Tertiary Care Hospital In India Research Articles

Psychological Consequences in pregnant women diagnosed with COVID-19 in a tertiary care hospital

Background: Pregnancy is a psychologically vulnerable phase in a woman's life. The diagnosis of COVID illness during pregnancy makes her susceptible to psychological problems. The support system has a crucial role in affecting the psychological state of pregnant women. Early detection can help in interventions for the mental health of these women. Objectives: To evaluate psychological consequences in pregnant women diagnosed with COVID-19 disease. Methods: This cross-sectional study was conducted in the Obstetrics and Gynecology unit of a tertiary care hospital in India; during the second wave of COVID-19 disease pandemic. A total of 40 pregnant women above 18 years of age diagnosed with COVID-19 disease were included. A thorough socio demographic and obstetrics evaluation was done. Psychological evaluation was done using the Depression, Anxiety, and Stress Scale – 21 (DASS-21), and perception of support was evaluated with the Multidimensional Scale of Perceived Social Support. Results: Mean gestational age was 30 weeks. A total of 35% of the cases were moderate, and 5% had severe COVID illness. On the DASS, 30% of women had mild depression, and 20% had moderate depression. A total of 77% of women reported anxiety, 32% with mild, 20% with moderate, and the rest 20 % with severe anxiety. Twenty percent of women had mild stress, and 7.5% showed severe stress. All 40 women reported moderate to high social support from a family member, friend, or significant another person. Conclusion: COVID-19 positive pregnant women, irrespective of its severity,had the presence of depression, anxiety, and stress. There was a lower proportion of depression, anxiety, and stress with the presence of social support.

Mutational Analysis of EGFR Mutations in Non-Small Cell Lung Carcinoma—An Indian Perspective of 212 Patients

Lung cancer is the world's leading cause of cancer-related deaths. Epidermal growth factor receptor (EGFR) is one of the critical oncogenes and plays a significant role in tumor proliferation and metastasis. Patients with sensitizing mutations in the EGFR gene have better clinical outcomes when treated with tyrosine kinase inhibitors (TKI). This study expands our knowledge of the spectrum of EGFR mutations among lung cancer patients in the Indian scenario. This is a retrospective descriptive study of all newly diagnosed patients with lung cancer in tertiary care hospital in India. All the samples were subjected to real-time PCR (q-PCR) analysis and confirmation of rare novel mutations was done using Sanger sequencing. Clinicopathological characteristics, mutational EGFR status, and location on the exon and metastatic sites were evaluated. An analysis of total 212 samples showed mutations in 38.67% of cases. Among these, five (5.9%) samples had mutations in exon 18, 41 (48.8%) samples had mutations in exon 19, 12 (14.28%) samples had mutations in exon 20, and 26 (30.95%) samples had mutations in exon 21. Eleven (13.41%) were found to be uncommon EGFR mutations. Additionally, six (21.4%) samples that had EGFR mutations were also positive for brain metastasis. Future testing on bigger panels will help to characterize the incidence of genetic mutations and to determine the appropriate targeted treatment choices for NSCLC patients.

Psychological Distress & Coping among Nurses working with COVID-19 patients in a tertiary care hospital in India: A cross-sectional study.

Objective: This study aimed to understand the psychological impact of COVID-19 pandemic on Indian nursing professionals and their strategies of coping with it. Method: This was a cross-sectional observational study conducted on nursing professionals (staff and students) of a tertiary care hospital, medical college and research centre in North India. Results: Among 103 participants, most participants were females (84.5%), graduates, married and lived with families. Most participants and their families responded to COVID duty with anxiety, fear and stress. Physical discomfort and inadequate PPE supply were main challenges perceived while working. Depressive symptoms were seen in 41% participants, 55% reported anxiety and 35% reported clinically significant stress. Participants working in COVID duty reported significantly higher anxiety compared to those who were not. Those with positive personal and family reactions towards COVID duties reported lower anxiety and stress scores. Those who perceived work-related discrimination had higher depression, anxiety and stress scores. Majority of participants employed approach-based coping styles with acceptance as the most commonly used coping strategy. Acceptance and planning were significantly higher in participants who had done COVID-19 duties compared to those who had not. Conclusion: Understanding adverse psychological impact of COVID-19 on nursing professionals is of utmost importance as it has a direct bearing on patient care. Efforts for promoting comfort in work environment, psychological, familial and social support and activities promoting healthy coping are recommended during challenging times.

