Department Of Tertiary Care Hospital Research Articles

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.

Implementation of disease-based standard order sets in emergency department of tertiary care hospital, Pakistan- a novel approach for enhancing patient care

To evaluate the efficacy of disease-based standard order sets in reducing time of order entry, order processing and medication dispensation in emergency department of a tertiary care hospital. The pilot study was conducted as part of a retrospective clinical audit using pre- and post-intervention design comprising data from July to September 2013 of the emergency department of a tertiary care hospital in Karachi. Data collected related to the reduction in medicine order entry, processing and dispensing time of eight common emergency conditions with standard order set. Subsequently, standard medication orders for the selected medical conditions were developed together with physicians of emergency and other specialties. Post-intervention data was collected and the two data sets were compared using SPSS version 23.0. Mean medication order entry and processing time from the physician end reduced from 67.7±22.7 seconds to 20.5±7.1 seconds. Mean medication order processing and dispensing time at pharmacist end reduced from 70.0±22.4 to 20.6±8.8 seconds. The difference between pre- and post intervention values was significant (p<0.001). Implementation of disease-based standard order set significantly improved efficiency.

Pattern of health problems amongst the elderly patients admitted in the emergency department of tertiary care hospital of North India.

Pattern of health problems amongst the elderly patients admitted in the emergency department of tertiary care hospital of North India.

Study of Epidemiological Factors Affecting Patients of Hypertension Attending Urban Health Training Centre of Community Medicine of Tertiary Care Hospital, Maharashtra

Introduction -Hypertension is a chronic condition causing coronary heart disease, stroke and other vascularcomplications. Aim and objective- To study epidemiological factors affecting patients of hypertensionattending urban health training centre of community medicine department of tertiary care hospital,Maharashtra. Material and Methods- The study was a hospital based observational descriptive studycarried out in urban health training centre of community medicine department of tertiary care hospital fromApril 2016 to September 2016 including all known cases of hypertension which was around 450. Result-Maximum cases were from age group 40-59 years (53.71 %) and 40.77 % were males and 59.23 % werefemales.Whereas 43 % and 14 % of study subjects were having BMI of 25-29.9 and ? 30 respectively, 35% were having family history of hypertension, 72% were having salt intake of > 5 gram, 67% were havingmixed diet, 55 % men were having waist-hip ratio > 0.9 and 67% women were having waist-hip ratio >0.8,45 % of total male subjects and 08 % female subjects were having habit of alcohol intake. Whereas 42 %of total male subjects and 28 % of female subjects were having habit of tobacco intake. Conclusion- Forthe control of hypertension decreased salt intake, physical activity, cessation of habits such as alcohol andtobacco intake and early detection and treatment are need of the hour.

Drug utilization study in patients visiting dermatology outpatient department in tertiary care hospital

Background: With the surge of basic and clinical research activities, and subsequent recognition of newer dermatological disorders; dermatology is now considered to be one of the most important specialties in a healthcare setup. Dermatological problem in India manifests as primary and secondary cutaneous complaints. The aim of this study was to assess current prescribing practices among physicians for dermatology patients in tertiary care hospital.Methods: A prospective, observational and cross-sectional study was conducted in Department of Pharmacology in collaboration with Department of Dermatology in a tertiary healthcare hospital. As per inclusion criteria, patients visiting Dermatology Outpatient department (OPD) from October 2018 to December 2018 were enrolled in the study.Results: The average number of drugs per encounter was 4.9. 100% of the drugs were prescribed by their generic name and those prescribed from World Health Organization (WHO) list of essential medicines were 68.9%. Analysis of polypharmacy showed maximum 11 and minimum 2 drug was prescribed. Overall analysis of the drugs showed, the most common route of administration was orally. Antihistamines, antifungals and steroids constitute the major bulk of drug prescribed.Conclusions: In our study, though polypharmacy was found but it was necessary as per the conditions. Anti-fungal, antihistamines and steroids were the most common drugs prescribed. Prescriptions with injections and steroids were less in the study population. All the drugs were prescribed by their generic name and most were present in the essential list of medicines. Use of Nonsteroidal anti-inflammatory drugs (NSAIDs) was higher in our study as compared to other studies.

