Medicine Of Tertiary Care Hospital Research Articles

Socio-Demographic and Clinical Characteristics of Patients Attending Department of Palliative Medicine in Tertiary Care Hospital

Background: Palliative care focuses on improving quality of life for patients with life-limiting illnesses and their families by addressing physical, psychological, emotional, and spiritual needs. Understanding the specific characteristics of these patients accessing this care is crucial for optimizing services and resource allocation. Therefore, studies focusing on the socio-demographic and clinical characteristics of patients attending palliative medicine departments in tertiary care hospitals are vital. These studies shed light on who accesses palliative care, what diseases they have, and the challenges they face. Method: Individuals aged 18 years and above, diagnosed with cancer, were enlisted in our study, and their sociodemographic-clinical information was gathered. A reassessment was conducted after 3 months, during which their treatments and side-effects profile were examined. Result: The predominant cases in our patient population involved oral cavity cancers, primarily affecting married men aged 40–60 residing in the National Capital Region. Those diagnosed with breast cancer were more inclined to undergo chemotherapy, experiencing associated side effects such as nausea, anorexia, and weight loss. Conclusion: Healthcare providers must be cognizant of these complications and should integrate an effective counseling mechanism before initiating treatment in such patients. Palliative care physicians play a pivotal role in palliative management, serving as trusted figures in their communities and offering both professional and psychotherapeutic support.

The serum creatinine to cystatin C ratio predicts the risk of acute exacerbation of chronic obstructive pulmonary disease.

The purpose of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) treatment is to minimize the negative impact of the current exacerbation and to prevent the development of subsequent events. Therefore, it is important to identify readily available serological indicators during hospital admission to assess the prognosis of patients with AECOPD. All patients hospitalized in a Department of Respiratory and Critical Care Medicine of tertiary care hospital between January 2021 and December 2021 for AECOPD were analyzed using univariate correlations and binary logistic regression analysis with 2 models for associations between demographic, clinical, and laboratory features and AECOPD risk. The ratio of creatinine to cystatin C (Cre/Cys C) ratio was significantly associated with age (r = -0.206, P = .000), weight (R = 0.331, P = .000), body mass index (BMI) (R = 0.133, P = .007), and forced vital capacity (FVC)% predicted (R = 0.130, P = .009). Multiple regression was performed to predict the Cre/Cys C ratio from age, weight, BMI, forced expiratory volume during 1 second/FVC ratio, and FVC% predicted FABP-4, with F (5, 405) = 24.571, P = .000, R2 = 0.233. The results showed that the most significant predictors of the Cre/Cys C ratio were age (P = .007), weight (P = .000), BMI (P = .000), and predicted forced expiratory volume during 1 second (P = .000). Multivariate analysis was performed to determine whether the Cre/Cys C ratio was a predictor of AECOPD risk. Model 1 showed that a low Cre/Cys C ratio was associated with an increased hospital length of stay (odds ratio: -0.114, 95% confidence interval: -0.061 to -0.005) and admission to the intensive care unit (odds ratio: 0.951, 95% confidence interval: 0.907-0.996). After adjustment for potential confounding factors, model 2 showed that a low Cre/Cys C ratio was not independently associated with AECOPD risk. The present study indicated that the Cre/Cys C ratio is an easy, cheap, repeatable, and promising tool that allows us to evaluate the risk of AECOPD using serum markers. A low Cre/Cys C ratio was associated with a prolonged hospital length of stay and admission to the intensive care unit in AECOPD patients. However, the associations were not independent.

Distribution of Ciprofloxacin- and Azithromycin-Resistant Genes among Salmonella Typhi Isolated from Human Blood.

Salmonella Typhi has developed resistance to different groups of antibiotics. The purpose of the present study was to assess the distribution of ciprofloxacin- and azithromycin-resistant genes among Salmonella Typhi isolated from human blood. This cross-sectional study was conducted in the Department of Microbiology of a tertiary care hospital in Bangladesh from July 2019-June 2020. Clinically suspected enteric fever patients, irrespective of age and gender, who attended the laboratory of the Department of Microbiology and outpatient department of Medicine of tertiary care hospital. Blood culture and sensitivity tests were done. The positive growth of Salmonella Typhi was identified by Gram staining, colony morphology, and biochemical test. Then, Salmonella Typhi was identified by using Salmonella-specific antisera. Final identification was made by using 16s rRNA by polymerase chain reaction (PCR). PCR was also done to detect quinolone and azithromycin resistance genes. A total number of 83 samples yielded positive cultures, of which 50 isolated organisms were identified as Salmonella species; however, among these isolates, Salmonella Typhi was detected in 40 (48.2%) isolates. Among 12 ciprofloxacin-resistant isolates, 8 (66.67%) were positive for the gyrA gene, 1 (8.33%) was positive for the qnrB gene and qnrS gene, 2 (16.67%) were positive for aac (6´)-Ib-cr. Among 12 azithromycin-resistant isolates, 2 (16.66%) were positive for mphA and mefA genes, respectively. In conclusion, the gyrA, aac (6´)-Ib-cr, mphA, and mefA genes are found for the first time in tertiary care hospitals from the quinolones and azithromycin-resistant Salmonella Typhi.

