King George Hospital Research Articles

Microbiological Profile and Antibiotic Resistance Pattern in Acuteexacerbations of COPD: A Study from Northern India

Background Chronic Obstructive Pulmonary Disorder (COPD) is a major cause of morbidity and one of the principal causes of death worldwide. The objective of this study is to identify the bacterial etiological agents in patients with acute exacerbations of COPDs by sputum culture and their antibiogram.MethodsThis is a prospective study comprising 100 diagnosed patients of COPD taken as GOLD Grade 4 who were admitted in the Department of Pulmonary Medicine, TB and Chest Hospital which comes under King George Hospital, Visakhapatnam.ResultsOut of 100 patients, 83 were males of which 87% were smokers. The most common organisms isolated were Gram negative bacilli in 51 patients and only 26 were Gram positive cocci. The most common Gram-negative isolate was Klebsiella pneumoniae 27 cases followed by Pseudomonas aeruginosa in 19 cases. The most common Gram-positive isolate was Streptococcus pneumoniae in 16 cases followed by Streptococcus pyogenes in 6 cases and Staphylococcus aureus in 2 cases.Conclusions Frequent exacerbations appear to be associated with worsening healthoutcomes and effort should focus on prompt and effective treatment of eachepisode. Bacterial pathogens, mostly Gram negative bacilli are found to be the chief etiological agents in AECOPD. Antibiotic therapy should be initiated early depending on the culture. Susceptibility patterns of that particular region should be determined to prevent antibiotic resistance and to decrease health costs.

Assessment of treatment outcome among HIV positive tuberculosis patients in Visakhapatnam

In March 2016, RNTCP revised its technical and operational guidelines. One of the major additions was introduction of Daily Regimen in the treatment of Drug sensitive TB, started initially among TB-HIV co-infected patients in 2017. The present study was taken up to assess the treatment outcomes of Tuberculosis among TB-HIV co-infected patients and certain factors related to the poorer outcome of the treatment.An Observational Longitudinal study conducted at an ART centre, attached to King George Hospital in Visakhapatnam District, Andhra Pradesh, among all TB-HIV co-infected patients newly diagnosed with Drug Susceptible Tuberculosis, aged above 18years, at the selected ART centre, from the month of June 2018 to December 2018. The sample size calculated was 88 with an absolute precision of 10. Ethical clearance from Institutional Ethics Committee, Andhra Medical College; Written informed consent from all the study participants were taken prior to start of study. Confidentiality of the study participants was maintained Qualitative variables were presented as proportions. Analytical statistics include chi-square test and regression analysis. 74% of the patients had a favourable treatment outcome, 15% of the patients died and 11% of the patients were lost to follow up. Occupational status of the study participant, Socio- economic class, tobacco using habit and their CD4 counts had a statistically significant impact on their TB treatment outcome.CD4 count below 200cells/mm, Tobacco use, Diabetes Mellitus- factors responsible for unfavourable treatment outcome of Tuberculosis treatment Case-specific approaches among LFUs may be carried out to bring improvements in the strategies which are already existing or framing new strategies.

The Incidence and Indications of Caesarean Sections in King George Hospital (KGH), Visakhapatnam

The Incidence and Indications of Caesarean Sections in King George Hospital (KGH), Visakhapatnam

Evaluation of Endometrial Thickness by Transvaginal Sonography in Postmenopausal Women with Bleeding: A Cross-sectional Study

