Department Of Tertiary Care Hospital Research Articles

A Quality Improvement Project: Development and Implementation of a Modified I-PASS Handover in the General Surgery Department of Tertiary Care Hospital in Pakistan

Introduction: In tertiary care settings, multidisciplinary teams are responsible for providing hi-tech, state of the art health care to the patients, which is impossible without a transparent, accountable communication system within and between teams, i.e. the patient handover. Aims & Objectives: This project aimed to introduce a handover document, based on handover best practices, in the General Surgery Department of Shaikh Zayed Hospital, Lahore, and improve it over time to make it compatible with the unique local demands. Place and duration of study: From 01 October 2019 to 30 March 2020 in General Surgery Department of Shaikh Zayed complex, Lahore, Pakistan. Material & Methods: The need for an official and standard handover for the general surgery department was discussed with a few stakeholders. Upon a thorough search of the literature, a slightly modified version of the I-PASS handover system was introduced. It contained items such as Biodata, diagnosis, active complaint, management, tasks to be done, potential risks, verbal handover and severity of the disease. Before the introduction of handover documents, a training session was held with three residents. Six months after the handover was introduced, qualitative feedback was collected from trainee residents and consultants in the General Surgery department. Results: Results showed compliance of 80% by residents (n=20), perceived improvement in patient safety standards and better organization of patient data by 95% of respondents (n=20). First Plan, Study, Design, Act cycle was completed. A second PSDA cycle was initiated. A new form of I-PASS handover system, based on feedback, was put in place in the General Surgery Department. Conclusion: This undertaking has fulfilled one of the recommendations of the Joint Commission and WHO to improve patient safety, and it also demonstrates that a structured handover improves the transfer of information among residents, minimizes errors and help avoidance of negligence.

The Success Rate of Endotracheal Intubation in the Emergency Department of Tertiary Care Hospital in Ethiopia, One-Year Retrospective Study.

Background Emergency medical care starts with airway assessment and intervention management. Endotracheal intubation is the definitive airway management in the emergency department (ED) for patients requiring a definitive airway. Successful first pass is recommended as the main objective of emergency intubation. There exists no published research regarding the success rates or complications that occur within Ethiopian hospitals emergency department intubation practice. Objective This study aimed to assess the success rate of emergency intubations in a tertiary hospital, Addis Ababa, Ethiopia. Methodology. This was a single institute retrospective documentation review on intubated patients from November 2017 to November 2018 in the emergency department of Addis Ababa Burn Emergency and Trauma Hospital. All intubations during the study period were included. Data were collected by trained data collectors from an intubation documentation sheet. Result Of 15,933 patients seen in the department, 256 (1.6%) patients were intubated. Of these, 194 (74.9%) were male, 123 (47.5%) sustained trauma, 65 (25.1%) were medical cases, and 13(5%) had poisoning. The primary indications for intubation were for airway protection (160 (61.8%)), followed by respiratory failure (72(27.8%)). One hundred and twenty-nine (49.8%) had sedative-only intubation, 110 (42.5%) had rapid sequence intubation, and 16 (6.2%) had intubation without medication. The first-pass success rate in this sample was 70.3% (180/256), second-pass 21.4% (55/256), and third-pass 7.4% (19/256), while the overall success rate was 99.2% (254/256). Hypoxia was the most common complication. Conclusion The intubation first-pass success rate was lower than existing studies, but the overall intubation success rate was satisfactory.

Quantitative association of educational status and effect of patient counseling among cancer patients: A cross-sectional analysis in a tertiary care hospital in South India.

Patient Counseling is desirable in chronic disease condition which is influenced by innumerable predictors. Educational status is one of the primary predictor which is usually ignored while considering the effect of patient counseling in cancer patients. Therefore, this study was aimed to determine the measure of association between education level and patient counseling among cancer patients. In the cross-sectional analysis, 90 cancer patients in inpatient setting at Oncology department of tertiary care hospital in South India were examined for a 24-week period through pharmacist-patient interview. The data were recorded in well-customized and validated data collection form. Bivariate analysis and linear regression analysis were performed using IBM SPSS Statistics 16.0, USA to assess the empirical relationship between the two determinants: education level and patient counseling. The study participants were aged between 11 to 80 years with 7:11 male to female ratio. Among 90 interviewed patients, 83.3% were counseled. Linear regression analysis demonstrated significant association between education status and patient counseling (p < 0.05). The study findings suggest that poor education status can be a barrier to patient's ability to seek and act on the counseling provided by the health care professionals. Thus, it recommends improvisation of counseling practice on patients from different educational divisions.