Clinical Profile of Cirrhosis of Liver with Special Reference to Bacteriological Profile of Patients at a Government Tertiary Care Center in Maharashtra

Background: Cirrhosis is defined as the histological development of regenerative nodules surrounded by fibrous bands in response to chronic liver injury that leads to portal hypertension and end stage liver disease. The exact prevalence of cirrhosis worldwide is unknown. Cirrhosis prevalence was estimated at 0.15% or 400,000 in the USA where it accounted for more than 25,000 deaths and 373,000 hospital discharges in 1998. This may be an underestimation as we recognize the high prevalence of undiagnosed cirrhosis in both NASH and hepatitis C. Similar numbers have been reported from Europe, and numbers are even higher in most Asian and African countries where chronic viral hepatitis B or C are frequent. Since compensated cirrhosis often goes undetected for prolonged periods of time, a reasonable estimate is that up to 1% of populations may have histological cirrhosis. Aim: To study clinical profile of cirrhotic patients. Material and Methods: A cross-sectional observational study was carried out at Inpatient Department of Medicine of tertiary care hospital. Total 100 cases were studied. Registration of patients was from October, 2019 to March 2021. They were registered when admitted under Medicine department. At the time of registration, the patients with exclusion criteria were not enrolled for study. The main objective of this study is to study the biochemical and bacteriological profile of cirrhotic patients. At the time of registration, the baseline information was taken especially with respect to sociodemographic factors, clinical findings, and other investigations. The data thus collected was analysed to study clinical profile of cirrhotic patients. Results: Mean age in years was 55.1 +15.06, ranging from 24 to 75. Majority 40% were in age group of 40 to 60 years. Majority 68% were males and 32% were females. Mean SBP was 150.15+21.54 ranging from 100 to 210. 66% had increased SBP i.e.>140 mm of Hg and Mean DBP was 91.64+11.87, ranging from 60 to112. ...........

Reporting of delayed adverse donor reactions in whole blood donors: Just the tip of an iceberg!

The study was planned to determine the incidence and analyze how various epidemiological factors tend to be associated with delayed adverse donor reactions (ADR). The prospective observational study was conducted in Department of Transfusion Medicine of tertiary care hospital from January to December 2019. Eligible blood donors were observed for any adverse reactions after 15 minutes of removal of phlebotomy needle. Further, telephonic calls were made to each enrolled blood donor on day-2 and day-7 of the whole blood donation. For each day, two calls were made at an interval of 4 hours before declaring the participant to be non-responder. A total of 1540 (84.1%) blood donors responded on day-2 and 1610 (87.9%) responded on day-7 of follow-up. Total 180 (11.2%) blood donors experienced delayed ADRs. Two donors (1.1%) experienced on-site while 178 (98.89%) reported off-site delayed ADRs when followed-up telephonically. The commonest delayed ADRs reported were bruise (n=72; 30.9%), arm-pain (n=61; 26.2%) and generalised weakness (n=44; 18.9%). Female donors (27.3% vs. 11.2%; P=0.004), first time donors (15.2 vs. 9.9%; P=0.002), donors with low body-weight (range of 45-60kg; 15.9% vs. 11.5% vs. 6.1%; P=0.011) and body mass index<18.5 (24% vs. 12.5% vs. 9.7% vs. 11.3%; P=0.028) experienced more delayed ADRs. Blood donors do experience delayed ADRs but these are not reported to the blood centers as these are usually mild. However, it is important to capture these delayed adverse donor reactions and report it to National Hemovigilance Program so that strategies can be formulated to prevent their occurrence and recurrence.