A Study to Evaluate Pharmacoeconomics of Antihypertensive Drugs in a Tertiary Care Teaching Hospital

Background: Hypertension is a major public health problem associated with large health burden as well as high economic burden at individual and population levels. A prospective observational study carried out in in-patients admitted to general medicine department of tertiary care hospital to evaluate the most cost effective therapy among the monotherapy of Amlodipine and combination therapy of telmisartan + hydrochlorthiazide.&#x0D; Methods: A total of 120 Hypertensive patients case records prescribed with monotherapy of Amlodipine and combination therapy of Telma H were reviewed and evaluated using descriptive statistics and ‘p’ value and assessed for their financial burden based on the cost per tablet for an year, Cost effectiveness ratio for the patients with controlled Blood Pressure by using a particular drug.&#x0D; Results: Out of 120 patients females were more (59.2%) and most of them were under the age group of 41-60 years. Majority of the patients had a known history of hypertension (65%). Most of the patients were prescribed with Telma H 40/12.5mg (40%) followed with Amlong 5mg (35.8%). There was a significant positive correlation (i.e., p value= 0.05) between persistence patterns of patients with drug therapy. Probability of patients with controlled Blood Pressure taking Amlong 10 mg were 82.35% followed by patients with Amlong 5mg.&#x0D; Conclusion: This study clearly showed that monotherapy of amlodipine is the most cost effective therapy than combination therapy of Telma H in order to reduce financial burden to the patient as well as to decrease the complications.&#x0D; Keywords: Hypertension, Pharmacoeconomics, Cost effectiveness, Blood Pressure.

A Study of Anatomical Variations in the Nasal Cavity in Cases of Chronic Rhinosinusitis.

Chronic rhinosinusitis is very common disorder encountered in general population. Anatomical variations in the nasal cavity are mainly responsible for improper drainage and subsequent chronic rhinosinusitis. Present study is crosssectional and observational study undertaken at ENT department of tertiary care hospital. 200 cases of chronic rhinosinusitis fulfilling inclusion criteria were evaluated for various anatomical variations in the nasal cavity using diagnostic nasal endoscopy and computed tomography. Present study of 200 cases showed male preponderance M: F ratio 1:0.56. Most cases (79.5%) belonged to age group 11-50. Nasal obstruction was presenting complaint in 90% cases. 78% cases had septal deviation. 20% had septal spur. 32% cases had enlarged inferior turbinate, 9% had paradoxical middle turbinate, 13% had enlarged middle turbinate, 1% had bifid middle turbinate. 12% had pneumatised middle turbinate. 7% had enlarged uninate process, 1.5% cases had hypoplastic uncinate process and 7% had enlarged ethmoidal bulla. 45% cases showed oval sphenoid ostium while 31% showed circular and 8% slit like opening. Agger nasi cells were present in 82% cases. All 200 cases had anatomical variations in nasal cavity so it can be concluded that these are responsible for chronic rhinosinusitis.

Assessment of Vitamin D status in patients attending tertiary care hospital in Northern Andhra Pradesh with musculoskeletal pain