Burden and baseline characteristics of patients with decompensated liver disease in Tertiary Care Hospital Gujrat.

Objective: To determine the load, clinical and laboratory findings of the patients with decompensated cirrhosis admitted in medical department of tertiary care hospital and to make plan for the improvement of these patients. Study Design: Cross Sectional study. Setting: Department of medicine of Aziz Bhatti Shaheed Teaching Hospital, Gujrat. Period: from 1st January 2019 to 31st March 2019. Material &amp; Methods: All 964 patients who were admitted included in study, clinical and laboratory features of patients with decompensated cirrhosis were recorded. Results: Male were in majority (53.7%), median age was 39 years. Decompensated cirrhosis was found in 216 (22.4%), patients due to complication of Diabetes Mellitus were 170 (17.6%), COPD &amp; Asthma was found in 130 patients(13.5%), Stroke &amp; Hypertension in 126 patients while Gastroenteritis 6% and infectious diseases RTI, UTI, Enteric Fever etc were present in 46 patients. Among 216 patients, one hundred &amp; seventy eight were Hepatitis C Positive, fifteen had Hepatitis B, and eight had history of alcohol consumption. Seven patients were both Hepatitis B and C positive while in 3.6% etiology was other than mentioned above. Ascites was noted in two hundred six patients, 36.5% had variceal bleed while 51 admitted due to encephalopathy. Conclusion: HCV related cirrhosis and its complications like upper GI bleed, encephalopathy, ascites and hepatoma are major burden on our hospitals and need special attention.

Assessment of Patients’ Understanding about Prescribed Medications at Outdoor Patient Department of Tertiary Care Hospital in Central Gujarat, India

Medication is an important part of a patient's treatment by clinicians and is one of the measures taken by them during the entire period of treatment. This descriptive cross-sectional study aims to assess patients’ understanding about prescribed medication obtained after consultation with clinicians at the outdoor patient department of a tertiary care hospital in central Gujarat, India. 184 patients from different clinical departments were interviewed after their consultation with the clinician. Majority of the subjects (45.5%) were 25-44 years of age, while the rest ranged from 45-54 years of age group. Furthermore, 55.5% of the subjects were female, 20.4% were Illiterate people, and 32.5% were educated up to primary level. The results showed that 84.3% of the patients were informed about proposed treatment duration, while 13.9% were informed about diet relation. Therefore, the patients had fair knowledge about the disease they were suffering from and proposed duration of treatment, but they were not aware of about the line of treatment. In conclusion, patients need to be educated about the correct use of medications by clinicians.

Clinical profile of hypoglycemia in emergency department of tertiary care hospital: A single center study

Background: Hypoglycemia is an endocrine emergency which presents with a variety of symptoms ranging from impaired cognitive function to convulsions, coma and death. This study would ascertain the causes, and also the frequency of presentation of hypoglycaemia in subjects presenting to a city accident and emergency department of a tertiary care hospital. Methodology: A retrospective review of records of case papers of hypoglycemic cases (HGT/RBS

High D-dimer is a predictor for short-term mortality in patients with active cancer and acute pulmonary embolism

Objectives: Acute pulmonary embolism (PE) is the main cause of death in cancer patients, but there are limited prognostic tools for the patients with active cancer and acute PE. We aimed to identify prognostic factors of 30-day mortality in patients with active cancer and acute PE. Methods: This retrospective observational study included all adult patients aged ≥18 years with active cancer and acute PE from February 2017 to February 2019 at the emergency department in tertiary care hospital, Seoul, Korea. The primary outcome is 30-day mortality. Results: A total of 178 patients were included with a mean age of 63.9 years (SD 10.4) and males of 52.8%. The overall 30-day mortality rate was 30.9%. In a multivariable logistic analysis, high D-dimer, defined as ≥median value of 14.7 µg/mL, with odds ratio (OR) 2.47 (95% confidence interval [CI], 1.15–5.33), high Pulmonary Embolism Severity Index (PESI) scores with OR 2.95 (95% CI, 1.21–7.75) for class IV and OR 2.90 (95% CI, 1.06–7.90) for class V, and Eastern Cooperative Oncology Group (ECOG) performance status 3/4 with OR 3.22 (95% CI, 1.18–8.76) were independent predictors of 30-day mortality. Conclusion: High D-dimer values, high PESI scores, and poor ECOG performance status may be reliable predictors of mortality in patients with active cancer and acute PE.