Evaluation of clinical Spectrum, antibiotic Sensitivity, and clinical Outcome in pediatric Age Group (0–18 Years) with Extended-spectrum Beta-lactamase-producing Escherichia coli-associated Urinary Tract Infection in Tertiary Care Hospital in India

Evaluation of clinical Spectrum, antibiotic Sensitivity, and clinical Outcome in pediatric Age Group (0–18 Years) with Extended-spectrum Beta-lactamase-producing Escherichia coli-associated Urinary Tract Infection in Tertiary Care Hospital in India

Transcortical sensory aphasia heralding SARS-Cov-2-induced autoimmune encephalitis with gyral restricted diffusion hyperintensities: a novel case report

BackgroundCoronavirus disease 2019 (CoVID-19), primarily thought of as a respiratory system disease is actually a multi-system disease with immunological implications. CNS involvement in COVID has been explained in recent literature mainly for stroke, encephalopathy, encephalitis, acute disseminated encephalomyelitis and myelopathy. There are few studies characterizing clinical spectrum of COVID autoimmune encephalitis. We present a unique case of post-COVID autoimmune encephalitis in a diabetic male presenting with language dysfunction and novel radiologic findings.Case presentationPatient admitted to inpatient department of a tertiary care hospital of India was evaluated by bedside clinical examination, routine blood tests, CSF study with intrathecal SARS-Cov-2 antibody detection, commercially available tests for autoimmune encephalitis, neuroviral panel with HSV PCR, EEG, 3-Tesla MRI and PET scan. Patient was found to have personality change and transcortical sensory aphasia in the outset of COVID encephalitis. MRI findings like temporal involvement and insular ribboning are also being reported. The patient was treated with IV immunoglobulin and is on an improving course.ConclusionsThis case reports dysphasia due to COVID-mediated injury to the language networks, with novel radiologic findings. Role of parainfectious versus immune etiology is also discussed. Further studies are needed to elucidate the mechanism and clinical spectrum of post-COVID autoimmune encephalitis.

Medication errors in an oncology inpatient setting in India-Audit by clinical pharmacists.

Good clinical practices and strict vigilance are needed, especially for patients receiving chemotherapy. Regular audits using a specially developed tool need to be conducted in the oncology wards to identify lapses in the use of chemotherapy drugs. Observational study was conducted in the adult and paediatric oncology inpatient settings in an Indian tertiary care hospital for a period of 2.5 years. It was an audit of case files of chemotherapy patients for their drug prescriptions, medication reconciliation records and adverse drug reports. Data was presented as frequencies and percentages. 1.3% medication errors and 0.23% adverse drug reactions were reported during the study period. Majority were transcription (38%) and drug reconstitution errors (29%) and were either in the near-miss or no-harm category. Medication errors were found in the oncology wards, but due to the vigilance of clinical pharmacists, none of the patients were harmed as a consequence of these errors.

Contactless monitoring of respiratory rate (RR) and heart rate (HR) in non-acuity settings: a clinical validity study

ObjectivePatient monitoring in general wards primarily involves intermittent observation of temperature, heart rate (HR), respiratory rate (RR) and blood pressure performed by the nursing staff. Several hours can lapse between...

TELEMEDICINE - A CRITICAL ANALYSIS OF ITS FUTURE IN INDIA

Background:There are enough statistics on the internet for current & future telemedicine usage pattern across geographies in terms of market size, consult volume, mobile penetration, enhanced network bandwidth, advancement in biomedical devices etc. On the other hand, there are enough differences of opinion because of challenges like patient experience, doctor adoption, accessibility, lack of centres, quality of connectivity, setup cost etc. Despite all the concerns pertaining to technology, experience, compliance and effectiveness, during the covid-19 pandemic, patients and caregivers, across countries, relied heavily on the platform to provide essential health care services to patients. During the Covid-19, telemedicine usage was an accessible and cost-effective approach to deliver high-quality care. Objective:To get an overview of the state of affairs for telemedicine in India and its future outlook, i.e., to understand if the usage of the telemedicine platform was a temporary phenomenon during covid-19 only or continue to stay. Further, associated queries were – Is it only for some specific specialties or is it going to be limited to some geo-regions or is it restricted to patients in a particular age group or is it a function the nature of visit (first or follow up).Apart from analysing above considerations, the paper also highlighted important features of a telemedicine platform. Finally, the paper also studied the role of government as a regulatory body as well as an enabler of telemedicine platform in India. Methodology:More than 1 year of telemedicine data for a JCI-accredited tertiary care hospital in India was studied. Additionally, physicians and patient perspective on experience and impact across multiple specialties, age group, gender and regions of the patient was further analysed. Tele-consultation trends were further compared during wave 1 and wave 2 of the covid-19. Doctor and patient experience on the usage of telemedicine were objectively assessed with questionnaires.