Introduction: Abnormal Uterine Bleeding (AUB), occurring atleast one year after menopause, is one of the most concerning complaints among gynaecological patients. Endometrial atrophy is the most common endometrial finding in women with Postmenopausal Bleeding (PMB), approximately 10-15% of whom have endometrial carcinoma. Earlier studies suggested that obesity, Type 2 diabetes mellitus, and hypertension are risk factors for endometrial hyperplasia. Diabetes mellitus, obesity, and hypertension form the triad of endometrial cancer. Aim: To assess endometrial thickness by Transvaginal Sonography (TVS) and compare it with histopathological findings in women with PMB, evaluating whether an endometrial thickness of <4 mm on TVS is more suggestive of malignancy. Materials and Methods: The present cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at King George Hospital, Vishakapatnam, Andhra Pradesh, India, from January 2022 to December 2022, comprising n=100 subjects. After routine necessary investigations for PMB, a transvaginal ultrasound examination was carried out to calculate endometrial thickness and compare it with the results of histopathological diagnosis of the endometrium. The parameters assessed were endometrial thickness and appearance, Type 2 Diabetes Mellitus (T2DM), hypertension, and Body Mass Index (BMI). The data was compiled and compared using the Chi-square test, with a p-value of ≤0.05 considered highly significant. Results: The results showed normal atrophic and thickened endometrium in 36% of subjects each, and abnormal endometrium such as hyperplasia, carcinoma, and polyps were recorded in 14%, 8%, and 6% (n=6) of cases, respectively. The histopathological results showed normal endometrium such as atrophic, secretory, and proliferative endometrium in 49%, 6%, and 19% of subjects, respectively. Abnormal endometrial findings such as endometrial hyperplasia, carcinoma, and polyps were observed in 14%, 7%, and 5% of cases, respectively. The majority of cases (58%) had endometrial thickness ≤4 mm, followed by 36% of cases with 5-10 mm and 6% of cases >11 mm, with mean and Standard Deviation (SD) values of 5.8±3. mm Statistical analysis data on the association between TVS findings and Histopathological Examination (HPE) findings was observed to be statistically significant (p<0.001). A statistically significant association was observed between T2DM, and BMI >25 kg/m2 together, DM+hypertension+BMI (Triad) and endometrial thickness, respectively. Conclusion: The TVS is easy, simple, non invasive, and involves no complications. Therefore, it can be used as the first diagnostic step in the investigations of women with PMB, combined with histopathological assessment.

Tiger Catheter for Difficult Femoral Artery Approach Coronary Catheterization

Background: While most catheters are designed for the natural anatomy of the coronaries at the origin, we often end up using multiple catheters in failed attempts to hook the coronary ostia in case of unusual origins. We had similar issues where we used multiple catheters in vain during femoral approach catheterizations and ended up successfully hooking with a tiger (TIG) catheter in a few of our cases in the catheterization laboratory. We mostly used Judkins left (JL) and Judkins right (JR) catheters as the first choice for femoral approach catheterizations. Hence, we wanted to see how frequently we had to use catheters other than JL and JR and which catheter was most useful in such cases. Methods: This is a retrospective study of catheterization laboratory angiographic data and recordings involving femoral artery approach coronary catheterization at King George Hospital, Visakhapatnam, from January 2022 to December 2022. We analyzed and interpreted the data of difficult femoral artery catheterizations where JL/JR catheters could not hook the coronaries successfully. We tabulated such data in percentages to understand which catheter was most useful in such cases. We analyzed the angiograms of such cases to understand the coronary origins. Results: Overall, 1130 cases underwent femoral artery approach coronary angiograms. Of them, 1100 (97.3%) cases could be hooked with JL and JR catheters. Thirty (2.65%) cases were found to be difficult femoral artery approach catheterizations where either JL or JR catheter could not be used successfully. Out of those difficult ones (30 cases – 100%), 22 (73.3%) cases could be hooked with TIG catheter, 4 (13.33%) cases with extra backup (EBU) catheter, 1 (3.33%) case with JR side hole (JRSH) catheter, 2 (6.66%) cases with no torque right (NTR) catheter, and 1 (3.33%) case with multipurpose catheter (MPA). Out of these 30 cases, a left coronary angiogram was needed other than a JL catheter in 8 cases, while a right coronary angiogram was needed other than a JR catheter in 25 cases, showing that the right coronary artery (RCA) was mostly involved in difficult catheterizations. For left coronary angiograms, 4 cases hooked with TIG (1 case – posteriorly/low takeoff, 1 – high takeoff, 1 – mid-takeoff, and 1 – RCA/left main coronary artery [LMCA] from left sinus) and 4 cases with EBU catheter (1 – anterior/high takeoff, 2 – high takeoffs, and 1 – posteriorly/high takeoff). For right coronary angiograms, 21 cases hooked with TIG (3 cases – left sinus/anteriorly, 3 – high takeoff/anteriorly, 3 – low takeoff, 2 – mid takeoff/anteriorly, 3 – posterior/high takeoff, 1 – RCA/LMCA from left sinus, 1 – posteriorly/left sinus, 3 – high takeoff, 1 – anteriorly/low takeoff, and 1 – right sinus/mid-takeoff), 1 case with JRSH, 1 case with MPA (anterior/high takeoff) and 2 cases with NTR (1 – low takeoff and 1 – high takeoff). Conclusion: We found that the TIG catheter was useful in difficult femoral approach catheterizations in the majority of cases and it can be tried in difficult cases.