A CASE REPORT ON CO-INFECTION OF COVID-19 WITH MALARIA

SARS Cov-2 is a new strain of coronavirus that’s appeared at the last quarter of 2019 in China. Malaria is an communicable disease caused by Plasmodium protozoa that is transmitted through a mosquitoes bite it is severe and fatal disease if not properly diagnosed and appropriately managed. Here we present the case of 39 years old male patient was attended to the outpatient department of internal medicine in tertiary care hospital in Hyderabad with chief complains of fever, chills, body pains. After all investigations she was diagnosed with SARS Cov-2 Positive. But after using all appropriate medications, there was no improvement in the patient condition. Then she was underwent for other investigations in that she was diagnosed with malaria disease. After using proper combination of anti-malarial medications, symptoms were subsided gradually or completely resolved.

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

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

Acute exacerbations of asthma occurring frequently time to check your techniques

Background: Asthmatics form a predominant section of patients in OPD. If poorly controlled the frequency of attacks requiring an emergency department visit adds to the burden. It was noticed that the patients who were on inhalational therapy had poor control despite the absence of other factors which could lead to exacerbations. Hence author evaluated the inhalational techniques.Methods: A prospective study undertaken in the department of medicine in tertiary care hospital in Dakshina Kannada District, Karnataka enlisting 25 patients admitted with acute exacerbation of bronchial asthma. The patients were assessed for their symptoms, signs and recurrent attacks along with their cough severity index and inhaler scores and the observations were tabulated.Results: Of the twenty-five, 15 were on inhalation therapy with various modes of deliveries. There were 15 males and 10 females from ages 20 to 50years. The number of attacks of asthma was higher in those not on inhalation therapies than those using inhalation therapies. Also, the level/severity of cough, measured as Cough Severity Index, was assessed among the two groups. Those on inhalation therapy had a lower grade of cough than those not on therapy . Mean AEC was 94 among those on inhalation therapy and 209 among those not on therapy. Inhalational score was calculated for each patient. There is a strong negative correlation of -0.709 between inhalation score and recurrent attacks, which is statistically significant (p=0.003). Lower inhalation scores were associated with recurrent attacks.Conclusions: Recurrent exacerbations in an asthmatic patient on inhalation therapy are due to improper inhalational technique. It was suggested that it is wise to spend time with the patients in authors OPD set up and teach them the correct techniques of using inhalational therapy hence reducing frequency of attacks and cost of health care in such patients.

A study of pattern of adverse drug reactions in inpatients department of medicine of tertiary care hospital in Madhya Pradesh, India

Background: Adverse Drug Reactions are the recognized hazards of drug therapy and they can occur with any class of drugs. The main aim of the study was to detect and analyze Adverse Drug Reactions in inpatients of medicine department in tertiarycare hospital. The study assesses the incidence and pattern of ADRs, identifying co-morbidities, past and present illness, assess causality and the offending drugs, monitoring and documenting suspected adverse drug reactions.Methods: A prospective study was conducted over a period of 6 months. The WHO definition of an ADR was adopted. Each ADR was assessed for its causality by using WHO probability scale. The severity of each ADR was assessed by using modified Hartwig et al, and Siegel scale.Results: A total 58 ADR were reported during study period out of which 28 (48.27%) were male and 30 (51.72%) were female patients. The assessment by WHO probability scale showed that out of 58 ADR 22 (37.93%) were probable and 17 (29.31%) were possible and 6 (10.34%) were certain. Most commonly involved system was gastrointestinal system with 24 (41.37%) ADRs. Severity assessment by modified Hartwig and Siegel scale showed that 22 (37.93%) were moderate, 32 (55.17%) were mild and 4 (6.89%) were severe ADRs. No lethal effects were observed or produced.Conclusions: The study concluded that Adverse Drug Reactions are common and some of them resulted in increased health care cost due to need of some interventions and increased length of hospital stay. The health system should promote the reporting of Adverse Drug Reactions, proper documentation and periodic reporting to regional pharmacovigilance centers to ensure drug safety.

A Prospective Observational Study on Microalbuminuria as Risk factor of Chronic Renal Failure in patients with Type 2 Diabetes

Objective: Microalbuminuria was initially entrench predicator for renal failure and risk factor of cardiovascular diseases in type 2 diabetes mellitus patients as well as in general population. The main aim of the study was to determine the risk factor of chronic renal failure in type 2 diabetes mellitus patients using microalbumuria as a marker. Methods: One hundred patients with type 2diabets mellitus patients, who are admitted in department of genral medicine in tertiary care hospital. The patients were evaluated patients age, detection of diabetes, sex, duration and clinical and biochemical observations: Blood pressure(BP), Blood sugar levels, serum creatinie (SrC), blood urea nitrogen (BUN) and microalbumuria. Results: In this study men population were found to be more percentage compared to female. The age group mean (50-70) patients was higher (22.5±8.26). Total no. of microalbuminuric in the study population was found to be 47.HbA1c were statistically significant. Duration of diabetic patients in microalbumuric patients is (15.6±8.621) Conclusion: Microalbuminuria is an accurate predicator for Renal failure. Microalbumuria use of the screening test in those type 2 diabetes patients is to detect the early renal failure. Elderly patients with type 2 diabetes have the great risk of renal failure . It is possible to delay the progression of chronic renal failure by treatment of ACE inhibitors. In some research study suggest that early treatment with ACE inhibitors has proven to improve the renal progression