Traumatic Optic Neuropathy: Analysis of Demographic and Clinical Parameters Over Three Years in a Tertiary Care Hospital in India.

Background Treatment options for traumatic optic neuropathy (TON) are limited and the role of steroids in the treatment of TON is still controversial. Hence this study was planned to highlight the role of steroids in the treatment of TON. Purpose The study aims to highlight the epidemiological and clinical characteristics, as well as the role of steroids, in TON cases seen during a three-year period at a tertiary care center in India. Methods This was a retrospective study that reviewed records of all cases of TON between January 2018 to January 2020. Results Twenty-three cases of TON were seen representing 1.26% cases of head injuries. The median age was 18 years. One patient (4.34%) had bilateral TON and 18 patients (78.26%) were referred from accident and trauma care. None of the patients presented directly to an ophthalmologist. The most common cause of injury was automobile accident (69.56%). Visual acuity at presentation was 20/80-20/100 in six (26.08%) cases. Fifteen (65.4%) patients had associated closed globe injury. Seven (30.43%) patients had ocular adnexal involvement and 10 (43.47%) patients had orbital fractures. Seventeen (73.91%) received steroid treatment and six of these patients showed visual improvement. Conclusions The study showed that there was no significant association between presenting visual acuity and treatment. The presence of significant ocular injury and orbital injury increased the likelihood of treatment. There was no difference between the treated and untreated groups with respect to final visual acuity.

Sputum Culture and Antibiogram in Infective Acute Exacerbation of Chronic Obstructive Pulmonary Disease in a Tertiary Care Hospital in India

Sputum Culture and Antibiogram in Infective Acute Exacerbation of Chronic Obstructive Pulmonary Disease in a Tertiary Care Hospital in India

Microbiological Profile in Patients Having Keratitis in a Tertiary Care Hospital in India.

Background Corneal ulcer or keratitis is defined as a loss of corneal epithelium with underlying stromal infiltration and suppuration associated with signs of inflammation. Corneal blindness is a significant public health problem worldwide; infectious keratitis is one of the predominant preventable causes of blindness. Several studies have evaluated microbial infectious keratitis's etiology, management, and outcome. However, there are regional variations in corneal ulcers' prevalence, risk factors, and outcome. The objective of this study was to isolate and identify the bacterial, fungal, viral, and protozoal etiological organisms causing infectious corneal ulcers along with their prevalence and antimicrobial sensitivity pattern. Methods A prospective observational study was done in the Department of Microbiology and RIO, Medical College & Hospital, Kolkata, for a period of 1 year (February 2019 to January 2020) after obtaining clearance from the Institutional Ethics Committee. Informed consent, demographic data, history of disease onset, duration of symptoms, associated co-morbidities, etc., were taken from the patients fulfilling the inclusion criteria. Corneal scraping samples were collected sterilely to detect bacterial, fungal, parasitic, and viral isolates and identified by standard laboratory procedures. Results A total of 80 patients were included in the study. The risk factors included foreign body in 24 (30%), blunt trauma in 10 (12.5%), steroid use in 8 (10%), contact lens user 4 (5%), and spontaneous in 34 (42.5%). Among these 80 patients, 18 showed growth of bacteria, includingStaphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes, andPseudomonas aeruginosa; four had growth of fungi, includingAspergillus spp. andFusarium spp,and two were positive for Herpes simplex virus by IFA. Conclusion Early diagnosis and prompt keratitis treatment are critical for preventing visual loss. The identification of the various causative agents of keratitis is essential for the proper management of the cases.