Drug utilization evaluation of psychotropic drugs in the psychiatry in-patient department of Tertiary care hospital

Objectives: To study the prescription pattern of psychotropic drugs in different psychiatric disorder. Methodology: The prospective observational study was conducted in 100 psychiatric in-patients at a tertiary care hospital in Bangalore. Study was conducted on gaining approval from the institutional human ethical committee. All patients who meet the study criteria were enrolled in to the study after taking the informed consent from the patients or their legal representatives. The demographic, clinical and medications data were documented into a specially designed case report form. All the data was analyzed using descriptive statistics. Results and Discussion: In 100 study subjects 194 different psychotropic drugs were prescribed. Among 194 psychotropic drugs 38.14% were sedatives and hypnotics, 36.08% were antipsychotics, 18.55% were antidepressants and 7.21% were mood stabilizer. Conclusion: This study found that schizophrenia was the most common illness in psychiatric patients. Male patients were more prone to psychiatric disorders than female. Most of the study populations were non-alcoholic and non-smokers. Sedatives and hypnotics of benzodiazepine class were found to be the most commonly used drugs followed by antipsychotics, anti-depressants and mood stabilizers in the studied population. Future studies to evaluate the drug utilization evaluation of psychotropic drugs in large patient populations are much needed to promote patient safety and increase the quality of psychiatric patients.

Clinical Profile of Pediatric Tuberculosis, Presenting to the Emergency Department of Tertiary Care Hospital in Karachi, Pakistan.

Abstract Background Tuberculosis (TB), a preventable airborne infectious disease, early detection is essential to improve health outcomes. Extent of childhood tuberculosis is unknown and is estimated to be around 6% of all incidences. Diagnosis of pediatric tuberculosis is always difficult and no age is spared, however, children &lt;5 years are more at risk. Children frequently admitted through emergencies of hospitals with different working diagnoses and later diagnosed as tuberculous. Despite multiple studies from Pakistan; the complex and multifaceted ED presentation of childhood tuberculosis was not looked in. Primary objective was to assess the clinical profile of tuberculosis patients presenting to ED, the secondary objective was to evaluate the relation of BCG vaccination, history of contact, and measles. Methods This was a retrospective chart review of children admitted to the study center with the discharge diagnosis of Childhood Tuberculosis from June 2010 to June 2015 as per WHO criteria. Patient demographic characters, medical history, and physical examination findings in ED along with vital signs and laboratory variables will be recorded from the charts. CXR, CBC, ESR, sputum analysis, and lab other parameters were recorded from an electronic database. Results We enrolled 264 children, majority, 139 (53%) were below 5 years of age, 152 (58%) males, 112 (42%) females. BCG vaccination was given to 81 (30%) male and, 60 (23%) female children. 183 (69%) children had pulmonary symptoms, 81 (31%) had extra extrapulmonary tuberculosis. The commonest extrapulmonary manifestation was GIT 34 (13%), followed by CNS 27 (10%) cases. Cough was found in 54 (31%) followed by respiratory distress 49 (27%), almost all of them were below 5 years of age. CXR was performed in all cases, 85 (32%) didn’t have radiological findings. The frequency of BCG vaccination status, history of contact, measles about age gender, and systemic involvement was also analyzed and found significant results. 23 children, had a history of contact and measles both. Miliary was found in 6 (26%) cases, however, 22 (99%) of 23 didn’t have BCG vaccination. History of weight loss was found in 46 (33%) who either didn’t get BCG vaccination or didn’t remember (no BCG scar, 123), out of 92 children with weight loss 31 (34%) have contact history. Conclusion Diagnosing childhood tuberculosis in emergency with vague/overlapping clinical presentations is a dilemma. Clinical scoring system may not identify most cases, hence suspicion must be high in all suspected cases with prolonged history, contact tracing methods, weight loss or failure to gain weight, etc.

