Medical Record Department Research Articles

Navigating Hysterectomy Choices: A Retrospective Study On Non-Descent Vaginal And Total Abdominal Hysterectomy In Rural Women

Background The aim of the study is to compare the results of non-descent vaginal and total abdominal hysterectomy procedures done in women in a tertiary care hospital. A retrospective study done by collecting the data from medical records who underwent non-descent vaginal and total abdominal hysterectomy done in women with fibroids, adenomyosis, endometrial atypical hyperplasia and abnormal uterine bleeding. Materials and Methodology This was a retrospective study done by collecting the data from medical record department of the hospital for the period of 6 months from April 2024 to September 2024. The total record of the study consisted of 400 patients out of which 200 patients underwent total abdominal hysterectomy and the rest 200 underwent non-descent vaginal hysterectomy. Those patients were pre-operatively assessed by physical, clinical, radiological evaluations as well as biochemical tests. Results The data of a total of 200 NDVH patients and 200 TAH patients was analysed which showed that NDVH patients had lower parity and BMI, smaller uterine sizes, and were more likely to have surgery for abnormal uterine bleeding. Intraoperative outcome was found to be better for NDVH, with less blood loss and shorter operative duration. The post-operative complications were significantly lower in the NDVH group, resulting in shorter hospital stays. Overall, NDVH outcomes were found to be superior to TAH. Conclusion: The non-descent vaginal hysterectomy has much advantages when compared to total abdominal hysterectomy

The Role of Early Mobilization in Outcome of Proximal Tibia Fractures Treated with Dual Plating

The management of bicondylar fracture of the proximal tibia is a challenging task and the aim of management is to achieve stable, painless and mobile joint and also to prevent the secondary degeneration of the joint. Open reduction and internal fixation with dual plating in such fractures is beneficial to address fracture fragments in different planes and also to achieve anatomical reduction under direct vision. It also allows stabilizing the fracture which helps in early mobilization of the patient. Early post-op rehabilitation is one the most important factor that play a vital role in outcome of the operated knees by preventing the post- operative stiffness and achieving good range of motion. This is a retrospective study conducted in Department of Orthopedic Surgery, Kurmitola General Hospital, Dhaka, Bangladesh from July to December 2022. Total 100 patients were included in the study. The functional outcome was evaluated according to Rasmussen scoring system. Mal-reduction of the articular surface was defined as an intra- articular step-off of at least 2 mm measured on scaled radiographs. Oldest patient was 71 years and youngest patient was 20 years old. Male were 79% and female were 21%. All the patients with bicondylar fracture treated with dual plating. Data was obtained from the Medical record department, indoor ward records, OPD registers and Operation theatre records. This study analyses the outcome of bicondylar proximal tibia fracture treated with dual plating in 100 patients. In our series we found 63 % excellent results and 28 % good results, while 7 % and 2% fair and poor outcome respectively. Fractures of proximal tibia are increasing with the increase in mechanization and increased road traffic in current world today. These fractures are more in men and those who use automobiles frequently for their outdoor ventures. Better preoperative planning in selection of approach can minimize the soft tissue injury and unnecessary periosteal stripping. ......

"Modernizing Cervical Cytology Screening with Liquid-Based Methods at Community-Level Hospitals: A Much-Needed Breakthrough for India".

Cervical cancer still ranks highest causing cancer-related morbidity and mortality in women in India. It is prudent to emphasise and implement cervical cancer screening strategies in the population efficiently and with regular intervals. Conventionally, PAP smear cytology is obtained by wooden spatula-Ayre's spatula. To improve sensitivity and specificity of the procedure and detection rate, better techniques of cells retrieval are available mainly liquid-based cytology (LBC), with help of cyto-brush. Literature has consistently proven efficiency of the technique and also reduced the proportion of inadequate sampling. We conduct this study to compare both the techniques and efficiency in a community hospital from data over 6years,to asses its role and benefits among Indian women. To compare conventional PAP smear and liquid-based cytology techniques analysing detection rates of positive lesions (CIN and also includes ASCUS and malignant), incidence of inadequate sampling, efficiency and cost-effectiveness. This is retrospective study at tertiary care obstetric hospital affiliated to government-run medical college in a metropolitan city of Mumbai. Data are retrieved from the Pathology Department, Medical Records Department, laboratory books and OPD registers. Pap's smear sampling was done mainly from OPD with all indications including routine tests as a part of gynaecological evaluation and screening, as well as for suspicious lesions on inspection. Group A consists women who had conventional PAP smear test for 3years (Dec 2015-Nov 2018) and Group B had women who benefited by LBC method for 3years (Dec 2018-Nov 2021). COVID-19 pandemic majorly affected the routine gynaecological OPD practice during 2021 as hospital was COVID facility hospital. Demographic parameters and presentations were comparable and similar. LBC methods have higher detection rate for positive reports, including ASCUS. But results were comparable in both groups and not statistically different. Importantly, incidences of inadequate sampling are reduced significantly with the LBC method. Unsatisfactory smears war high in Group A (7.752%) compared to Group B (3.712%) p-value 0.005, stating the increased rate of requirement of sending repeat smears, which involves higher engagement of time, resources and active participation from healthcare personnel. Good detection rates and significantly low rates of unsatisfactory smears make LBC rational and cost-effective. These are the times to switch to liquid-based cytology techniques, especially at the community level hospitals; in order to detect more women with cervical premalignant as well as malignant neoplastic lesions and to save lives. This can be made possible by emphasising the policy makers to incorporate these services through quality resources.