Analysis of Perinatal Mortality in a Tertiary Care Hospital in India: A Retrospective Observational Study

Analysis of Perinatal Mortality in a Tertiary Care Hospital in India: A Retrospective Observational Study

Comparison of Generic Dasatinib Versus Imatinib in Newly Diagnosed Chronic Phase Chronic Myeloid Leukemia with Reference to Early Molecular Response: Results from a Single-Center, Randomized Controlled Study from India

Background: Chronic myeloid leukemia (CML) is the commonest leukemia in adult population in India. The advent of tyrosine kinase inhibitors (TKI) targeting BCR-ABL1 fusion transcript in CML has dramatically improved survival of CML patients. Generic formulations of imatinib mesylate have been the mainstay of TKI therapy in Indian CML patients for more than a decade, due to prohibitive costs of 2nd generation TKIs and poor socio-economic status of majority of patients. However, with the availability of generic dasatinib in India since March 2021, the cost of dasatinib therapy has become comparable to that of generic imatinib treatment, thereby enabling more extensive use of dasatinib as first-line TKI therapy in CML patients in India. Achievement of early molecular response (EMR) after 3 months of first-line TKI therapy, defined as blood BCR-ABL1 transcript level ≤ 10% [international scale (IS)], has emerged as an important predictor of favorable long-term outcome in CML-CP. There is scarcity of data on efficacy & safety of generic formulations of dasatinib vis-à-vis generic imatinib in CML-CP patients in India, which the present study has attempted to explore at a tertiary care hospital in India. Objectives: The objectives of the study were to compare early molecular response (EMR) [defined as BCR-ABL1 transcript level ≤ 10%, I.S.] at 3 months of therapy with generic dasatinib versus generic imatinib in newly diagnosed CML-CP patients and to compare treatment-related adverse effects in the two groups. Methods: This randomized controlled study enrolled newly diagnosed CML-CP patients after obtaining institutional ethics committee approval & informed consent. Inclusion Criteria:Newly diagnosed patients with chronic phase CML.Age ≥ 12 years. Exclusion Criteria:Patients with de novo accelerated phase or blast phase CML.Pregnancy & lactation.Patients with pre-existing pleural effusion, grade ≥ 3 lung disease, or pulmonary arterial hypertension.Patients with angina, or grade ≥ 3 cardiac disease [as defined by the New York Heart Association (NYHA) criteria] at diagnosis.Patients with prolonged QTc interval (> 480 msec) at baseline. The EUTOS long-term survival (ELTS) risk score was calculated at diagnosis. Patients were randomized to one of the two following treatment groups: Group A: Dasatinib 100 mg p.o. once daily (60 mg/m2/day for age <18 years). Group B: Imatinib 400 mg p.o. once daily (340 mg/m2/day for age < 18 years). Follow up & monitoring of patients was done every 2 weekly till completion of 3 months of TKI therapy, followed by assessment of hematological response & molecular response as per standard criteria. Results: A total of 61 consecutive CML patients were screened between June 2021 and March 2022, out of which 54 patients with confirmed diagnosis of CML-CP were enrolled in the study and were randomized to receive generic dasatinib or generic imatinib as first-line therapy and were followed up for 3 months for EMR and complete hematological response (CHR). Four patients were lost to follow up and data was analyzed for 50 patients for whom EMR results at 3 months was available. Out of these 50 patients, 24 patients received dasatinib & 26 patients received imatinib. The median age of patients was 33 years (range 18-64 years), with male: female ratio of 1.3: 1. Achievement of CHR was documented in 96% of patients in both dasatinib & imatinib treatment arms. EMR at 3 months was achieved in overall 72% patients in study [19/24 patients (79%) in dasatinib arm & 17/26 patients (65%) in imatinib arm]. However, the difference was not statistically significant (p = 0.27). Notably, EMR rates in ELTS intermediate-risk group was 86% in dasatinib arm versus 42% in imatinib arm, and EMR rates in ELTS high-risk group was 82% in dasatinib arm versus 57% in imatinib arm (p = 0.33). The incidence of grade 3-4 adverse events was not significantly different in the two treatment groups. The patient characteristics & treatment results are summarized in Table 1 & Figure 1. Conclusion: The results of the present study suggested that generic formulations of dasatinib were well-tolerated and were associated with improved early molecular response rates compared to generic imatinib in CML-CP patients in India. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Perceived psychological impact of COVID-19 on patients with selected chronic diseases and their coping strategies