Prediction of culprit artery from ECG in acute ST elevation myocardial infarction and correlating with coronary angiography

Acute myocardial infarction (AMI) is one of the most common diagnoses in hospitalized patients in industrialized countries. The early (30-day) mortality rate from AMI is ~30%, with more than half of these deaths occurring before the stricken individual reaches the hospital.When patients present with acute coronary syndrome, The 12-lead electrocardiogram (ECG) recorded by the alarmed general practitioner or ambulance staff is a pivotal diagnostic and triage tool since it is at the center of the decision pathway for management. In this study the accuracy of ECG in identifying the culprit artery was determined by comparing ECG finding with angiography finding which is a direct visualization procedure.To assess the value of electrocardiogram in predicting the culprit artery in acute ST elevation MI and correlating with coronary angiogram finding. A Cross Sectional Observational study was carried out for a period of 11months from February 2021 to December 2021 among 100 Patients admitted to ICCU, Dept of Cardiology, King George Hospital, Visakhapatnam who were diagnosed with acute ST-elevation myocardial infarction. The accuracy of ECG in identifying the culprit artery was determined by comparing ECG finding with angiography finding which is a direct visualization procedure. The sensitivity of ECG in predicting LAD as infarct related artery when compared to CAG, which was taken as standard test is 94.10%, specificity 89.79% the positive predictive value is 90.56% and the negative predictive value is 93.61%. In the present study, ECG well correlated with CAG (90.56%) in predicting LAD as infarct related artery.

Socio-demographic correlates and psychosocial stressors among suicide attempters attending a tertiary care general hospital

Abstract Introduction: Suicide is a rapidly growing and critical public health concern in India and around the world. Interpersonal, social, familial, psychological along with genetic vulnerabilities were important risk factors for suicidal attempts. Methods: This was a hospital-based cross-sectional study done at King George Hospital, Visakhapatnam. All the suicide attempters admitted to the General Medicine department were evaluated at the psychiatric department. A total of 117 patients were included in our study with convenient sampling. Beck’s suicide intent scale, Presumptive stressful life event scale, and semi-structured proforma for socio-demographic and clinical variables were used to assess the study participants. Results: Financial struggles (19.6%) and conflict with family members (14.5%) were the stressful life events among most of the suicide attempts. Most of the study sample used pesticide consumption (20.5%) as the commonest mode of suicidal attempt. The majority of the suicide attempters (53%) had medium suicidal intent. There was a significant association between marriage and stressful life event score (p=0.001). The use of pesticides was significantly higher among men than women (p=0.002) and the use of household agents was significantly high among women than men (p=0.013). Conclusion: Psychosocial stressors also play an important role in attempting suicide and hence to prevent suicidal attempts, there is a need for the development of innovative strategies to decrease the stigma, to improve coping skills and to promote help-seeking from mental health services.

AEROBIC BACTERIAL PROFILE AND ANTIBIOGRAM OF BRONCHOALVEOLAR LAVAGES IN PULMONARY INFECTIONS AT A TERTIARY CARE HOSPITAL

Objective: Lower respiratory tract infections (LRTIs) are one of the common clinical problems in community and hospital settings and the commonest causes of morbidity and mortality. In pulmonary infections, BAL fluid sample has high sensitivity and reliability in diagnosis. To determine the distribution of bacterial isolates in BAL samples and antibiotic sensitivity patterns in most frequently isolated bacterial pathogens other than Mycobacterium tuberculosis.
 Methods: The study was conducted on 218 BAL samples received in the microbiology laboratory, Andhra Medical College from various wards of King George Hospital; Visakhapatnam; Andhra Pradesh, over a period of one year (from January 2022 to December 2022). All samples were processed according to standard microbiology protocols. Antimicrobial susceptibility was tested by the Kirby-Bauer disc diffusion method as per the CLSI guidelines 2022.
 Results: Total 218 BAL samples were studied. Among 218 BAL samples, 144(66%) samples were from male patients and 74(34%) samples from female patients. Out of 218 samples, 119(55%) were culture positive and 99(45%) were culture negative. Among 119 bacterial isolates, most predominant pathogen was Klebsiella pneumoniae 51(42.8%) followed by Pseudomonas aeruginosa 46(38.6%), Escherichia coli 11(9.2%), Enterobacter species 6(5.0%), Acinetobacter species 3(2.5%) and Staphylococcus aureus 2(1.68%). Out of these isolated pathogens, Gram-negative bacilli were more. These gram-negative isolates were most sensitive to Piperacillin-Tazobactam (74.3%) followed by Meropenem (71.7%), Amikacin (60.6%) and least sensitive to Ceftazidime (39.3%) and Cefotaxime (37.6%).
 Conclusion: The present study shows that gram-negative bacilli were more commonly isolated in BAL samples and the bacterial isolates were most sensitive to Piperacillin-Tazobactam and Meropenem and highly resistance to Cefotaxime and Ceftazidime. Hence, formulating a regular antibiogram in hospitals will help in developing local antibiotic policies, which may provide better patient management and judicious use of antibiotics by clinicians to prevent the risk of the emergence of multidrug-resistant pathogens.

