Multispecialty Hospital Research Articles

Common Echocardiographic Diagnoses in Patients at Tertiary Care Center: An Observational Study

Introduction: Echocardiography is an indispensable tool for the diagnosis and management of cardiac patients. It is important to know the spectrum of cardiac abnormalities detected by echocardiography for the proper management of patients. The aim of this study was to evaluate the echocardiographic diagnosis of patients at a multispecialty tertiary care hospital and find out the prevalence of various cardiac diseases diagnosed via echocardiography.Methods: This was a retrospective cross sectional study carried out at the Echocardiography lab of National Academy of Health Sciences. Records of all patients who had done Echocardiography from February 2024 to April 2024 were analyzed. Ethical approval was obtained from Institutional Review Committee (Reference Number:1231/2080/81).Results: Out of 3593 cases, there were 1750 (48.71%) female and 1843 (51.29%) male. Normal echocardiographic study was seen in 1184 (32.95%). Mean age was 56.13±17.38 years. Left ventricle diastolic dysfunction was seen among 1428 (39.74%), followed by tricuspid regurgitation 1026 (28.55%) and pulmonary hypertension 497 (13.83%). Other findings were, left ventricular hypertrophy 204 (5.67%), Left ventricular systolic dysfunction 165 (4.59%), rheumatic heart disease 102 (2.83%) and, congenital heart disease was the lowest documented finding, seen in 30 (0.83%).Conclusions: Most common diseases diagnosed by echocardiography in our study were, diastolic dysfunction, tricuspid regurgitation and pulmonary hypertension.

Appropriateness of Empirical Antibiotic Use and Concordence with the WHO Aware Classification in Hospitalized Patients

Background: Antibiotic prescription trends analysis is essential for monitoring the sensitivity and resistance patterns of microorganisms discovered, regularly generating and updating antibiograms, and providing the context for antibiotic usage and prevalence. Specifically, consistent prescription patterns and antibiotic therapy practices with the WHO AWaRe (Access, Watch, and Reserve) classification of antibiotics and the national or WHO essential medicine list would enhance the prudent use of antibiotics, prevent the emergence and spread of antimicrobial resistance, and preserve antibiotic efficacy for future requirements. Objective: This study aimed to analyze selection of antibiotics for empirical use and definitive therapy and to evaluate rational use of antibiotics according to the WHO-AWaRe (Access, Watch, and Reserve) categories in hospitalized patients. Methodology: An observational and cross-sectional study was conducted in a 300 bedded multispecialty tertiary care hospital from October 2022 to March 2023 for a period of six months. Evaluation of demographic data based on antimicrobial susceptibility reports, pathogen characteristics, and infection site; evaluation of antibiotics administered before and after AST reports; and classification of antibiotics using WHO AWaRe metrics from the WHO essential medicines list. Descriptive statistics were applied for the data collected using Microsoft Excel. Results are expressed as total count, frequency, and percentages. Results: Antimicrobial susceptibility results from 162 patients were gathered from the laboratory. Of these 138 (85.18%) patients had positive results for Gram-negative bacteria and 24 (14.81%) for Gram-positive bacteria. The mean (SD) age of patients was 55 ± 28 years; predominantly male patients 92 (56.79%). 107 (66%) patients were hospitalized for 1-5 days. Monotherapy was given in 17 (10.5%) patients, Most of the patients were admitted into the general medicine 94 (58.02%), Bacteria were mainly isolated from urine (65 isolates, 40.1%), and a total of 36 organisms were isolated. The proportions of appropriate empirical therapy use were 84.05% for Gram-negative bacteria. A total of 706 antibiotics were prescribed out of which 334 are prescribed before AST and 372 are prescribed after AST. More prescribed empirical antibiotics were from the ‘Watch’ group (55.69%), followed by the ‘Access’ group (25.75%). ‘Reserve’ category (8.38%) and ‘not-recommended’ category (10.18%) antibiotics were also prescribed. A greater number of prescribed definitive antibiotics were from the ‘Watch’ group (48.11%). ‘Access’ group antibiotics should be preferable to the ‘Watch’ group. ‘Reserve’ antibiotics are always used as the last option when “Access” and “Watch” group antibiotics don’t work. Conclusion: The high use of empirical antibiotics especially from the ‘Watch’ category is a disturbing trend as observed in our study. . Increasing the use of ‘Access' antibiotics while limiting the use of ‘Watch' and ‘Reserve' antibiotics at the same time is the highest priority for preserving effectiveness of important antibiotics and minimizing the danger of AMR. Conducting such studies and analysis of such data periodically would pave the way for promotion of rational use of antimicrobials and help restrict the emergence of resistant strains of bacteria.