Pattern of occupational lung disease among industrial workers attending a medical college of Eastern India.

Occupational lung diseases (OLDs) contribute a significant proportion to the global burden of pulmonary morbidities but are grossly misdiagnosed due to the relative lack of attribution given to occupational exposures. Obstructive lung diseases are known to be associated with long-lasting disability and loss of earning capacity (LOEC) among workers in industrial setups, thus reducing nationwide productivity. In this context, the study aimed to find out the pattern of OLD and factors associated with the severity of it among patients in a tertiary care hospital. The study was a record-based secondary data analysis conducted in the Medical Records Department of a Medical College in Kolkata. A computerized database of patients attending Special Medical Board (SMB) examinations from the Department of Medical Records was utilized for data collection. A data abstraction format was constructed to collect information on pulmonary morbidity, occupational exposure, and sociodemographic and behavioral variables. Extracted data were analyzed in Microsoft Excel and Statistical Package for Social Sciences (SPSS) software. After a review of records, it was shown that 62.3% (66 out of 106 people) of the study subjects had an obstructive type of OLD, the most common being Jute Byssinosis. A negative correlation (Spearman's ρ = -0.136) was found between pulmonary function (FEV1/FVC) and LOEC (%) in the study subjects. In the multivariable logistic regression, exposure to organic dust was found to be significantly associated with worsened lung function {adjusted-Odd's Ratio (95% Confidence Interval) =3.11 (1.1-8.8), P value = 0.03}. OLD is an understated health issue, especially in an industrial diaspora of developing countries, like India. Healthcare facilities should utilize their resources properly for the advancement of medical surveillance in industries where organic dust is produced. Health education of the stakeholders regarding the consequences of OLDs and the benefits of preventive primary approaches will go a long way in alleviating the burden of disease.

Antibiotic Resistance Pattern of Bacteria Isolated from Clinical Specimens: A Hospital-Based Cross-sectional Study in Kathmandu, Nepal

Antibiotics are vital in combating infectious diseases, yet their increasing use fosters resistance. Antimicrobial resistance (AMR) is rising in Nepal due to factors such as indiscriminate, inappropriate, and inadequate antibiotic usage. This study aims to explore the association between demographic factors and the prevalence of specific bacterial strains within the surveyed population. Additionally, it seeks to determine the antibiotic resistance patterns of these bacteria. Antibiotic susceptibility or resistance data were retrieved from the Medical Records Department (MRD) of the Manmohan Memorial Medical College and Teaching Hospital (MMMCTH) in Kathmandu. Samples from patients with certain types of bacterial infections were included, with 56 from sputum reports, 46 from urine, and 8 from blood samples out of 110 retrieved. Analysis revealed that sputum samples were mostly from older males, while urine samples were mostly from females. Yet, gender did not significantly influence bacterial presence across sample types. Overall, Escherichia coli was the most prevalent bacterium (74%), followed by Salmonella typhi (25%), Staphylococcus aureus (25%), and Klebsiella pneumoniae (23%) isolated from different type of clinical samples. Altogether, 6-15 antibiotics were assessed for sensitivity, with 2–6 antibiotics showing sensitivity to blood bacteria, 1-6 antibiotics demonstrating sensitivity to sputum bacteria, and 3–8 antibiotics exhibiting sensitivity to urine bacteria. Many investigated antibiotics were resistant, only gentamicin exhibited sensitivity for all types of bacteria found in blood, sputum and urine. These findings underscore the importance of discerning bacterial resistance patterns for effective antimicrobial treatment selection.