COMPARATIVE ANALYSIS OF SERUM MAGNESIUM & ZINC LEVELS AND THEIR ASSOCIATIONS WITH PRETERM LABOUR

Background: Preterm is dened as babies born alive before 37 weeks of pregnanc, it occurs when there is a regular contraction of uterus which results in opening of cervix after 20 weeks and before 37 weeks of gestation. preterm labour is spontaneous but it can also be due to a biochemical changes in body functions at the cellular level of trace elements such as magnesium and zinc. The main objective of this study is to nd the association of hypomagnesaemia and low zinc levels in preterm delivered women and to compare the maternal serum magnesium and zinc levels between Preterm and Term delivered mothers. Methods: A Comparative study was done in the Department of Biochemistry, Andhra Medical College, Visakhapatnam. Atotal of 126 women who were admitted to the labour room at Department of Obstetrics and gynaecology, King George Hospital, Visakhapatnam were selected for this study. All the subjects were divided into two groups as Preterm Consists of 63 women with spontaneous preterm labour delivered between 28- 37 weeks and Term Consists of 63 Women with Term labour after 37 weeks. Results: Women with Preterm labour had a signicantly low serum magnesium level with a mean serum magnesium level of 1.8 mg/dl with SD of 0.38 whereas the patients with Term labour had a mean serum magnesium level of 2.09 mg/dl with SD of 0.50 and also low zinc levels in Preterm labour with mean zinc levels of 51.28 µg/dl with SD 10.9 whereas patients with Term labour had mean serum zinc levels of 56.5 µg/dl with SD 9.7. The difference of serum magnesium and zinc levels observed between the study population and control population is independent of factors like maternal age, parity, gestational age, Blood pressure and socioeconomic status. In this study there is non signicant weak correlation was found between Demographic data and parametric data. Conclusions:Serum magnesium and zinc levels can be used as predictors for preterm labour. Spontaneous preterm delivery can be avoided by early assessment of maternal magnesium and zinc status and also by simple oral supplementation of magnesium and zinc which might provide an easy and inexpensive means to decrease the problems related to preterm labour. There is a further scope for research on serum magnesium and zinc levels based on gestational age.

A STUDY OF CORRELATION OF PREOPERATIVE RADIOLOGICAL DIAGNOSIS WITH OPERATIVE FINDINGS IN BLUNT INJURY ABDOMEN

Introduction: Trauma has been called the neglected disease of modern society, despite its close companionship with man1. Abdominal trauma caused by blunt force is a common presentation in the emergency room seen in adults and children. They are usually an outcome of road trafc accidents, fall from heights or fall on any blunt objects or due to assaults2. They are associated with a high morbidity and mortality which can be avoided with early diagnosis and management. To study the correlation Objective: of preoperative diagnosis made by radiological evaluation with the intraoperative ndings in cases of blunt abdominal trauma. Materials and methods: The present study was conducted on 60 clinically suspected patients of blunt abdominal trauma presenting to the Emergency Department, King George Hospital, Visakhapatnam. The study was conducted after prior approval by the Institutional Ethics Committee and informed and written consent from the patient. 60 patients with clinical suspicion of blunt abdominal trauma were selected. After thorough clinical examination, the patients were subjected to X-ray chest and abdomen, Ultrasonography (USG) and Computed Tomography (CT) imaging. After arriving at a pre-operative diagnosis, these patients were followed up and correlation of this diagnosis was done with the intraoperative ndings and the results were evaluated. The data entry was done using M.S.Excel and statistical analysis was done using Statistical package for social sciences (SPSS version 16) for M.S.Windows. Fischers exact test was used. p-value less than 0.05 was considered to be statistically signicant. It was observed that preoperative diagnosis ma Results: de with CT had a higher degree of correlation with the intraoperative ndings when compared to Ultrasonography. It can be concluded that CT i Conclusion: s a better tool for preoperative evaluation when compared to USG in cases of blunt abdominal trauma