An Observational Study of Electrolytes and Other Metabolic Parameters in Patients with Delirium in Hospital Settings

Abstract Background: Despite extensive research, pathophysiology of delirium remains inadequately understood, with studies suggesting a role for inflammatory mediators, cholinergic deficiency, and metabolic disturbances. Aim: This study aims to explore the association of electrolytes and other metabolic parameters in hospitalized delirium patients as compared to age- and gender-matched nondelirious controls. Materials and Methods: The observational case–control study was conducted at a multispecialty hospital in eastern India where 100 inpatients diagnosed with delirium (cases) and an equal number of age- and gender-matched nondelirious inpatients (controls) were administered a semi-structured pro forma for sociodemographic variables and assessed for electrolytes and other metabolic parameters. Statistical analysis employed Pearson’s Chi-square test to assess the significance of differences between the two groups. Results: The study revealed statistically significant differences in metabolic disturbances in delirium cases as compared to controls with a greater association of hyperglycemia (P = 0.009), hyponatremia (P = 0.002), hypercalcemia (P = 0.001), hyperkalemia (P = 0.030), and hypokalemia (P = 0.005) among delirium patients. Hypoalbuminemia (P = 0.002) and elevated bilirubin levels (P = 0.014) as well as uremia (P < 0.001) and elevated creatinine levels (P < 0.001) also had a greater association with delirium cases than controls. Sociodemographic analysis revealed a higher incidence of delirium in older adults and males. Conclusion: There was a significant association between delirium and various biochemical disturbances, highlighting the importance of thorough metabolic workup to identify and correct these disturbances which would potentially enhance delirium outcomes. There is a need for further studies to explore the causal pathways of these associations and the impact of targeted metabolic interventions on delirium outcomes.

Role of computed tomography enteroclysis in the evaluation of small bowel diseases

Background: Examining small bowel loops within the peritoneal cavity poses significant challenges because of their length and overlapping nature. Aims and Objectives: This study aimed to evaluate the utility of computed tomography enteroclysis (CTE) in diagnosing small intestinal diseases and to understand its clinical application. Materials and Methods: The study was conducted from November 2019 to October 2021 in 30 patients undergoing CTE treatment. The day before treatment, bowel preparation included a low-residue diet, lots of fluids, an overnight fast of 8–12 h, and laxatives. A 16-slice Aquilion Lightning computed tomography (CT) scanner was used in general hospitals, and a 128-slice GE Healthcare helical CT scanner was used in multispecialty hospitals. Results: Among the 30 patients, 20 (66.7%) were male, and 10 (33.3%) were female, predominantly aged between 30 and 60 years old. Positive findings were noted in 23 patients (76.7%), including intestinal tuberculosis, inflammatory bowel disease, small bowel obstruction, and neoplastic lesions. Various small intestinal pathologies, such as non-specific edema, intussusception, and ischemic bowel disease, were also identified. Conclusion: This raises the standard of current small bowel imaging by delivering suitable intestinal distension using the enteral volume challenge principle and helps identify and characterize small-bowel problems.

Assessment of knowledge levels amongst pre-operative patients regarding the importance of postmastectomy exercises for optimal outcome: ACross-sectional study