Introduction: vitamin D deficiency involve the musculoskeletal system leading toproximal muscle weakness, bone pain, and osteomalacia which is largely unrecognized by bothphysicians and patients.The prevalence of vitamin D (&lt;20ng/dl) deficiency among patients attending the orthopedic outpatient department in tertiary care hospital with complaints of non-specific symptoms of body pain and low back pain without any other co morbid condition is our study. Methodology: A cross sectional study was conducted among 468 adult patients above the age 20 yearsattending orthopedic department of a tertiary care hospital with non-specific complaints of general body pain/back pain/tiredness/weakness on working and walking with no other symptoms such as injury,fever, GIT problems or known medical illness and no relief of the pain symptoms with routine treatments with analgesics and rest and physiotherapy were screened for Vitamin D levels when other routine test such as complete blood count, ESR, BI, sugar, RFT were normal. Results: out of 468 patients tested, 386 (82.4%) of the study population had below normal vitamin D, of them 49.1% had deficiency, 33.3% had insufficiency and 17.5% had sufficient vitamin D level. The proportion of patients Vitamin D deficiency is higher in the age group 30-59 whereas insufficiency was higher in the age group 20-39 compared to other age group and it was found statically significant.

Comparative Study of Outcome of Type 1 Tympanoplasty in Dry and Wet Ear in Tertiary Care Hospital.

Chronic suppurative otitis media is very common otological disease in general population. Persistent wet ear produces dilemma for ENT surgeons whether to go ahead with tympanoplasty or not. Present study compare outcome of type 1 tympanoplasty in both wet and dry ear. Present study is randomized, prospective, Interventional type of study carried in ENT department of tertiary care hospital over period of 18months. Total 62 cases fulfilling study criteria were included in the study, which were equally divided in dry and wet group. All cases underwent type 1 tympanoplasty. Temporalis fascia was used as graft material in all cases. Most of the patients in both dry and wet group belonged to the age group between 21 to 30 (40.32%). 26 (41.94%) were males and 36 (58.06%) were females. Male: Female ratio was 1:1.38. After 12weeks 27 (87.10%) cases of dry group and 20 (64.52%) cases of wet group had significant hearing improvement and in dry group 28 (90.32%) cases had intact graft while in wet group 23 (74.19%) cases had intact graft. According to the statistical analysis, in current study, there is no significant differences between the success rates of wet and dry ears, either in terms of graft uptake or the hearing improvement, thus it can be concluded that the presence of minimal ear discharge at the time of surgery does not affect the success rate of type 1 tympanoplasty.

Abandonment of Patient in Emergency Department of Tertiary Care Hospital of Eastern Nepal – a Case Study

Introduction: With increasing of workload of emergency room employees, many of the community’s emergency hospitals are now facing another challenge, i.e. the abandonment of patient in emergency Department. It seems undesirable in most hospital service settings due to loss of revenue and ill-will. The hospital’s staffs feel that they have no option but to keep those sufferers until a further plan can be made. It presents a dilemma for the staffs of Emergency and for the hospital administrators as well. The current case report presents an abandoned patient in Emergency Department of B. P. Koirala Institute of Health Sciences (BPKIHS).&#x0D; Case Report: A 70-year old male brought by police and was left abandoned in emergency ward of BPKIHS in altered conscious state. The patient was managed in emergency ward with conservative management nearly for six weeks.&#x0D; Conclusion: The problem is multidimensional, is in conflict of the concept towards achievement of Millennium Development Goals (MDGs) and a challenge to social security.

Assessment of Dietary Practices Among Pregnant Anemic Females

Intoduction: Anemia is interpreted as low blood hemoglobin values. This medical condition can both developed and underdeveloped countries. The ability of blood to transfer oxygen to tissues is affected when the hemoglobin is low, which in turn develops symptoms such as fatigue, compromised physical work capacity, and shortness of breath. Objective:This study was conductedto find out the dietary practices among pregnant females. Methods: It was a comparative cross-sectional study. The substantial data was collected from the gynecology department, vaccination department of Tertiary Care Hospitals, Lahore.Nonprobability convenient sampling criteria were utilized in the study. 150 participants were selected for the study. This sample was finalized based on exclusion and inclusion criteria. Out of 150 pregnant females, 75 anemic pregnant females were placed in the experimental group and 75 non-anemic pregnant females were assigned to the control group. The exclusion criteria suggested that non-pregnant and non-cooperative patients will not be included in the study.Results:Maximum women belonged to the age group 26-30 years, and the employment status of the women was a housewife. 45% of women also had craving for pica because of the anemia. 68% of women were falling in the category of moderate anemia. The malpractices in diet were also inducing iron deficiency like 59% of women took tea after the meal. It was also interpreted that non-consumption of beef (41% of women), chicken (22% of women), fish (58% of women), and egg (34% of women) were recorded to be more anemic.Conclusion: The current study investigated the causative factors of anemia. It was inferred that low socio-economic status and less consumption of iron-rich foods make women prone to anemia. Pregnant women are also not cognizant wit iron-absorption inhibiting foods which leads to complications and abnormalities in pregnancy outcomes.