KNOWLEDGE, ATTITUDE AND PRACTICES TOWARDS BREAST FEEDING AMONG LACTATING MOTHERS IN KING GEORGE HOSPITAL, A TERTIARY CARE CENTER

Background: Exclusive breastfeeding (EBF) is recommended for the first sixmonths of age by the World HealthOrganization. Mothers good knowledge andpositive attitude play key roles in the process of exclusivebreastfeeding practices. Objectives:The objective of the present study was to examine theknowledge and attitude towards breast feedingpractices among lactating mothers in inpatient wards in the Department of Obstetrics and Gynaecology, King George Hospital, Visakhapatnam. Methodology: A cross sectional descriptive study was carried out amongrandomly selected postnatal mothers at Inpatient wards in the Department of obstetrics, King George Hospital, a tertiary care center in Visakhapatnam. Data was collected through face-to-face interview using astructuredquestionnaire. Results: Our findings revealed that a majority 86%(n=284) of the mothers werebreastfeeders.About 58%(n=191) believed that colostrum is nutritionally beneficial to child. About 46%(n=152) initiated breast feeding within an hour. 70%(n=231) of mothers felt it should be given for >6 months. 83%(n=274) of mothers were against pre lacteal feeds. Mothers have goodknowledge and practices on breast feeding andfair attitude toward breast feeding. Conclusion: The breastfeeding practices in India still can be improved, although women were aware of the exclusive breastfeeding and its importancethey did not practice this to the fullest. We suggest access to nutrition information pertaining to breastfeeding can be strengthened further through various community programmes. Individual breastfeeding counsellingand health education on nutrition to the mother by health workers should be promoted.

CHALLENGES, CHANCES & CHANGES WITH OBSTETRIC CO- MORBIDITIES IN PREGNANT WOMEN WITH COVID-19

Introduction:Covid 19 pandemic had a significant impact on peoples lives all over the world, and pregnant women are one of the most vulnerable groups of population more so with obstetric comorbidities. Aim: To study the association of obstetrical co-morbid conditions and the course of covid 19 infection in pregnant women. Methods: It is a cross-sectional, quantitative observational study carried out atKingGeorgeHospital,Andhra Medical College,Visakhapatnam. Study participants were women diagnosed with covid 19 infection who were admitted at CSR block, King George Hospital during the period April 2021-October 2021. ICU admissions, maternal mortality in women with covid 19 infection, and their association with obstetrical co morbidities were studied. Results:Among 392 hospitalized pregnant women with covid19 diagnosis,122 were asymptomatic at the time of admission.Majority of patients were in age group between 21-30yrs .60 women had obstetric comorbidities like preeclampsia, obesity, and GDM.. Preeclampsia accounted for6.1% of the population in the study,GDM for 3.6%, and obesity for 5.6%.Of all individuals, 48 (12.2%)were admitted in Intensive Care Unit,35 women required invasive mechanical ventilation and 24 deaths were reported which accounts to 6.1%.Obesity was found to have a significant association with covid 19 morbidity and mortality in this study,where as no significant association was found with other obstetric comorbid conditions such as gestational diabetes and preeclampsia. Conclusions:Though all three comorbid conditions contributed to morbidity such as ICU admissions and deaths, obesity alone showed a statistically significant association with maternal morbidity and mortality.Identification of risk factors during hospitalisation is therefore crucial for directing preventative measures and initiate appropriate treatment.