Prescription Patterns of Antimicrobial Drugs in Hospitalized Patients in Tertiary Care Hospital of Kathmandu

Introduction: Antimicrobial drugs are one of the most commonly prescribed drugs in hospital. Overuse and irrational use of antimicrobials is a key factor behind rapidly spreading antimicrobial resistance in microorganisms. Use of irrational and unnecessary antimicrobials remains common in the developing countries. This study was conducted to analyze the prescription pattern of antimicrobials in the department of internal medicine of tertiary care hospital. Methods: Antimicrobials are among the most commonly prescribed drugs in hospital. Overuse and irrational use of antimicrobials is a key factor behind rapidly spreading antimicrobial resistance in microorganisms. Use of irrational and unnecessary antimicrobials remains common in the developing countries. This study was conducted to analyze the prescription pattern of antimicrobials in the department of internal medicine of tertiary care hospital. Results: The mean duration of hospitalization among the study population was 5 days. Of the 460 medicines prescribed, mostly indicated for respiratory infections, and the most common antibiotic was from the group cephalosporin 209 (69.7 %). 55 % of prescriptions include only one drug, 39 % with two drugs and 6% with three or more than three drugs. Conclusion: The mean duration of hospitalization among the study population was 5 days. Of the 460 medicines prescribed, mostly indicated for respiratory infections, and the most common antibiotic was from the group cephalosporin 209 (69.7 %). 55 % of prescriptions include only one drug, 39 % with two drugs and 6% with three or more than three drugs.

Lipid Profile in a Tertiary Care Center

Lipid profile is changing with changing developmental status and lifestyle in less developed countries and coronary artery disease risk factor is rising. The aim of the study is to find the lipid pattern in Department of Medicine in tertiary care hospital. An observational prospective study was conducted in 408 subjects from January 2009 to February 2010. Study subjects were selected irrespective of co-morbid condition and coronary risk factors. The mean triglycerides, cholesterol, LDL, HDL were 138.3 +/- 78.3 mg/dl, 180.2 +/- 53.7 mg/dl, 113.8 +/- 41.2 mg/dl, 40.1 +/- 10.1 mg/dl respectively. The Triglycerides (>140 mg/dl), Cholesterol (>250 mg/dl), LDL (>92 mg/dl), HDL (<45mg/dl) were 35.5%, 7.6%, 67.9%, 76% respectively. Lipid profile is becoming atherogenic with high triglyceride, high LDL and low HDL being the most common abnormality. An epidemiological study is recommended to understand the true burden of the disease in the community.

Long-term economic effects of team-based clinical case management of patients with chronic minor disease and long-term absence from working life.

To examine the socio-economic effects of team-based clinical case management of patients with chronic minor disease bound for early retirement. Marginal analysis of programme costs and benefits to society compared with no-programme baseline of costs occurring in society due to productivity loss. Prospective patient data collection on admission, discharge, and at one year and five years after discharge to determine programme effectiveness. Out-patient clinic at the department of social medicine in tertiary care hospital. 239 patients with minor disease and long-term vocational absence consecutively admitted to the study. At the one-year evaluation, 17 patients had been readmitted to the team, 7 could not be found, 6 declined the interview and 2 were deceased. At the five-year evaluation of 49 patients who were active after one year, one was deceased and 10 were unable to be found. Vocational activity. Programme costs. Benefits to society measured by decrease in indirect costs. The one-year vocational rehabilitation rate from the program was 20.5% and the five-year rehabilitation rate was 11.3%. The total discounted cost for case management of the 239 patients was 7.3 MSEK (600,000 Pounds). The decrease in the indirect costs to society from the 28 patients found active after five years was 35.1 MSEK (2,500,000 Pounds). The net present value of the programme at the 1991 price level was 27.5 MSEK (2,365,000 Pounds). Tertiary care level team-based clinical case management for vocational rehabilitation of patients with chronic minor disease has a positive cost-benefit ratio. A cross-boundary awareness at a health policy level is needed of the societal costs involved for this group of patients who fall between the traditional services in health care and social work.