Clinicopathological Profiles of and Patterns of Recurrence in Triple-Negative Breast Cancer Patients at a Cancer Care Center in Southern India.

Triple-negative breast cancer (TNBC) is characterized by the absence of expression of the estrogen receptor and the progesterone receptor by immunohistochemistry and human epidermal growth factor receptor overexpression absence either by immunohistochemistry or absence of amplification by fluorescence in-situ hybridization. TNBCs tend to have rapid growth when compared to other subtypes of breast cancer. TNBC is associated with higher histologic grade and more advanced disease at presentation. TNBC shows aggressive behavior and a high chance of recurrence. The aim was to analyze the clinicopathological profiles of and recurrence patterns in TNBC patients at our institute where most patients are from rural areas. This retrospective study was done at a tertiary cancer care center in Southern India where most patients come from rural backgrounds. Institutional Ethics Committee approval was obtained before the study. Case files of all breast cancer patients registered and treated at our center from 2014 to 2019 were retrieved from the medical record department and reviewed. Data from patients diagnosed with triple-negative breast cancer were identified and analyzed. Among the 841 breast cancer patients registered in our study, 150 (17.8%) were diagnosed with TNBC. The median age of diagnosis was 47 years. The majority of the patients, 89 (59.3%) presented with T2 tumors, and lymph node involvement was observed in 88 (58.6%) cases. Patient distribution based on cancer stage revealed that 77 (51.3%) had early-stage breast cancer (EBC), 70 (46.6%) had locally advanced breast cancer (LABC), and only three patients were categorized as having metastatic breast cancer (MBC). Modified radical mastectomy (MRM) was the preferred surgical approach in 144 (96%) cases, while only four patients underwent breast-conserving surgery (BCS). Adjuvant chemotherapy was administered to 119 (79.3%) patients, with 30 (20%) receiving both neoadjuvant and adjuvant chemotherapy (NACT/ACT). Among those who underwent NACT/ACT, a pathological complete response was observed in five (16.6%) patients out of 30 patients. The median duration of follow-up was 32.8 months. Among all patients, 36 (24%) experienced recurrence, with seven (19.4%) having local recurrence, 24 (66.6%) developing distant metastases, two patients experiencing both local and distant recurrence, and three patients developing contralateral breast cancer. Additionally, three patients experienced a second primary cancer. The most common sites of metastases were the lungs (14), followed by the bone (seven), the liver (four), and the brain (four). Recurrence rates were notably high within the first one to three years post-diagnosis. The median disease-free survival (DFS) of TNBC patients was estimated to be 65.6 months with no statistically significant difference (p=0.174) between EBC and LABC patients. TNBC is known for its heterogeneity. While it is often regarded as being more responsive to chemotherapy compared to other subtypes of breast cancer, TNBCs tend to behave aggressively, basically due to the underlying aggressive tumor biology. Though there are many treatment options for different subtypes of breast cancer, therapeutic modalities are limited for TNBCs. Aggressive tumor biology with limited treatment options denotes a gap in the development of novel strategies to improve outcomes in this subset of breast cancer patients.

Simulation based CPR Training of EMS Staff and its Utility in Managing Remote Patients at Tertiary Care Hospital of Central India