Study of Lung Function in COVID-19 Pneumonia Recovered Individuals

BACKGROUND
 Corona virus disease 2019 (COVID-19) is an acute respiratory infectious disease caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2). Pulmonary system is the most commonly affected organ system by COVID-19. SARS-CoV-2 results in disruption of ACE/ACE2 balance leading to RAAS activation. The present study was carried out to determine the lung function in the recovery phase of COVID -19 by spirometry in India.
 METHODS
 A prospective (Follow up) observational study was done on 100 patients from March 2021 to November 2021. COVID-19 patients with RT-PCR positive results aged between 25 to 60 years were enrolled in the study. All the subjects were health care workers working in King George Hospital, Visakhapatnam. They were followed for a period of 3 months.
 RESULTS
 The mean age was 48.35 ± 11.07 years. 71 % were males. The mean height was 162.85 ± 7.47 cm while the mean weight was 36.71 ± 1.12 kg. During enrolment, the mean forced vital capacity (FVC) was 2.22 ± 0.68 L, forced expiratory volume (FEV1) was 1.97 ± 0.63 L and FEV1/FVC% was 89.35 ± 13.27 %. There was no statistically significant difference in FVC between enrolment and various periods of follow up at 1 and 3 months. There was a statistically significant difference between FEV1 and FEV1/FVC% between enrolment and various periods of follow up at 1 and 3 months.
 CONCLUSIONS
 COVID-19 infection has an impact on the lung functions. PFT done 3 months later after clinical cure/discharge showed an improvement in FEV1 and FEV1/FVC% in the present study. Long-term follow-up of the lung function in post-COVID-19 survivors is recommended.

A prospective observational study of functional outcome of fracture distal end of Tibia, treated with minimally invasive plating osteosynthesis (Mippo) technic

Background: Distal tibia fractures including Tibia pilon fractures present a challenge as to their best method of management due to subcutaneous location of larger portion of tibia, paucity of soft tissue coverage and precarious blood supply to the distal leg. The involvement of the ankle joint and the vulnerability of the surrounding soft tissues further complicate these already complex injuries. Numerous classifications have been proposed for these fractures, however AO-OTA alphanumeric classifications the most comprehensive as well as the most commonly quoted classification. The lower end of the tibia including its medial and the lateral malleoli of the fibula form a socket (mortise) into which the body of the talus articulates, and along with capsule and ligament thus form the ankle joint. Any disruption of length, axis or rotation of the fibula or the tibia can result in an incongruent ankle joint. The lateral aspect of the distal tibia forms a triangular notch where the fibula articulates. The interosseous membrane and the anterior and posterior tibiofibular ligaments bind these bones together.Aim: To evaluate the efficiency of internal fixation for the fractures of distal tibia by using minimally invasive plating osteosynthesis [Mippo] technique. To assess the functional outcome of Mippo technique with locking compression plate and dynamic compression plate.Methods: A prospective observational study of patients above the age of 20 years with distal tibia fracture admitted in King George hospital, Visakhapatnam. Study duration 9 months.Results: There were 72 patients in the study including 50 males (69.4%) and 22 females (30.6%) of mean age 46 years. The commonest cause of injury was RTA with High energy trauma with total of 31 patients (43.06%) followed by Low energy RTA with total of 28 patients (38.89%) and the rest 28 of the patients with Low energy fall (18.06%) respectively. All fractures united at an average of 15 weeks (range 12 to 20 weeks). As regards pain, 48 patients (66.66%) were pain-free, 18 patients (25%) had only occasional pain.Conclusion: It is well accepted that the final outcome of distal tibial fractures including pilon fractures with this MIPPO technique, a single stage operative procedure. It is obvious that these are not directly influenced by this technique MIPPO, single-stage operative procedure, contributing to a favorable outcome.

Pathogenic Organisms Causing Respiratory Infections in Patients with Chronic Kidney Disease, Stage V on Maintenance Haemodialysis: A Cross-Sectional Study

Introduction: Pulmonary infections are the most common infectious cause of disability and mortality in Chronic Kidney Disease (CKD) stage V patients on haemodialysis after cardiovascular disease. The incidence of pathogenic invasion of the lungs causing pneumonia is markedly higher in CKD stage V patients undergoing haemodialysis as compared to the general population. The risk is due to various factors including immune dysfunction, prolonged hospital stays leading to contact exposure, and hospital-acquired infections. The other important factors are anaemia, uremic toxins promoting pulmonary oedema, age, and vascular access through the arteriovenous fistula and internal jugular vein leading to catheter-induced respiratory infections. Aim: To study the common pathogens involved in causing lung infection in CKD stage V patients on maintenance haemodialysis. Materials and Methods: This cross-sectional study was conducted in the Department of Medicine/Nephrology at Andhra Medical College and King George Hospital, Visakhapatnam, Andhra Pradesh, India. The duration of the study was one month, from June 2019 to July 2019. A total of 50 patients were included in the study with CKD stage V on haemodialysis. The samples were between ages 18 to 75 years with respiratory symptoms and signs including fever, productive cough, and shortness of breath being the major complaints. These patients were subjected to certain investigations to isolate the organism. The parameters assessed were blood culture and sputum culture, haemoglobin, and chest X-ray. Sputum examination for Acid-fast Bacilli (AFB) was done to rule out tuberculosis. Statistical Package for Social Sciences (SPSS) version 17.0 was used for statistical analysis and measurement, data were expressed as the Mean±Standard Deviation (SD). Results: The majority of the subjects were in the mean age group of 49 years and males were predominantly affected. The commonly isolated organism was gram-negative bacilli-Pseudomonas, with access common through arteriovenous fistula as compared to Escherichia coli (E.coli), which was common in patients with access through Internal Jugular Vein (IJV). Conclusion: The respiratory infection, that posed the burden in the present study was pneumonia. The common organism isolated was gram-negative bacteria being pseudomonas. The respiratory infections identified, were more through Arteriovenous Fistula (AVF) access and common in patients with moderate to severe anaemia.