Corona Virus Disease-19 (COVID-19) has caused psychological distress in patients with chronic diseases, irrespective of whether they had contracted COVID infection or not. However, coping with such serious impact is necessary and the outcome varies based on the coping strategies adapted. Hence this research was conducted to analyze the perceived psychological impact of COVID-19 on patients affected with selected chronic diseases and their coping strategies. Following proportionate stratified Sampling technique 144 Subjects, who had not contracted COVID-19 during the study period but were admitted with history of selected chronic diseases such as diabetes, hypertension, heart disease in selected acute care, adult wards of a tertiary care hospital in India, were selected for the study. After obtaining consent, data was collected through interview using researcher prepared instrument. Majority of the study Subjects (57.6%) were above 50 years of age and 56.9% were females. 13.6% of the subjects expressed moderate psychological impact due to COVID pandemic. 64% of the study subjects reported to practice less amount of avoidant coping. Majority of them (62.5%) had followed high amounts of emotion focused coping and 34% of them had followed problem focused coping. As we continue to face ongoing threats of COVID, it is our vital responsibility to teach patients and public on positive coping strategies to reduce their psychological impact and to prevent them from taking resort with maladaptive coping strategies.

A clinicopathological and immunophenotypic study of nodal Hodgkin’s lymphomas

Introduction and Aim: Hodgkin’s lymphoma is a B cell lymphoma, the diagnosis of which is characterized by the presence of neoplastic Hodgkin’s/Reed Sternberg cells (HRS) and the unique cellular microenvironment. Clinical examinations, morphology and immunophenotypic study aids in the accurate diagnosis of Hodgkin’s lymphoma (HL). The literature available on the clinicopathological and immunohistochemistry (IHC) profile of Hodgkin’s lymphoma in Indian population is inadequate. This study was carried out to describe the clinicopathological and immunohistochemical profile of patients in an Indian tertiary care hospital. Methodology: An observational, descriptive study was carried out and included all diagnosed cases of nodal HL for a period of 4 and half years. The demographic details and common clinical presentation were retrieved from the records. The Haematoxylin and eosin (H and E) slides and IHC stained slides for CD15, CD30, CD20, LCA and CD3 were retrieved and studied. Each case was assigned to one of the following histological subtypes. mixed cellularity (MC), nodular sclerosis (NS), lymphocyte rich (LR), lymphocyte depleted (LD) and nodular lymphocyte predominant Hodgkin’s lymphoma (NLPHL). Those cases where histological subtyping could not be done due to equivocal features were grouped as unclassifiable. Results: A total number of 65 cases of Hodgkin’s lymphoma were included. A unimodal distribution and male preponderance was noted. The subtype of Mixed cellularity predominated the series followed by nodular sclerosis, lymphocyte rich and lymphocyte depleted. There was only one case of Nodular Lymphocyte Predominant Hodgkin’s lymphoma. Immunoreactivity of CD 30 was seen in all cases of classical Hodgkin’s Lymphoma. Conclusion: Our study reaffirms the findings from previous research ,highlighting the difference in clinicopathological profile of HL from its western counterpart. The usage of immunohistochemistry should be done for all cases of HL since it aids in the diagnosis and also in identification of potential therapeutic targets.

Association of Acute Phase Reactants with COVID-19-related Severity and Mortality: A Study in a Tertiary Care Hospital in India

Association of Acute Phase Reactants with COVID-19-related Severity and Mortality: A Study in a Tertiary Care Hospital in India

241 (PB-065) Poster - Single nucleotide polymorphisms of ABCB1 (rs1128503) and ABCC2 (rs145008610) genes and its clinical impact in ER & PR positive breast cancer patients in a tertiary care hospital of India

Background: Inter-individual differences in drug response are frequent clinical challenge due to genetic variation. ATP-binding cassette (ABC) transporters are crucial determinants of drug disposition and have been studied extensively in response to chemotherapeutic regimen and tamoxifen treatment. But no major findings were established till date in Indian scenario that correlates the effect of drug in ABC polymorphism.

