients with the ultimate goal of raising awareness among clinicians on safe medication usage. Materials and Methods: This was a Cross-sectional study conducted at the K.S. Hegde charitable hospital. The medical records of the patients admitted to the ICU of the hospital from January 2017 to June 2017 formed material for the study, were analyzed using the database from Lexicomp ® Solutions android mobile application for Potential Drug-Drug Interactions. Results: Among the 176 patients,81.39% had Potential Drug-Drug Interactions, with cardiovascular drugs (22.6%) being the majority group followed by respiratory drugs (17. 97%). Among these 73.2% of the interactions were clinically relevant with the majority being moderate (72.26%) in severity with fair (72.6%) documentation and belonging to Category C (61.080%) in risk rating. The pharmacodynamics type of interactions was more (59.31%) than pharmacokinetic type (36.13%). Conclusion: The high prevalence of Potential Drug-Drug in the ICU setting emphasizes the need for effective medication management and pharmacological consultation to reduce the adverse effect and improve the therapeutic outcome in these patients. Key words: Potential Drug-Drug Interactions, Severity, Documentation, Risk rating.

Relation of Menarche, and Breast and Ovarian Cancer in Women

AbstractCancer is one of the leading causes of death in India and it has become an important public health problem, with more than 800,000 new cases being reported every year. In India, the most frequent cancers usually seen among women are those of cervix, uterus, breast, ovary, lip, oral cavity, and esophagus. Among these, breast and ovarian cancer are seen frequently in Indian women. The study is aimed at finding the relationship of menarche with breast and ovarian cancer, and also determining the association between types of cancer and selected demographic variables. A descriptive study was conducted on a sample consisting of 100 participants at the Justice K.S Hegde Charitable Hospital, Mangaluru. The result showed that majority (56%) of the sample experienced their first menarche at less than 13 years and had no family history of breast or ovarian cancer. Among the 100 women, 62% were diagnosed with breast cancer. There is a significant association between types of cancer and age. The p-value is 0.027 at (p &lt; 0.05) level of significance. The study concluded that there is a significant association between types of cancer with age.

Patient Health Seeking and Diagnostic Delay in Extrapulmonary Tuberculosis: A Hospital Based Study from Central India.

Objective We aimed to investigate the awareness, health care seeking behavior, and diagnostic delay in extrapulmonary tuberculosis (EPTB) in a resource-constrained setting from Central India. Setting and Method Questionnaire based interview of 1220 EPTB patients ≥14 years of age was conducted between July 2004 and August 2012 at Ujjain charitable Hospital, Ujjain, India. Results Only 15% of patients had ever heard about EPTB and 2-4% knew about its prevention or treatment. Only 12% patients first sought medical advice while 49% patients practiced self-medication, 28% consulted traditional healers and 11% drug store/pharmacy. The median patient delay was 8 weeks (4.6-21.4 weeks). Majority (78%) of patients visited ≥3 health centers. Thirty-eight percent patients first visited any government health facility. Majority (97%) who first visited district and primary public health center were referred to private sector for investigations and 82% patients changed the consultation to private doctor after initial visit to public hospital. The median health system delay was 7 weeks (0.6-16.4 weeks). Conclusion Patients had very poor awareness of EPTB. Patients were referred from public to private sector in search of diagnostic facilities. Improvement of public awareness about EPTB and better public-private partnership may contribute towards reduction in diagnostic delay.

Drug utilization evaluation of anticancer drugs in a charitable hospital

Abstract Background: Evaluating the prescribing patterns of anticancer and supportive care drugs is necessary for ensuring effectiveness and patient's quality of life. Aim: This study aims to evaluate the prescribing patterns in patients receiving chemotherapy. Settings and Design: A prospective observational study was conducted in the Department of Medical Oncology at Justice K. S. Hegde Charitable Hospital. Methods: The study was conducted for 8 months from September 2017 to April 2018. Cancer patients who were above 18 years and are on chemotherapy along with supportive care medications were enrolled. Statistical Analysis: Data were analyzed using descriptive statistics. Continuous data were expressed as mean ± standard deviation, and the nominal data were expressed as frequency and percentages. Results: Among 230 patients, majority of patients were in the age group of 45–60 years (47%), females (51.7%), Stage III (51.3%), solid tumor (85.5%), breast cancer (21.7%), doublet regimen (60.4%), who received doxorubicin and cyclophosphamide (36%) in breast cancer while paclitaxel and carboplatin (16.52%) were mostly prescribed among the different cancer types. The most commonly prescribed supportive care medications were dexamethasone (100%), ranitidine (100%), filgrastim (67.4%), tramadol and paracetamol (23.91%), and levofloxacin (9.56%). The percentage of drugs prescribed from the National List Essential Medicine and the World Health Organization (WHO) model list was 80.84% and 78.92%, respectively. Conclusion: According to the WHO core prescribing indicators, the average number of drugs per prescription was 9.63. Majority of the cancer patients were prescribed with paclitaxel and carboplatin (16.52%); dexamethasone and ranitidine (100%) were coadministered in all patients during their chemotherapy cycles.

Cytopathologic study of lymphadenopathy in tertiary care charitable hospital at Jalgaon: A retrospective study

Cytopathologic study of lymphadenopathy in tertiary care charitable hospital at Jalgaon: A retrospective study

Nutritional Assessment of Tribal Women in Kainatty, Wayanad: A Cross-Sectional Study.

Introduction:Women from a society reflect the culture that they are a part of and tribal women are the most disadvantaged considering the levels of illiteracy and ignorance. As per the National Family Health Survey 4 reports, in Kerala, undernutrition is particularly common among women from scheduled tribes, 20%. This study was done to assess the nutritional status and its associated factors among tribal women in the reproductive age group at Wayanad.Materials and Methods:A hospital-based cross-sectional study was carried out during January 2017 at Amrita Kripa Charitable Hospital in Kainatty, Wayanad. The minimum calculated sample size was 186. Using systematic random sampling, every third tribal woman in the age group of 15–49 years attending the general outpatient department as patient or bystander was interviewed using a pretested semi-structured questionnaire and examined for height, weight, body mass index, and pallor. Data were analyzed using SPSS version 21.Results:Data were collected from a total of 223 study participants; 53.8% of them were undernourished (<18.5 kg/m2) with 25% severe underweight and 3.1% and 2.7% preobese and obese women. Participants who were <30 years of age (0.001), those who used smokeless tobacco (0.008), and women from the Paniya tribe 0.001 had significantly higher odds of undernutrition.Conclusion:Almost one-fourth of the study participants were severely undernourished and 5.8% belonged to obese and preobese categories, thereby indicating the gravity of the nutritional difficulties among tribal women. A well-planned and coordinated effort is needed to address the scenario of malnutrition among tribal women.