Abstract Introduction: AVBRH is 1500-bedded tertiary care hospital that caters to patients from areas within more than a 50 km radius. Emergency medical services (EMS) are established and frequently on the run. The EMS team has 10 basic life support (BLS) ambulances with 20 drivers and 20 paramedical staff. Daily, 3–5 highly critical patients who are in need of cardiopulmonary resuscitation (CPR) are transferred to the AVBRH hospital. The optimal medical care while transferring the patient to AVBRH hospital was unmonitored and without any benchmark. A low-risk simulation-based environment to practice can be valuable to maintain a wide array of skills. Effective and prompt delivery of expert instruction and guidance by a telesimulation is approved to be a beneficial approach in this setting. Training of EMS staff helps to improve patient care and satisfaction. Hence, we decided to undertake the simulation-based CPR training of the staff and correlate the outcome with existing mortality data of Medical record department (MRD). Objective: To optimize health care while transferring the patient to a tertiary hospital by BLS training and teleassisting. To see the impact of teaching and assisting on overall patient outcomes at the emergency department. Methodology: Forty EMS participants were enrolled and trained for 2 days. On day 1, they were trained in BLS, while on day 2, training in working as a team through simulation at school of virtual learning was done. They were trained to work as a team through simulated case scenarios with effective telecommunication while transferring the patient to the hospital. After training, these EMS staff were monitored and assisted according to the protocol of BLS by the emergency medicine department through telecommunication on the field for the next 3 months and reassessed again after the completion of 3 months. The following tabulated assessment format is used for EMS staff attending to the patient on the field. The prefield assessment on the same day of training and on postfield assessment after 3 months at school of virtual learning-simulation lab (SVL) was conducted. The data were gathered, tabulated, and analyzed for the percentage. Conclusion and Recommendation: Simulation-based teaching by a facilitator along with effective telesimulation creates an important link and gaps in the bridge between knowledge and technical skills. It has been found that overall patient care and performance of EMS staff was significantly improved; hence, recommendations for continuous assistance while transferring the patients are given. Training of the newly appointed EMS crew and the other available EMS services from the district should be aligned with assisted telecommunication services of AVBRH. Regular audit for quality improvement in EMS performance to be imparted.

Sociodemographic features, serum urea, creatinine and blood urea nitrogen/creatinine ratio in chronic kidney disease patients – A record based retrospective study

Objectives: Chronic kidney disease (CKD) is a progressive reduction in renal function. It is a condition where the kidneys lose their normal function, especially excretory and regulatory functions. Urea and creatinine are good indicators of a normal functioning kidney and an increase in the serum indicates kidney dysfunction. Blood urea nitrogen (BUN) and serum creatinine are widely accepted and the most common parameters to assess renal functions. The present study was done to assess the serum urea, creatinine levels, and BUN-creatinine ratio (BCR) in CKD subjects. Material and Methods: It was a record-based retrospective study. Data were obtained from the Medical Records Department. The patients diagnosed with CKD in August 2023 were extracted from the records. Details such as hospital ID, age, gender, and blood parameters such as serum urea, creatinine levels, and BCR were obtained. Categorical data were summarized as frequency (percentage). Results: It was found that the number of male patients was 24 (75.4%) and the number of female patients was 14 (24.6%). The majority of patients belonging to the age group category of 50–75 were 42 in number (73.6%). Abnormal creatinine values were found in 54 patients (94.7%). Conclusion: The present study found that male gender and age group 50–75 years were most commonly affected with CKD. The serum creatinine level was found to be predominately abnormal compared to the serum urea level and BCR.

Unit Cost Analysis of Haemodialysis Services By Activity Based Costing Approach as a Strategy For Increasing Hospital Profits

One of the catastrophic diseases that is the focus of health insurance financing is kidney failure. Haemodialysis is a type of kidney replacement therapy for chronic kidney disease using special equipment. One method of financing haemodialysis procedures is the National Health Insurance Program. Hospitals, as health service providers for JKN participants, have an interest in the INACBG rates. Based on the Regulation of the Minister of Health of the Republic of Indonesia Number 3 of 2023 concerning Health Service Tariff Standards in the Implementation of the Health Insurance Program, there are changes to tariffs for haemodialysis services. With the current tariff changes, single-use and re-use services are divided into two different tariffs. The research was conducted at Siloam Hospital Bali. The data taken is secondary data originating from the Financial Division of Siloam Hospital Bali, the Medical Records Department of Siloam Hospital Bali, and the Haemodialysis Department of Siloam Hospital Bali during the period January–April 2023. The data collected and the hypothesis formulated in this research will be tested using the MANOVA (Multivariate Analysis of Variance) test method, using SPSS software. The research results show that there is a significant difference in total costs for re-use and single-use haemodialysis services; there is a significant difference in the total INACBG rates per patient for re-use and single-use haemodialysis services and there is no significant difference in the difference between INACBG rates and total costs in re-use and single-use haemodialysis services.

A Descriptive Study on Existing System in Medical Records Department and Its Gap Analysis in Multispecialty Hospital

The study goals are to assess the efficiency of the current medical record system and the current system for keeping medical records and to stipulate the advantages and downsides of completely linking computerized health databases with patient anamnesis. The study analyse the existing system of documentation of the medical record department, to identify bottlenecks in the existing system of medical records, and to provide recommendations to overcome the bottlenecks and implement the required changes in the required medical records department. And to discover user responses to computerized health databases, whether users are satisfied or not with computerized health databases, and what is users' perceptions of computerized health databases through a data collection process that includes direct observation and questionnaires for MRD staff, doctors, and nurses. Therefore, the medical records department has become an important department in every hospital, providing a variety of services not only to patients but also to the hospital& efficient operation, as well as playing a key role in health promotion and patient care quality.