Isolated Proximal Ureteric Injury after a Penetrating Stab Wound to Lumbar Region

Urological injuries fall far behind other abdominal injuries when it comes to involvement during trauma. Amongst urological trauma, ureteral injuries account for 1-2.5%. An isolated ureteral injury is infrequently encountered because of a safe retroperitoneal location and a smaller diameter of the ureter as compared to other organs. A high index of suspicion is needed as a delayed or missed diagnosis of penetrating ureteral trauma or an unrecognised and mismanaged ureteral injury can lead to significant complications, including formation of urinoma, abscess, ureteral stricture or urinary fistula, and potential loss of the ipsilateral kidney. The present case report is of a 35-year-old male who presented to the Emergency Department of tertiary care hospital with a stab injury in left lumbar region and was diagnosed with isolated ureteral injury on Contrast Enhanced Computed Tomography (CECT). Without much delay, ureteroscopy was done, a double J stent was placed and ureteroureterostomy was performed.

Magnitude of patients' satisfaction with nursing care in 152 patients of tertiary care hospital; A cross sectional descriptive study

Aim: Purpose of the study is to determine the magnitude of patient satisfaction with nursing care in tertiary care hospital of Peshawar.Materials and Methods: A cross-sectional descriptive study was conducted in inpatients’ department of tertiary care hospital of Peshawar. Using non probability convenient sampling technique patients were sampled. Study was completed in six months duration. Data was collected through Patient Satisfaction with Nursing Care Scale (PSNCS); self administered semi-structured questionnaire from patients aged 20 and above and who had spent at least two days receiving nursing care in wards. Data was analyzed by SPSS version 19.Results: The level of patients’ satisfaction measured with ten dimensions. Findings showed that satisfaction rate by warm welcome of nurses was 67.8%, orientation from ward environment was 75.5%, and work collaboration of nurses was 92.8%, in care provision, to provide prior information regarding any procedure was 82%, in collaborative communication was 89.9%, in unavoidable attitude and listening were 92.1%, nurses knowledge and skill and performance was 84.2%.Conclusion: Overall study results showed that patients were satisfied from nursing care they received but some aspects i.e. welcome by nurses and environment of ward still need improvement. Patients feel uncertain about their upcoming tests and treatment by health care provider so study suggests that nurses should welcome them warmly and ward environment should be clean, calm and friendly which can help in decreasing patients’ uncertainty.

Sociodemographic, clinical profile, and psychiatric morbidities among patients with attempted suicide in a tertiary care center: A study from Central India.

Background:Suicide is a major public health concern and is considered one of the leading causes of death globally. Previous suicidal attempts can be considered as a predictor of underlying psychiatric illness. Identifying factors behind suicidal attempt can help mental health professionals for early diagnosis and treatment as well as designing effective suicide prevention strategies.Aim:The aim of the study is to assess sociodemographic, clinical characteristics, and prevalence of psychiatric morbidities among patients with attempted suicide.Methods:A cross-sectional study was conducted in the emergency department of tertiary care hospital; patients of attempted suicide attending emergency from January 1, 2014, to January 1, 2020, constituted the sample for the study. Data were collected using semi-structured questionnaire which contained sociodemographic and clinical variables. All the subjects were administered mini-international neuropsychiatric interview (MINI), MINI Kid was applied for subjects <18 years, and MINI Plus was applied for subjects above 18 years. Patients were diagnosed according to the ICD-10 Classification of Mental and Behavioral Disorders for research.Results:Suicide attempt was seen more commonly in males, and the most common age group is between 21 and 40 years residing in urban settings. The most common method was consumption of unknown substances (75.35%). Factors leading to suicide are multidimensional in nature. 30.4% of the patients had impulsive traits. 86.5% of people who attempted suicide had a history of psychiatric illness. Detailed assessment of patients for psychiatric illness and psychosocial factors is crucial for planning suicide prevention strategies and policymaking.Conclusions:Young population is at high risk for suicide. More than 80% of these have diagnosable psychiatric illness.