EVALUATION OF DRUG UTILIZATION PATTERN IN THE PEDIATRIC DEPARTMENT OF A TERTIARY CARE HOSPITAL IN SRINAGAR, JAMMU & KASHMIR, INDIA

Introduction: Irrational drug use, especially antimicrobials in a pediatric population, has become a commonly noted practice. Most of the drugsprescribed for children have not been tested in the pediatric population due to the difficulties in carrying out clinical studies in children andethical issues due to children not being able to make their own decisions to participate in a clinical trial. Objective: The main aim of this studywas to evaluate the pediatric drug utilization pattern in a tertiary care hospital. Material and methods: This study was conducted at a Tertiarycare hospital, Srinagar, Jammu &amp;Kashmir, India for a period of 6 months. It was a prospective, descriptive, cross-sectional study. Results: Thisstudy evaluated a total of 205 patients from the inpatient department of the pediatric department of Tertiary care hospital, Srinagar, Jammu &amp;Kashmir, India. Out of 205 patients, 62.4% (128) were male and 37.6% (77) were female. The number of male patients was more than the numberof female patients. A total of 767 medicines were prescribed to 205 patients. Mean ± SEM of medicines prescribed was 3.74 ±0.07. Mean ± SEMof medicines prescribed 125 for male patients was 3.76 ± 0.10, while for female patients it was 3.69 ± 0.11. Conclusion: Development andimplementation of Standard Treatment Guidelines (STGs) based on essential drug concept and promoting rational drug therapy will lead to moreand more rational prescribing in pediatrics. Periodic prescriptions analysis and effective feedback to clinicians should be done based on results toensure rational prescribing and effective health care management, which will ultimately lead to better child health.

Premature ejaculation among post-coronary artery stenting patients attending cardiology out patient department of tertiary care hospitals

Premature ejaculation (PE) is the most frequent sexual complaint of men. It may develop not only due to psychiatric disorders but also due to many chronic organic illnesses. Coronary artery stenting is an invasive procedure to manage coronary artery disease which is one of the leading chronic illnesses all over the world. Patients who survive from coronary artery diseases by getting invasive cardiac procedures, often develop reduced sexual function. The aim of the study was to identify the frequency of premature ejaculation among post coronary artery stenting patients. This was a descriptive, cross sectional study conducted in cardiology outpatient department (OPD) of Bangabandhu Sheikh Mujib Medical University (BSMMU) and cardiology OPD of National Institute of Cardiovascular Diseases (NICVD) from October 2017 to September 2018. 153 patients were selected purposively. After taking written consent a predetermined questionnaire containing 11 socio-demographic variables was filled for each patient through face to face interview. After that PEDT bangle version was applied.37.25% post coronary artery stenting male scored 11 or more and were identified as highly suggestive to have PE. Among the socio-demographic variables, Regular exercise, amount of sleep per day, smoking and history of chronic physical illness were found to be significantly associated with PE among post coronary artery stenting patients. The study showed that the patients who practiced a disciplined and healthy lifestyle were not in risk. The research findings may help us for the early diagnosis and better treatment plan to reduce patient sufferings.&#x0D; Bang J Psychiatry June 2018; 32(1): 9-13