Background: Post-operative exercises play a crucial role in the recovery process for mastectomy patients. Assessing preoperative knowledge can guide effective educational interventions. Aim: The primary objective of the study was to evaluate the knowledge levels of pre-operative breast cancer patients regarding post-operative exercises. Materials and Methods: A descriptive cross-sectional study was conducted from March 2021 to March 2022 at Female District Hospital and Satish Pandey Memorial (SCPM) Multi-Specialty Hospital, Gonda, Uttar Pradesh. Using a purposive sampling technique, 150 pre-operative breast cancer patients were selected. Data were collected via questionnaires assessing demographic variables and knowledge of post-operative exercises. Statistical analysis was conducted using SPSS, with significance set at 95% confidence interval. Results: Findings showed 27.3% of patients had no knowledge, 33.3% had inadequate knowledge, 27.3% had moderate knowledge, and 12% had adequate knowledge, with a mean score of 2.24 (SD = 0.98). Chi-square analysis indicated significant associations between knowledge levels and demographic factors such as age, education, occupation, family type, and living area, (p<0.05). Conclusion: The study highlights varied knowledge levels regarding post-operative exercises among mastectomy patients, with many showing inadequate understanding. Educational programs are essential to improve knowledge and promote better recovery outcomes.

Understanding the knowledge about diabetic and its effect on eye among patients visiting a multi-specialty hospital: a cross-sectional study

Background: The objective of this study was to access the knowledge about diabetic and its effect on eye. Methods: A cross-sectional study was conducted among 352 patients visiting a multi-specialty hospital of Moradabad, Uttar Pradesh. The study was conducted among the age group 29 to 80 years. A pre validated questionnaire was used to collect the responses about knowledge on diabetic and its effect on eye. Results: The study included a sample of 352 individuals aged between 29 and 80 years, with a mean age of 53.7 years. The gender distribution was fairly balanced, with 53.7% females and 46.3% males. Most participants resided in urban areas (60.8%), while the remaining 39.2% were from rural localities. Out of the 352 individuals surveyed, 282 participants, accounting for 80.1% of the total, indicated that they had heard of diabetic retinopathy. Out of the 352 individuals surveyed, 236 provided valid responses on asking diabetes affect eyes. Conclusions: Despite of good knowledge of participants about diabetic, eye health care providers must prioritize comprehensive education about the ocular complications of diabetes during routine consultations. Such interventions are crucial for early detection and management of diabetic eye diseases, which can significantly reduce the risk of vision loss and improve the quality of life for these patients.

A Dashboard for Monitoring Opioids: Initiating and Assessing the Impact of Opioid Stewardship Programme in the Pain Management at Multispeciality Hospital in India

A Dashboard for Monitoring Opioids: Initiating and Assessing the Impact of Opioid Stewardship Programme in the Pain Management at Multispeciality Hospital in India

A Cross-Sectional Study to Assess the Quality of Life Among Critical Care Nurses Working in Multispecialty Hospitals of Aurangabad, Maharashtra

A Cross-Sectional Study to Assess the Quality of Life Among Critical Care Nurses Working in Multispecialty Hospitals of Aurangabad, Maharashtra

Estimation of the Economic and Environmental Impact of Single-Use Instruments in Routine Cataract Surgery.

To estimate the economic and environmental impact of single-use instruments (SUIs) to perform standard cataract surgery in six ophthalmology centers located in Europe and in the United States. Online survey and interview. Comparative cost analysis based on an online survey with follow-up questionnaire and interview. The carbon footprint calculation was made by ClimatePartner. Annual costs of reusable instruments (RUIs) were calculated based on data provided by the centers. Annual costs of SUIs were estimated based on the average-selling price of a single-use cataract set of 5 instruments and the reported annual volume of cataract surgery. The calculation carbon footprint of a cataract instrument covered the whole life cycle from production to end-of-life. Annual costs for SUIs were found inferior or similar to the annual costs for RUIs for 4 out of the 6 centers included in this study. The centers where SUIs were demonstrated to be the most cost-effective were also associated with the highest costs of sterilization per instrument. The carbon footprint of 5-years usage of a cataract instrument was found to be 5478.2 kg CO2 eq for SUIs without recycling, 4639.9 kg CO2 eq for SUIs with recycling and 20.6 kg CO2 eq for RUIs. The study demonstrated that SUIs can be an alternative solution to using RUIs in multispecialty hospitals associated with high sterilization costs.