Evaluation of Routine Coagulation Parameter in Suspected Acute Myocardial Infarction Patients Attending Emergency Department of Tertiary Care Hospital

Introduction: Heart attack in medical terminology is generally called as Acute Myocardial Infarction (AMI). When blood flow is abruptly cut-off to the heart muscle, it damages the myocardial tissue. This could be the consequence of blocked coronary arteries. The plaque formed due to the deposition of cholesterol and other fatty material over a period of time is the leading cause of this blockage. Aim: To assess the level of Prothrombin Time (PT) and activated Partial Thromboplastin Time (aPTT) in cardiac and non-cardiac chest pain and their association to Body Mass Index (BMI). Materials and Methods: The present study was an observational case-control type of study which included 100 subjects of age group 30-65 years from March 2019 to April 2020. Out of them 50 were non-cardiac chest pain individuals which were control and 50 Cardiac chest pain arrived within 6-8 hours of chest pain who suspected to be Myocardial Infarction (MI) from Emergency Department, Dhiraj General Hospital, Gujarat, India. BMI was calculated by height and weight. PT and aPTT analysis was carried out using STAGO-S.A.S. coagulation analyser. Results: There were increased levels of PT and aPTT (statistically significant) in AMI cases compared to corresponding age and sex matched controls (p&lt;0.0001). Pearson correlation analysis in AMI patients, a slightly positive correlation between BMI and aPTT was observed (r=0.19, p&lt;0.001) and also between PT and aPTT (r=0.66, p&lt;0.001). Conclusion: There was a slightly positive correlation found between BMI and aPTT which indicated that the weight and height of the patients do not affect the plasma PT and aPTT levels on anticoagulant therapy.

Patterns of Diabetic Patients visit in Emergency Department in Tertiary Care Hospital

Introduction: Diabetes mellitus is a global health problem with increasing incidence worldwide in an epidemic form including Nepal. This chronic disease leads to many complications, hospital admissions and premature morbidity and mortality. This study aimed to study the cause and number of emergency visits and to evaluate the rate and duration of hospitalisation among diabetic patients who visit the emergency department&#x0D; Method: This was an observational cross-sectional study including 98 diabetic patients of &gt;18 years presenting to emergency department of KIST medical college and teaching hospital between January 2020 to June 2020. The number and reason of emergency visits as well as number and duration of hospitalization was recorded in a semi structured proforma. The data entry was done in Microsoft Excel and analysis was done using the SPSS 24.&#x0D; Result: While 61 cases (62.2%) of this sample utilized the emergency department (ED) services in last 12 months’ period, 32.7% reported using ED once and 23.5% used 2-3 times and only 6% of the subjects had visited emergency more than 4 times within 12 months. Heart disease (18.1%) and infections (18.1%) were the most common reason for ED visit. There were 62 (63.3%) admissions from ED, 32.2% patients were hospitalized for 1-3 days, 50% were hospitalized for 3-7 days and 17.8% stayed for 1-2 weeks’ duration in the hospital.&#x0D; Conclusion: Majority of the diabetic patients had utilized ED more than once in past 12 months and the most common cause was found to be related to cardiac illness and infections. More than half of the diabetic patients visiting ED were admitted for mostly 3-7 days’ duration.

Retrospective study of bacteriological profile and their antibiotic sensitivity pattern in urine of pediatric patients (0-12 years) in a tertiary care hospital of South Gujarat

Urinary Tract Infections are common bacterial infections in pediatric age group. The diagnosis of UTI is very often missed in lower pediatric age group due to minimal and nonspecific symptoms. Etiological agents of UTI are variable and commonly depend on time, geographical location and age of patients. However E.coli and Klebsiella pneumoniae account for most of the cases. Present study aims at to determine prevalence and to evaluate changing trends of etiology and antibiogram of urinary isolates in children of 0-12 year age group attending Tertiary care hospital, of South Gujarat. A retrospective study was carried out in the Microbiology department of Tertiary care hospital of South Gujarat including all indoor pediatric patient’s urine samples received over duration of 6 months. Urine samples were processed according to routine protocol of the microbiology laboratory. Different bacterial isolates from urine samples were identified by using various biochemical reactions. Antibiotic-Susceptibility Testing was done using Kirby bauer disc diffusion method according to CLSI guidelines, 2018 for particular year. Qualitative data were presented as a proportion. Total 59 samples showed bacterial growth out of 595 indoor pediatric urine samples. Gram positive cocci were the predominant causative group of pediatric UTI accounting for 52.45%. Whereas Gram negative bacilli were 47.54%. Enterococcus group was the predominant etiological agent for 45.90% with maximum resistance to Primary line of drugs like Penicillin G and Ampicillin.Drug resistance pattern amongst urinary isolates of pediatric patients indicates that antibiotic selection should be based on knowledge of the local prevalence of bacterial organisms and antibiotic sensitivities rather than empirical treatment.