OBSERVATIONAL STUDY ON PLACENTA ACCRETA SPECTRUM DISORDERS IN A TERTIARY CENTRE FOR TWO YEARS

Introduction: Incidence of placenta previa is 3-5per 1000 pregnancies. Placenta previa includes: i) Low lying placenta: when the lower edge of placenta is within 2cms distance from internal os. (ii) Placenta previa : when placenta lies directly over the internal os. The rising incidence of cesarean section combined with increasing maternal age, the number of cases of placenta previa and its complications, including placenta accreta spectrum (PAS), will continue to increase. Aims And Objectives:To analyse : Incidence Evaluate risk factors Maternal and Neonatal outcome Methodology: A retrospective study was conducted over a period of 2 years (august 2020 - august 2022) in the Department of Obstetrics and Gynaecology, King George Hospital, Visakhapatnam. A total of 144 pregnant women with placenta previa were enrolled in this study according to the inclusion and exclusion criteria. Systematic analysis was done with respect to their age, parity, gestational age, past obstetric history, period of gestation at delivery, mode of delivery, birthweight Criteria Inclusion: Singleton pregnant women with placenta previa confirmed by ultrasonography gestational age beyond 28 weeks were selected irrespective of their parity alive or dead fetus. Exclusion: Women with multiple gestation pregnancies are excluded to avoid overrepresentation of studying high risk women. Discussion: Incidence of Placenta previa in King George Hospital, Visakhapatnam, Andhra Pradesh over a period of 2 years is 1.0% as total no. of deliveries in that year was 13552 of which placenta previa were 144. Incidence was found to be maximum i.e.,37.5% among age of 20-24 age group, 11.1% in the age group of >30 years. Placenta previa incidence was highest among multigravida accounting for 76.3% of which 43.6% were previous c-sections and 33.3% were previous abortions Conclusion: Community level education regarding Safe Abortion Practices and Anemia correction should be done. Complete management and mock drills for PostPartum Hemmarhage management in cases of Placenta previa is important inorder to reduce the maternal and fetal complications Safe abortion procedures and also C section Audit should be done.

Impact of Covid-19 Pandemic on Mental Wellbeing of Healthcare Professionals: A Cross-Sectional Study

BACKGROUND
 COVID 19 pandemic posed a varied group of challenges to health care workers (HCWs) like new disease with no treatment, less treatment options available, worry for infection to family members, shortage of personal protective equipment (PPEs), uncertainty, and stress associated with lockdowns. HCWs are highly vulnerable to negative mental distress; this psychological distress varies in different group of HCWs and also on different psychological domains. In this study, we wanted to assess the impact of COVID 19 on the psychological well-being of health care professionals when providing care to COVID-19 patients.
 METHODS
 A cross-sectional observational study was conducted on doctors providing care to COVID -19 patients at King George Hospital, Visakhapatnam, during the second wave of COVID from March 2021 to December 2021. The questionnaire included three domains – Personal questions, work related questions, and pandemic related questions. The response to the questions was recorded in Likert’s scale.
 RESULTS
 50 (50.00 %) were sometimes physically exhausted, 49 (49.00 %) participants were sometimes emotionally exhausted, and 46 (46.00 %) participants reported that sometimes they felt worn out (extremely tired). 54 (54.00 %) participants reported that sometimes they were frustrated with their work, and 46 (46.00 %) participants reported sometimes feeling burnt out because of the work. 48 (48.00 %) participants reported sometimes feeling depressed, 38 (38.00 %) participants stated sometime having a fear of catching COVID-19 infection, and 44 (44.00 %) participants reported consistently having to fear of family members getting infected due to the exposure in work environment.
 CONCLUSIONS
 In total, COVID-19 had a negative effect on psychological well-being of the HCWs, but that was not severe to cause any specific psychological disorders. There was no significant difference in mental health impact between the genders and age groups of the participants.