A Retrospective Study Comparing the Surgical Results of Platysma Myocutaneous Flap, Buccal Pad of Fat, and Nasolabial Flap for Reconstruction After Fibrotomy in Cases of Oral Submucous Fibrosis.

To evaluate the effectiveness of nasolabial flap (NLF), a buccal pad of fat flap (BFP), and platysma myocutaneous flap (PMF) for reconstruction following fibrotomy for individuals with oral submucous fibrosis (OSMF). A retrospective study was conducted among patients diagnosed with grade III and IV OSMFin the Departmentof Oral and Maxillofacial Surgery at Sharad Pawar Dental Collegebetween January 2016 and August 2018. The essential patient information was obtained from the Medical Record Department (MRD) at Acharya Vinoba Bhave Rural Hospital (AVBRH), Datta Meghe Institute of Medical Sciences (DMIMS) Sawangi (Meghe) Wardha. The patients were categorized into three groups: the NLF, the BFP, and the PMF groups. Each group had 16 patients, and factors such as interincisal width, diminished burning sensation in the mouth, inter-commissure distance, and flap necrosis were compared pre- and post-operatively. Student's unpaired t-test and chi-square test were employed for statistical analysis. Mean interincisal mouth-opening increased from pre-operative 4.79 to 41.42 mm post-operatively in the NLF group, BFP group from 6 to 39.42 mm and in the PMF group from 9.26 to 39.34 mm with p value=0.0001. NLF group showed complete and partial resolution of the burning sensation of the mouth at 93.75% and 6.25%, BFP at 62.25% and 32.75% while in PMF it was 68.5% and 31.25% respectively. One year postoperatively 3.28 mm increase in inter-commissure width was observed in the NLF group with a marginal increase in the PMF group and a negligible increase in the BFP group. 18.75% partial flap necrosis was seen in BFP, 18.75% in the PMF group, and 6.25% in the NFL group. All the flaps are efficacious in treating OSMF, however, NLF stands ahead with its higher reliability owing to its excellent blood supply.

C-reactive Protein Kinetics During In-Patient Treatment of COVID-19-Associated Rhino-Orbito-Cerebral Mucormycosis: A Retrospective Cohort Study in a Tertiary Hospital in Central India.

COVID-associated rhino-orbito-cerebral Mucormycosis (CA-ROCM), henceforth referred to as Covid-Associated Mucormycosis (CAM), is a serious and fatal condition unless treated promptly and completely. The main treatment of the CAM is complete surgical debridement and administration of systemic antifungals. The first line antifungal recommended for CAM is Amphotericin-B. Since Amphotericin-B has systemic side effects mainly on the renal system, a timely decision to start and end Amphotericin-B therapy is very essential. Besides the Computed Tomography (CT) scan, serum levels of C-reactive protein (CRP) levels are a good indicator of CAM-associated inflammation levels in the patient's body. By monitoring the CRP levels, we can titrate amphotericin treatment to cause minimal harm to the kidneys.Our study was done to analyze the kinetics of C-reactive protein in patients of CAM admitted in a tertiary-care hospital and compare it with the CRP levels in COVID-associated non-Mucormycosis Sinusitis patients. Aim and objective To study the kinetics of serum C-reactive protein (CRP) levels among patients undergoing in-patient care for COVID-associated rhino-orbito-cerebral mucormycosis and compare with serum CRPlevels in COVID-19 patients suffering from sinusitis without rhino-orbito-cerebral mucormycosis. Materials and methods This was a retrospective cohort study. The source of data was post-COVID sinusitis patients who were admitted during 2nd wave of COVID-19 in India in our hospital whose medical records were accessed by the Medical Records Department. The subjects were recruited into the two study groups namely the Mucormycosis group and the non-Mucormycosis group based on the histopathological report of the nasal biopsy specimen. The medical records of each member of the two groups were studied for the levels of serum C-reactive protein measured at the time of admission and every 5(+1) days thereafter till the time of discharge. The kinetics of serum C-reactive protein levels, which is a marker of inflammation is studied in each of the two groups and compared using statistical methods. Results There was a significant difference between Mucormycosis and Non-Mucormycosis groups in CRP-level kinetics. However, there was no significant trend of decrease or increase over time in Mucormycosis as well as non-Mucormycosis cases. Conclusion CRP is an important biomarker in assessing the septic response to COVID-associated rhino-orbito-cerebral mucormycosis. Detection of raised CRP levels helps in prompt early initiation of anti-fungal treatment. Also, monitoring the levels of serum CRP will guide in deciding the time to stop the antifungals at an appropriate time. CRP monitoring is commonly available and affordable. Hence, we recommend CRP monitoring of in-patients of CAM.