Differences in the Clinical Presentation and Biochemical Profile of the Patients with Primary Hyperparathyroidism with regard to their Serum Vitamin D Levels: a Single-center Experience.

The association between vitamin D deficiency and primary hyperparathyroidism (PHPT) is common and has clear implications. Vitamin D deficiency is commonly seen in PHPT population and exacerbates its severity with skeletal and metabolic effects. Retrospective data collection and review were done in patients who underwent surgery for PHPT at a tertiary care hospital in India between January 2011 and December 2020. A total of 150 subjects were included in the study and were divided into group 1 (vitamin D < 20ng/ml, deficient), group 2 (vitamin D 21-29ng/ml, insufficient), and group 3 (vitamin D > 30ng/ml, sufficient). There was no difference in the duration of symptoms or the symptomatology between the three groups. Mean pre-operative serum calcium and serum phosphorous levels were also comparable in all the three groups. Mean pre-operative parathyroid hormone (PTH) levels in the three groups were 703 ± 996 vs 343.6 ± 396 vs 343.6 ± 396pg/ml, respectively (P = 0.009). There was a statistically significant difference in group 1 vs groups 2 and 3 in their mean weight of the parathyroid gland (P = 0.018) and high alkaline phosphatase (ALP) levels (P = 0.047). Post-operative symptomatic hypocalcemia was observed in 17.3% of patients. Post-operative hungry bone syndrome occurred in 4 patients, all in group 1. PHPT in patients with low serum vitamin D was associated with higher serum PTH levels, increased frequency of high serum ALP levels, and higher weight of the excised gland, with no difference in the serum calcium and phosphorous.

Co-infections in Hospitalized COVID-19 Patients- A Prospective Observational Study

SARS -CoV-2 was first reported in Wuhan and declared a pandemic in March 2020. Co-infections during other pandemics have been associated with severe outcomes, but data are scarce regarding co-infections in COVID-19 patients. Our study evaluated co-infections prevalence and its impact on morbidity and mortality in hospitalized COVID -19 patients. This prospective observational study included 100 patients admitted to a high-dependency unit at a tertiary care hospital in India. Prevalence of co-infections and clinical outcome-related data were analyzed in COVID-19 patients satisfying the inclusion criteria. 14% of patients had co-infections, out of which urinary tract infection was found in 9%. Patients with co-infections had a higher mortality rate (p<0.0004). Urinary co-infection emerged as an independent risk factor for mortality (p <0.001). Co-infections associated with COVID-19 infections are an essential risk factor for morbidity and mortality. Early identification and timely treatment of co-infections may help in improving clinical outcomes.

CBNAAT: Advantage and Efficacy in Pulmonary Tuberculosis (PTB) atop on Traditional Methods for Diagnosis in a Tertiary Care Hospital in India

Background: Mycobacterium Tuberculosis (MTB) is one of the most ancient diseases of mankind. Pulmonary tuberculosis (PTB) is the most common, despite the diagnosis and treatment of TB. Many studies reported, a collaboration between PTB susceptibility. In our research study, we report meantime findings after enrolling 732 of a planned 212 participants.&#x0D; Study Design: A descriptive cross-sectional study.&#x0D; Methods: The study conducted on patients with TB in west India was conducted in the Department of Microbiology, Index Medical College; Indore Madhya Pradesh. Patients suspected of PTB were qualified for screening if their age varied from 25 to 60 years and with both gender, signs and symptoms associated with PTB such as cough for more than 2 weeks, fever, weight loss, chest pain, and abnormal chest X-ray findings in results and cartridge-based nucleic acid amplification test (CBNAAT) positive. All Patients were monitored monthly while they visited in TB and chest clinic for TB treatment.&#x0D; Results: A total of 937 patients were selected for the study. Out of which only 732 patients were enrolled. About 212 patents were positive for CBNAAT and 520 were found negative. The confirmed positive CBNAAT patients do not have a history of tuberculosis. In this study about 21.72% were ZN stain positive, 33.46% were culture positive and 28.96% were CBNAAT positive.&#x0D; Conclusion: The current scenario of traditionally AFB-negative PTB is not sensitive enough to establish the diagnosis of active tuberculosis without CBNAAT. They underdiagnose PTB and over-treat people without PTB.