Emergency Stay Duration of Patients in Emergency Department of A Tertiary Care Hospital in Nepal: A Descriptive Cross-sectional Study

Emergency department of a hospital is responsible for providing medical and surgical care to patients arriving at the hospital in need of immediate care. Emergency department is not staffed or equipped to provide prolonged care. Duration of stay in the Emergency department directly affects the quality of patient care. Longer length of stay is associated with Emergency department overcrowding, decline in patient care, increased mortality and decreased patients satisfaction. The main aim of this study is to find the mean stay duration of patients in the emergency department of a tertiary care hospital in Nepal. This is a descriptive cross-sectional study which was conducted in a tertiary care teaching hospital from Jan 15,2019 to Jan 30, 2019. Ethical clearance was obtained from Kathmandu Medical College- Instutional Review Committee. The calculated sample size was 587. Consecutive sampling technique was used. The data thus obtained was entered in SPSS version 20 and necessary calculations were done. The mean emergency stay duration was obtained to be 3.18 hours at 95% confidence interval (C.I and standard deviation was 2.51 hours. Female had longer mean duration of stay (3.25 hours) compared to male (3.11 hours). The maximum length of stay was 15.3 hours. Most of the patients attending the emergency department were discharged right through the emergency department 398 ( 67.8%). Mean duration of stay was longest (5.06 hours) for the referral group. The mean stay duration in Emergency Department of tertiary care hospital in Nepal is getting shorter compared to similar study done previously.

Study of Missing Clinical Details in Computed Tomography Radiology Request Forms: A Descriptive Cross-sectional Study

Detailed clinical history through a properly filled requisition form can help a radiologist in making a diagnosis. The objective of this study was to observe the missing clinical details of Computed Tomography requisition forms at radiology department in tertiary care hospital. This descriptive cross-sectional study was done in 196 Computed Tomography requisition forms in the department of radiology from September 2019 to October 2019. Ethical clearance from the Institutional Review Committee - Reference No. 120720194 was obtained. An informed consent from the participants was taken prior to the procedure. Convenient sampling was done. The data obtained were computed and analyzed using Statistical Package for Social Sciences to tabulate the results. The results were displayed in frequency and proportion of binary data. All the request forms had name filled, however date was filled in 183 (93.4%), age was filled in 195 (99.5%), sex was filled in 193 (98.5%) and address was only in 30 (15.3%) of the forms. Clinical history and provisional diagnosis were written in 179 (91.3%) forms. Signature was found in more than half of forms 135 (68.9%) whereas the department referring the patient was filled in 92 (46.9%) of forms and the name of doctor referring the patient was not filled mostly. The handwriting was clear in 191 (97.4%) of cases and standard words were used. Use of non-standard abbreviation was found in only 2 (1%) forms. Clinical details were filled in most of the requisition forms however other parameters were still incompletely and inadequately filled.

Psychological Evaluation of Patients Referred With Diagnosis of Psychogenic Tinnitus to Psychiatry Out Patient Department in Tertiary Care Hospital of North India

Psychological Evaluation of Patients Referred With Diagnosis of Psychogenic Tinnitus to Psychiatry Out Patient Department in Tertiary Care Hospital of North India

An evaluation of fixed dose combinations and it’s practices at medicine department of tertiary care hospital, Nepal