A STUDY ON INDICATIONS, MODE OF HYSTERECTOMY AND HISTOPATHOLOGICAL ANALYSIS OF HYSTERECTOMY SPECIMENS

Objectives: To study the age distribution, indications, modes of hysterectomy, concurrent surgery done along with hysterectomy, and histopathological analysis of hysterectomized specimens. Methods: This study was conducted in the Department of Obstetrics and Gynecology, Mediciti Institute of Medical Sciences, a tertiary teaching hospital at Medchal. Medical records of 240 cases of hysterectomy performed from January 2015 to December 2021 were retrieved from the Medical Record Department. The age distribution, indications of hysterectomy, mode of hysterectomy, concurrent oophorectomy, and histopathological reports of hysterectomy specimens were analyzed in this study. Results: Out of the total 240 hysterectomies, 51.25% were in the age group of 40–49 years, followed by the age group of 50–59 years, i.e., 19.5%. Common indications for hysterectomy were AUB (36.25%), fibroids (34.58%), and UV prolapse (29.16%). Abdominal hysterectomy (62.5%) was performed more commonly than vaginal hysterectomy (29.16%). Histopathological analysis showed the most common pathologies as atrophic endometrium, leiomyoma in the myometrium, and inflammation in the cervix. Concurrent bilateral oophorectomy was done in 51.66%, unilateral oophorectomy was done in 10%, and ovaries were conserved in 38.33%. Conclusion: Hysterectomy is a common major gynecological surgery performed, most commonly in the perimenopausal age group. Although there is an increased trend toward the laparoscopic route, the abdominal route is still the preferred route. Leiomyoma is the most common pathology found in hysterectomized specimens. AUB being the most common indication for hysterectomy, there should be increased use of medical management, and patients should be counseled for conservative management in order to prevent increased surgical interventions.

IJCM_407A: Mortality pattern among adults at a tertiary care centre, Tamil Nadu -a retrospective observational study

Background: Records of vital events like death constitute an important component of the Health Information System. Therefore, these hospital-based death records maintained by Medical Records Department (MRD) can provide information regarding the causes and distribution of deaths, pattern of major illness which are of immense importance in planning health care services. But obtaining meaningful statistics from these records is considerably lacking. Hence, the need of present study. Objective: 1. To identify the mortality pattern among 18-45 years in tertiary care hospital, Madurai, Tamil Nadu from January to December 2022 2. To evaluate socio-demographic distribution and causes of deaths during that period. Methodology: It was an Institution based retrospective observational study. From MRD, Complete enumeration of hospital records of all medically certified deaths of in-patients of 18-45 years who died during January 1st to December 31st 2022 was carried out from May 2023 to August 2023 (n=2038). Data was checked for completeness, entered into Excel sheet and analyzed using SPSS software. Necessary permission was sought from hospital administrative authority to access the hospital records. Results: Among 2038 deaths, 72.52% were males, 26.60% belonged to 41 to 45 years of age. After categorization of all deaths, Road Traffic Accident (RTA) constituted the leading cause of death (28.26%; n=576) followed by Respiratory System (RS)(11.68%), CVS(9.22%) and others. Coronary Artery Disease constituted 39.36% deaths among CVS, 63.12% by Cerebrovascular Accidents among CNS and 23.95% by pneumonia among RS and 77.70% by CKD among renal. In all age groups, RTA constitute the major cause of death with maximum mortality among 18 to 25 years. RS and RTA constituted the major cause of mortality among females and males respectively. Significant association observed between age, gender and causes of mortality(P<0.05) Conclusion: More stringent measures needed to combat RTA deaths

IJCM_97A: Clinico-epidemiological profile and outcome of Severe Acute Malnutrition children admitted to the nutritional rehabilitation centre of a tertiary care hospital in Kalaburagi, Karnataka: a retrospective study