A Randomised Controlled Study of High Dose Statin Versus Statin Plus Ezetimibe Therapy in Patients with Acute Coronary Syndrome

AIM: To assess the efficacy of statin and ezetimibe combination compared to statin given as monotherapy in maintaining optimum cholesterol level. METHODOLOGY: A Prospective Randomized Interventional study was conducted including 68 patients with ACS with the duration of six months carried out in the Cardiology Department of tertiary care Hospital, Kerala. SPSS 20 version was used to perform the statistical analysis of the collected data. Independent t-test was used to compare quantitative variables between control and case group and paired t-test for comparison of demographic variables. The level of significance was 0.05. RESULTS AND DISCUSSION: Mean LDL-C of control group at baseline was found to be 129.64mg/dL and that of case group was found to be 125.73mg/dL. Mean difference was found to be 3.90. On using Independent t-test, there was no significant difference in LDL-C between the groups with p= 0.664 (t value= 0.437). Mean LDL-C of control group on review was found to be 125.42mg/dL and that of case group was found to be 109.33mg/ dl. Mean difference was found to be 16.09. On using Independent t-test, there was significant difference in LDL-C between the groups with p&lt;0.05 (t value=2.036). CONCLUSION: The LDL-C levels plummets the most in patients who are at highest risk of recurrent coronary event. Therapy using a combination of statin and ezetimibe resulted in remarkable reduction in elevated lipid cholesterol with a similar safety profile compared with doubling of statin dose. Its superior lipid altering efficacy by dual inhibition of cholesterol synthesis and intestinal absorption makes it a drug of choice for ACS.

A prospective observational study on acute exacerbation of chronic obstructive pulmonary disease in pulmonology department of tertiary care hospital

BackgroundChronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gasses. An acute exacerbation of COPD refers to a flare up or episode where a person breathing becomes worse than normal. An acute exacerbation of COPD refers to a flare up or episode where a person breathing becomes worse than normal. Acute exacerbation in COPD (AECOPD) is frequent in the course of the illness and is the most common reason for medical visits, hospital admissions, and mortality among these patients. Exacerbations of COPD are associated with increased morbidity and mortality. To assess the exposure and severity of acute exacerbations of COPD with COPD Assessment Test (CAT Scale) and mMRC (modified Medical Research Council) Dyspnea scale. Study design was a hospital-based prospective observational study. Study site was conducted at Pulmonology Department of Government General Hospital, Vijayawada.ResultsThe total patients were 197. Out of which, 119 were from In-patient Department (IPD) and 78 were from Out-patient Department (OPD). In this study, males were 167 (85%), among which, IPD were 97 (49%), OPD were 70 (36%), and females were 30 (15%), among which, IPD were 22 (11%), OPD were 8 (4%).ConclusionThe morbidity and mortality of COPD have been increased in recent years. This study concludes that there is a relation between risk of acute exacerbations in COPD with habitual history and occupational history. Increase in exposure to occupational hazards, smoking habit leads to an increase in risk of acute exacerbations in COPD patients. The level of severity was more in smokers and the patients who had biomass, organic dust, and mineral exposure. When severity was observed, group D severity is more observed in population according to CAT scale and mMRC dyspnea scale.