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; A large proportion of fixed dose combinations (FDCs) are manufactured and used widely in Nepal. This study aimed to evaluate the FDCs and its utilization in medicine department of tertiary care hospital.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A cross-sectional study was conducted for 50 days among admitted patients in the medicine department of tertiary care hospital, Nepal. A predesigned form was used to collect the data at the time of patient discharge. Only the oral FDCs were selected for study.&lt;strong&gt; &lt;/strong&gt;Microsoft Excel 2007 was used for statistical analysis and data were presented as number and percentage in tabulated and figure forms. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Oral FDCs were used in 27.08% of admitted patients. A total of 295 FDCs were prescribed in 208 patients with 44 FDC items in 58 different brand names. Categorically, the most commonly used FDCs were of analgesics (34.24%) followed by antibiotics (25.76%) and vitamin supplements (22.71%). The 27.27% of FDCs prescribed contain more than two active pharmaceutical ingredients (APIs) up to nine and the highest number of APIs were found in vitamin supplements. All FDCs were prescribed in the brand names. The very few 2.27% and 4.55% of FDCs were prescribed from the essential medicine list of Nepal and world health organization, respectively.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The use of FDCs listed in essential medicine list was very poor. Similarly, generic prescribing was also zero. The regulatory body must study the rationality of FDC before production, marketing, importing, and utilization in hospital.&lt;/p&gt;

Prescribing pattern of antibiotics among postoperative patients admitted in gynaecology and obstetrics department of tertiary care hospital in Northern India

Background: The objective of the study was to study the prescribing pattern of the antibiotics in postoperative patients admitted in gynaecology and obstetrics.Methods: Current prospective observational study was conducted in the department of pharmacology, Government Medical College, Kathua in collaboration with department of gynaecology and obstetrics for a period of six months duration from 1st May 2019 to 31st October 2019. The case sheets of all post operated patients above eighteen years of age admitted were studied and analyzed.Results: Total of 1807 case sheets were analyzed and showed that 4245 antibiotics were prescribed with an average of 2.3 antibiotics prescribed. Oral cefuroxime (17.3%) was maximally prescribed in patients who delivered normal presentation with episiotomy and injection ceftriaxone along with tinidazole and gentamycin were prescribed (58.4%) where caesarean section was done. While injection ceftriaxone and sulbactum along with tinidazole and gentamycin (17.09%) was prescribed in patients who were operated for gynaecological diseases. Maximum (80%) of the antibiotics were prescribed under brand name.Conclusions: Cephalosporin’s are commonly prescribed antibiotic and in eighty percent brand names were prescribed. Results underscore that antibiotic in generic name should be encouraged.

Implementation of disease-based standard order sets in emergency department of tertiary care hospital, Pakistan- a novel approach for enhancing patient care

Implementation of disease-based standard order sets in emergency department of tertiary care hospital, Pakistan- a novel approach for enhancing patient care

Prevalence of vitamin D deficiency and its relationship with epileptic severity in a pediatric department of tertiary care hospital

Aim To evaluate the prevalence of vitamin D deficiency in pediatric epileptic patients and to assess if there is any correlation between vitamin D level and disease severity in epileptic patients. Objective To estimate vitamin D deficiency and insufficiency as percentage of enrolled patients in pediatric department and to identify if there is any correlation between vitamin D deficiency and factors such as age, sex, BMI, total serum calcium levels, antiepileptic drugs, and types of seizures. Patients and methods A prospective interventional clinical study was carried out in a tertiary care hospital between September 2018 and February 2019. We included 30 pediatric epileptic patients of age group 1–14 years from whom the blood samples were withdrawn and were sent to the laboratory for the estimation of vitamin D levels. Results The data collected was analyzed using statistical method χ2 and analysis of variance in Prism 8.0 version. The prevalence of vitamin D deficiency and its correlation with epilepsy was determined. In this study, we found that there was a high prevalence of vitamin D deficiency in pediatric epileptic patients (23 patients out of 30–73%). The other risk factors for vitamin D deficiency found in this study are children of age group 5–10 years (43%), malnourished patients (40%), hypocalcemic patients (40%), and patients who use antiepileptic drugs for more than 2 years (57%). Conclusion Based on the aforementioned scientific analysis, it can be concluded that there is a high prevalence of vitamin D deficiency in pediatric patients with epilepsy. So, vitamin D3 supplements should be given for all epileptic children even before the initiation of antiepileptic therapy. Patients’ parents were educated on the importance of vitamin D.