Efficacy of a Mixture of Palmitoyl ethonalamide, acetyl L Carnitine and Vitamin E as a Nutraceutical in Decreasing the Intensity of Chronic Pain – A Randomized Double Blinded Trial

Background: Chronic pain poses a significant challenge to individuals worldwide, prompting a search for innovative therapies beyond traditional methods. This randomized double-blinded trial was carried out in a multi-specialty hospital in South India which explores the potential efficacy of a novel nutraceutical combination—palmitoyl ethanolamide (PEA), acetyl-L-carnitine (ALC), and vitamin E—in alleviating chronic pain. Methods: The study involved 51 participants with chronic pain persisting for more than three months, randomly assigned to either the treatment group (Group N) or the control group (Group C).Results: The nutraceutical intervention, known as Myofatige, demonstrated a substantial reduction in pain intensity, as evidenced by a significant decrease in both numerical rating scale (NRS) and Likert satisfaction scores. The VAS scores decreased from 6.76± 0.95 to 3.23± 0.99 in Group N (p value < 0.0001) while it was from 6.5 ±1.02 to 5.88± 1.07 in group C (p = 0.19). The pretreatment Likert scores of Group N decreased from 3.88± 0.65 to2.04 ± 0.84 while in Group C it was from 4.01 ±0.12 to 3.73± 1.00. The inter group difference was statistically significant (p value < 0.0001). Throughout the three-month trial, safety and compliance were meticulously monitored, with just two people in the treatment group experiencing temporary frequent stools. There were no major adverse events reported, which supports the safety profile of the nutraceutical combination.Conclusion: While acknowledging limitations such as a small sample size and a single-centre study, the findings suggest that the nutraceutical combination of PEA, ALC, and vitamin E as Myofatige holds promise as a therapeutic intervention for nociceptive pain. Further research is warranted to explore the specific contributions of each component and potential synergistic effects in a larger and more diverse population.

Healthcare Operations Management: Optimizing Patient Flow and Quality Care in India

Patients' preferences changed from general practice to sub-specialty practice because there was no referral system in place. Most people would rather speak with a medical expert. The cheap medical tariff may make it easier for patients to see a doctor. Patients can see a doctor for even less money thanks to medical insurance companies. In addition, the cost of a doctor's appointment remains the same regardless of how straightforward the case may be. It fosters competition between general practitioners and experts, with the belief that the latter are superior. In addition, confusion and repeated visits to the doctor are caused by a patient's lack of trust in medical professionals and their ignorance of medical procedures. Social Security recipients' hospitals are overworked. The quality of services decreases as the patient base grows. Equipment and facilities are ageing out of date. Providers are forced to restrict their flexibility and ability to adjust to the unique needs of their patients due to staffing shortages and scheduling constraints. Physicians may be forced to refer patients to paramedical departments instead of doing a complete examination in order to deliver a proper diagnosis due to the rising demand for medical services. The current study, which makes reference to India, focusses on healthcare quality management strategies in multispecialty hospitals.

Health-related quality of life and its association with disease activity/functional status in rheumatoid arthritis: A cross-sectional study from South India.

Rheumatoid arthritis (RA) is an autoimmune disease with chronic pain that gradually becomes incapacitating and negatively influences the health-related quality of life (HRQoL). This study estimates HRQoL in RA using the EuroQol five dimensions (EQ-5D) tool and its association with functional status and disease activity. RA patients (n = 320) aged above 18 years, visiting outpatient clinic at a tertiary care multispecialty hospital in south India were the study participants. Sociodemographic, clinical, and laboratory data were collected from them. EQ-5D-5L questionnaire and the EQ Global Health Visual Analogue Scale (EQ-VAS) were used to measure HRQoL. Disease activity was measured using Disease Activity Score-28 (DAS-28), and the Health Assessment Questionnaire (HAQ) was used to assess functional status. Pearson's correlation and multiple linear regression were used to measure association, and statistical significance was considered at p < 0.05. The EQ-5D utility score was 0.54 ± 0.36, pain and anxiety were the most affected domains, and the mean EQ-VAS was 63.05 ± 18.54%. A moderate to high disease activity was present in 85% (DAS-28 > 3.2), and a severe functional disability in 32.8% (HAQ > 1.5) of study participants. The mean EQ-5D scores for RA patients were 0.78 (0.65-0.90) for no disease activity, 0.73 (0.65-0.80) for mild, 0.53 (0.32-0.74) for moderate and 0.47 (0.32-0.62) for high disease activity. In multiple linear regression analysis, HAQ and age independently predicted EQ-5D. RA significantly impacts HRQoL, and interventions focussing on pain and anxiety management are essential. The study's EQ-5D values could help estimate Quality Adjusted Life Years (QALY) while conducting economic evaluation studies in RA within an Indian context.