Background: Severe acute malnutrition is the major cause for under- five morbidity and mortality. According to NFHS 5 (2019-20), 7.7% of malnourished children under 5 years in India were severely wasted and in Karnataka it is 8.4 %. There is paucity of data on risk factors and clinical outcomes related to SAM children in North Karnataka, hence the present study was conducted. Objectives: 1. To assess the clinico-epidemiological profile of SAM children. 2. To determine the risk factors of SAM children admitted in NRC. 3. To study outcomes of SAM children admitted in NRC. Methodology: Study setting: Nutritional Rehabilitation Centre of Gulbarga Institute of Medical Sciences, a Tertiary care hospital in Kalaburagi. Study design: A retrospective record- based cross-sectional study Study population: All children under 5 years of age admitted with SAM in the NRC at GIMS, Kalaburagi. Study duration: December 2022- November 2023 Sample size: As per data from Medical Records Department, total number of SAM children admitted in NRC is 180 between December 2022 to November 2023. DATA COLLECTION METHOD: In all the admitted patients, a detailed history including socio demographic, clinical presentation, birth order, immunization and duration of stay in NRC, physical examination findings and investigations were collected from available records. Anthropometric measurements like weight, length /height, MUAC and weight for height were collected and analysed using WHO growth charts. The outcomes included whether the children completed duration of stay at NRC were cured with weight gain, no weight gain or succumbed to malnutrition. Inclusion criteria: All children under 5 years who were admitted and fulfilled the criteria of SAM by WHO. Exclusion Criteria: 1. Case sheets of admitted SAM children with incomplete data. STATISTICAL ANALYSIS: Data were entered in Microsoft excel sheet and analyzed using SPSS version 20. Results: Among 150 SAM children analysed,77 (51.7%) males and 73(48.3%) females had weight for height below - 3SD. Conclusion: Hospital-based management of SAM children in NRC with adherence to updated WHO standard guidelines has helped in reducing mortality and morbidity among undernourished children.

Healthcare Schemes to overcome financial toxicity of COVID-19: A Retrospective Single Center Study

BackgroundIndian healthcare system was nearly crashed during the pandemic and victims of COVID-19 experienced huge health related economic burden. Thus, we aimed to quantify the direct medical cost associated with COVID-19 management along with the healthcare schemes. MethodsA retrospective study was conducted for the duration of 8 months where the data of COVID-19 patients of one year (2020-2021) was collected from the medical record department. The data of COVID-19 patients of age 18 to 65 years with confirmed diagnosis based on RT-PCR test were included in the study whereas the data of special population such as pregnant, hemodialysis and patient undergoing surgery were excluded. ResultsOut of 1011 COVID-19 patients, 63.5% were males and 36.5% were female with the mean age of 43.8±14.5 years and with 9.47 days mean length of hospitalization. On direct medical cost analysis, USD 1060.92 was the total median expenses which includes COVID package plus outside COVID package expenses. Similarly, USD 728 and USD 51.1 were the median amount claimed through healthcare schemes and median co-payments respectively. The total median expenses with and without healthcare schemes were found to be USD 1061.37 and USD 1052.94 respectively whereas co-payments with and without schemes were USD 26.005 and USD 1046.64. ConclusionHealthcare schemes are the best strategy to overcome the direct medical cost associated with the management of the disease. Quantifying the medical cost could provide an insight to develop effective policy to counteract the financial toxicity among patients.

Outcomes and Complications of Donor and Recipient of Renal Transplantation: An Experience from Tertiary Care Center – A Retrospective Observational Study

Introduction: Kidney transplantation has emerged as a preferred method for improving survival and quality of life for patients with end-stage renal disease in comparison with dialysis. Living donation provides a better patient and allograft survival when compared with deceased-donor transplantation, specifically when the live donor transplant is accomplished before the onset of dialysis. The present study aimed to create and add data for the long-term survival, complications occurred in donor as well as in recipient both in single study in India. Materials and Methods: We performed a retrospective cohort study of all adult patients undergoing renal transplantation. Data on kidney transplantation and operative variables, as well as follow-up data, were obtained retrospectively from the Internal Medical Record Department. The primary outcomes examined were both donor and recipient and graft survival after 2 years and 5 years. Secondary outcomes included the presence of acute rejection and delayed graft function, as well as the rate of postoperative complications. Results: A total of 500 donors and 500 recipients participated in the research overall. The mean warm ischemia time was 3.1 ± 1.4 min and cold ischemia time was 44.3 ± 23.4 min. Surgical complications were encountered in 32.8% (164/500) of patients. The 2-year and 5-year graft survival rates were 90.2% and 84.8%, respectively. Conclusion: Our patients’ rate of complications was not greater than that noted in the previous publications. A thorough and meticulous medical assessment of the donor and recipient is required, as well as a rigorous and responsible evaluation of the indications.