CAESAREAN DELIVERY DURING SECOND STAGE OF LABOR- A STUDY OF FETOMATERNAL OUTCOME IN A TERTIARY CARE HOSPITAL

Background: There is an alarming rise in Caesarean section (CS) leading to increased adverse outcomes for both the mother and fetus when compared with vaginal delivery despite the efforts to limit operative abdominal deliveries. Within this increasing CS rate, there is a concerning increase in the rate of second stage cesarean section. Cesarean sections performed at full dilatation (FDCS) are becoming increasingly common in obstetric practice Aim: To analyze the indications and assess feto-maternal outcomes in caesarian section in second stage of labor. Material And Methods: This was a retrospective hospital based observational study assessed all caesarean sections performed at full cervical dilatation between September 2020 and September 2021 at King George hospital, Visakhapatnam, Andhra Pradesh. Caesarean section cases were identified through the operating theatre data log. The medical record, specifically the record of labor and operation reports, was reviewed for all CS cases over the study period. Results: During the index period, a total of 3800 women delivered by caesarean section, (2900 emergency and 900 elective cases) .A total of 340 women were at full cervical dilatation, >37 weeks gestation with a singleton fetus in cephalic presentation were studied. Mean duration of surgery was 57.68 min. Secondary arrest of descent was seen in 53.8% of cases and NICU admission in 6.76%,APGAR <7 at birth in 9.11% cases. Conclusion: Although second stage of labor was sometimes appropriate, there are no specific guidelines for safe practice. It is a technically demanding procedure. It has additional associated risks for mother and fetus due to the nature of emergency situation.

A STUDY ON HAEMOTOLOGICAL ABNORMALITIES IN CHRONIC LIVER DISEASE

Background:- Chronic liver disease ia an end stage disease and hematological abnormalities are common nding in it, adding morbidity to primary pathology and increase the mortality. The study was conducted to assess the hematological abnormalities and haemostatic derangements in CLD patients. Broadly , the hematological abnormalities are viewed under abnormalities in RBCs, WBCs, platelets and coagualation prole total 100 patients who fullled our Methods:- criteria were enrolled in our hospital , king George hospital, Visakhapatnam . patients were investigated after their oral and written consents wherever required. various Results :- hematological abnormalities encountered were normocytic normochromic anemia followed by microcytic anemia. Macrocytic anemia mostly in alcoholics. Leukocytosis was observed more than leucopenia and thrombocytopenia. prothrombin time and APTT were increased. Conclusion:- every chronic liver disease patients must be evaluated for hematological abnormalities and should be treated accordingly as early as possible to decrease mortality.

A CLINICAL STUDY OF VENTILATOR ASSOCIATED PNEUMONIA IN A TERTIARY CARE CENTER

Introduction: Ventilator-associated pneumonia (VAP) is a nosocomial pneumonia in mechanically ventilated patients that develops 48hours after initiation of mechanical ventilation. Despite recent advances VAP complicates 8-28% of the patients receiving mechanical ventilation.1-5 Objectives: To determine the incidence, risk factors, clinical prole and outcome of VAP in a tertiary care hospital. Methods: 100 children between 1 month to 12 years of age who received mechanical ventilation for >48hours in PICU King George Hospital were enrolled in the study. The demographic details of the patients, underlying illness, duration of ventilation, medications administered and investigations performed and outcome of these children was noted. Results: Majority of children with VAP had a Clinical Pulmonary Infection score (CPIS) of>8.Incidence of VAP was 26%. Statistically signicant difference was found with VAP in association with factors like purulent aspirate, un-cuffed ET tube, multiple intubations, and duration of mechanical ventilation>5days with gram negative bacilli(Acinetobacter and klebsiella) being the important causative agents. Conclusion: Awareness about the risk factors & their prevention will help in reducing VAP related morbidity and mortality. Early institution of empirical sensitive antibiotics improves outcomes in children with VAP and also helps to prevent the risk of multidrug resistance