Iron deficiency in febrile seizures: a prospective case control study

Background: The objective of the study was to evaluate the role of iron deficiency in febrile seizures.Methods: Case control study conducted at Pediatric department of Tertiary care hospital. A total 70 cases and 70 controls were included in the study. Consecutive cases and controls were selected. Cases were children of age group 6 months to 5 years with simple febrile seizures and controls were children of same age group with short febrile illness without any seizures. After consent, detailed history was taken and clinical examination were carried out for both groups. Blood investigations were done to diagnose iron deficiency in both cases and controls. Iron deficiency was diagnosed as per WHO criteria haemoglobin &lt;11 g/dl in cases &lt;5 years mean corpuscular volume&lt;70 fl, mean corpuscular haemoglobin &lt;27 pg and serum ferritin&lt;30 microgram/dl.Results: Mean corpuscular volume was less than 70 fl/ml in 51% cases and 31% controls and mean corpuscular hemoglobin was less than 27 pg/ml in 84% cases and 40% of controls indicating statistically significant association of MCV and MCH between cases and controls .Serum ferritin was less than 30 ng/ml in 44% in cases as compared to 26% of controls, there was statistically significant difference between serum ferritin levels in cases and controls. From the above findings, study showed statistically significant association between iron deficiency anaemia and febrile seizures (p value &lt;0.01; OR- 8.05 (3.6-17.93) (df-1).Conclusions: Iron deficiency is a major risk factor for simple febrile seizures in age group of 6 months to 60 months.

Prevalence and risk factors of dysnatremia in sick newborns admitted in neonatal intensive care unit: a cross-sectional study

Background: The objective of the study was to study the prevalence and various risk factors of dysnatremia in sick newborns admitted in neonatal intensive care unit (NICU).Methods: Cross sectional study conducted in Paediatric Department of tertiary care hospital from February 2016 to October 2016 which includes 384 neonates admitted to NICU during the study period. After informed consent, detailed history was taken and clinical examination carried out in both cases and controls. Blood investigations were done to diagnose sodium levels in sick neonates. Based on the corrected sodium values, the subjects were classified as having hyponatremia (serum sodium &lt;135 meq/l), hypernatremia (serum sodium &gt;145 meq/l) or normonatremia (serum sodium 135 to 145 meq/l).Results: The mean (SD) (range) serum sodium in sick newborns measured was 136.72 (6.7) (115-165) meq/l at a median (range) age of 56.97 (1-545) hours. Out of 384 sodium values obtained, 285 (74.2%) were sent on ≤3 days, 64 (16.7%) between 4th to the 6th day and 35 (9.1%) were sent on ≥7 days. The overall frequency of dysnatremia in 384 sodium values from 384 patients was 142 (37%). Hyponatremia was observed in 117 (30.5%) and hypernatremia in 25 (6.5%) of sodium values. Hyponatremia observed in term, low birth weight, very low birth weight and extremely low birth weight neonates were 16.4%, 25.2%, 67.2% and 100% respectively whereas hypernatremia were 10.1%, 4.6%, 3.4% and 0% respectively. Various risk factors for hyponatremia namely; prematurity, necrotizing enterocolitis, renal failure, birth asphyxia, sepsis, meningitis, vomiting/ nasogastric drainage.Conclusions: Hyponatremia are common in sick newborns in NICU.

A descriptive study of vancomycin resistant enterococci in Tertiary Care Hospital of Western India

Enterococci are second most commonly isolated hospital-acquired pathogen from urinary tract and wounds. Being notorious organism enterococci has presented treatment challenges resulted in newer drug development followed by resistance development in segments; such as Vancomycin. Present study aims at detecting prevalence, distribution and susceptibility patterns of Vancomycin Resistant Enterococci (VRE) found in clinical isolates.A descriptive study was carried out in the Microbiology department of Tertiary care hospital, Western India including a total of 36,027 clinical isolates received in the duration over 2 years from indoor patients across disciplines. Enterococci were recognized by standard biochemical tests. Anti-microbial susceptibility testing was done as per CLSI guideline. VRE was distinguished by disc diffusion method and Minimum Inhibitory Concentration Test. Qualitative data were presented as proportions.On susceptibility testing, the prevalence of VRE was found out to be 11.13%. Maximum number of VRE isolates were from Urine (49.06%), followed by blood culture (32.08%), and swab (5.66%). Among VRE; 56.6% isolates were E. Faecium followed by other enterococcus (35.85%) and E. Faecalis (7.55%) respectively. Highest resistance was found for penicillin, ampicillin and levofloxacin, while most sensitive were linezolid and fosfomycin.Considering versatile ability to advance and transmit antimicrobial resistance, VRE represents a bottle neck in treatment strategies. Rational prescription of antibiotic, VRE surveillance and timely antibiogram in admitted cases is the need of hour.