ANALYSIS OF CRITICAL THINKING SKILLS THROUGH ARGUMENTATIVE ESSAY WRITING

The information about the present students’ critical students is essential as the initial data of their critical thinking skills for improvement purpose. The unavailability of such test in medical record department, Faculty of Health and Technique Bandung University encouraged the researcher to use language learning, particularly argumentative essay writing as the medium to measure the skills. This study aims at investigating the level of critical thinking skills through argumentative essay writing and analyzing the perception of students on a language learning that requires critical thinking skills. The respondents are second semester students from medical record department numbering to 35 taken purposively. To collect the data, essay writing test and questionnaire were distributed. The resulted essays were rated according to rubric of argumentative essay and then categorized them into five categories of very high, high, mediocre, low and very low. To support the finding, the information from questionnaire was used. The result of analysis showed that the students’ critical thinking as implied in the essay is still in mediocre level and only 35% scored above the mediocre level. The students faced difficulties in supporting the ideas with relevant and credible arguments and in creating constructive suggestion or solution. It was also revealed that students with high and very high critical thinking skills preferred more language learning activities that require high order thinking and vice versa.

Decoding the diagnostic landscape of adnexal masses: a retrospective observational study at a tertiary care centre assessing the efficacy of the RMI-2 index

Background: This study aimed to determine the utility of RMI 2 in distinguishing benign and malignant adnexal masses in low-income countries. Methods: For the purpose of this retrospective observational study, relevant data from patients who attended a tertiary care institution in central Gujarat between June 2020 and June 2022 were obtained from the Medical Records Department (MRD). Ultrasound and biochemical parameters along with epidemiological factors were identified and an RMI 2 score was calculated followed by statistical analysis. Results: Twenty-five (37.87%) of the sixty-six instances that were investigated were benign, two (3.03%) were borderline, and thirty-nine (59.09%), were malignant. Using RMI 2 at the traditional cut-off value of 250, results showed a sensitivity of 85.2% (95 %; CI=68.9-95.05), a specificity of 66.6% (95 %; CI=47.1-82.7 %), a positive predictive value of 74.36%, and a negative predictive value of 80.0 %. The ROC showed an AUC of 0.68 (CI=0.5-0.7) with a standard error of 0.07 (p=0.009). Conclusions: With a cut-off point of 250, RMI 2 was able to identify malignant masses with an 85.2% sensitivity and 66.6% specificity to enable timely referral to more advanced institutions for improved management in resource-constrained settings where its affordability and user-friendliness are favourable.

The correlation between stress score. Quality and duration of sleep with lipid profile and glycemic status.

Diabetes (DM) is a disease of global concern. Studies have suggested that sleep disturbance is affiliated with insulin resistance and poor lipid. Impaired glucose tolerance precedes the diabetic state and we are aware that the blood glucose levels are deranged in these patients, but not much research is done to comment on the pattern of lipid abnormalities, sleep quality and stress in these patients. Hence our study is aimed to identify abnormal patterns or similarities in the above parameters in pre diabetic and diabetic groups. This is a cross - sectional study carried out at the tertiary care hospitals.The data of 45 pre diabetic and diabetic (30 to 70 years) were collected from the files history from Medical Records Department (MRD) after taking permission. The following parameters like glucose and lipid parameters were taken for the study and standard questionnaire was given to correlate the sleep and stress levels. Data analysis were done using SPSS (Statistical Package for Social Sciences) version write the verson number). In the pre diabetic participants, sleep duration varied with stress levels (p=0.03) and their HDL was positively correlated to HbA1c (p=0.02) In the diabetic participants, TC (total cholesterol) varied with both stress (p=0.02) and sleep quality (p=0.001), LDL,& TC: HDL ratio varied only with sleep quality (p=0.04 ratio quality (p=0.01). Triglyceride levels were significantly higher in the diabetic group (p=0.04), as it is a major component of the triad of diabetic dyslipidemia. No other correlations or variations were significant. Poor sleep, abnormal lipid profiles, and stress may serve as risk factors predicting the onset of prediabetes and poor glycemic control. Confirming a direct relationship between these parameters through cohort or experimental studies could facilitate early detection of diabetes and encourage the adoption of appropriate healthy lifestyle measures.