Correlation of Grayscale Ultrasound and Doppler Evaluation with Histopathological Diagnosis in Cases of Tubercular Cervical Lymphadenitis

ABSTRACT Introduction: Cervical lymphadenopathy is a relatively common clinical presentation that can have varied causes including reactive, inflammatory, tubercular, or neoplastic etiologies. Sonography is most often the first line of investigation used in clinical practice to characterize the enlarged nodes with respect to their location, number, size, and morphological imaging characteristics and determine the differential etiological possibilities. Materials and Methods: The present study was conducted involving 434 patients who presented over a period of 3 years to radiology departments of three multispecialty hospitals for the evaluation of cervical swellings. The study aimed to establish the correlation between the ultrasound and Doppler parameters used in clinical practice and the final histological diagnosis in cases of tubercular cervical lymphadenitis. Results: Overall, a female predisposition was observed in the proportion of patients who presented with cervical lymphadenopathy. A similar increased female percentage was also observed in cases finally detected to have tubercular pathology. The highest diagnostic indices were obtained for two ultrasound parameters of “matted nodes” and “caseous necrosis with posterior acoustic enhancement.” Although other features such as hypoechoic nodes, Doppler findings of peripheral vascularity, and high resistive index (RI)/pulsatility index (PI) values demonstrated high sensitivity, they showed poor specificity, positive predictive values, and low accuracy. Conclusion: In ultrasound scans for suspected cases of tubercular cervical lymphadenitis, the maximum weightage should be given to “matted nodes” and “caseous necrosis with posterior acoustic enhancement” parameters to differentiate the tubercular etiology from other potential causes. These parameters demonstrate high sensitivity, specificity, positive predictive value, and accuracy. Hence, they can be relied upon to start timely anti-tubercular treatment and follow-up with patients on a clinical-radiological basis. This can supplement waiting for suboptimal cytology reports that are difficult to arrive at, specifically in tubercular cervical lymphadenitis cases. The same applies as well to biopsy specimens that are hard to obtain from cervical nodes with associated potential grave complications.

“Impact of Zumba on General Anxiety Disorder – An Experimental Study among Nurses, UAE”

Purpose: To measure the result of Zumba on General Anxiety Disorder among nurses at multispecialty government hospital. Materials and Methods: A true experimental design was selected for this study. 70 nurses from multispecialty hospital partook this study. Samples were arbitrarily dispensed to both control and study group. Study group underwent 30 minutes of Zumba, daily for 3 months. Data were gathered via online before and after the Zumba from both study and control group. The instrument used to collect data was General Anxiety Disorder- 7 scale. Findings: The mean value in the study group test (12.89) was significantly less than the control group (19.6) with the t value of -15.762 at 5% in the level of significance. It shows there is a momentous drop of general anxiety Disease after doing Zumba. Zumba is certainly one of the best option to treat the General Anxiety Disease (GAD), which enables to increase the mental health as well as the overall wellbeing of the nurses. Implications to Theory, Practice and Policy: Since Zumba is a mixture of music and fun workout can safely include in the nurse’s routine even within the hospital to reduce nurse's GAD.

Nursing Care in Prevention of Post-Operative Pulmonary Complications among High-Risk Hospitalized Patients: A Case Study Design

Introduction: Post-operative pulmonary complications (PPCs) such as pneumonia, atelectasis, and respiratory failure significantly impact surgical outcomes, especially among high-risk patients with pre-existing respiratory conditions, advanced age, or those undergoing major surgeries. Effective prevention of PPCs is critical for improving patient outcomes. Nursing care plays a pivotal role in this prevention through early mobilization, respiratory exercises, proper positioning, and vigilant monitoring.Objectives :This study investigates the effectiveness of nursing care in preventing PPCs among high-risk hospitalized patients.Methods: A descriptive case study design was used, involving 15 patients from a multispecialty hospital in Trivandrum who met the inclusion criteria of having more than four risk factors for PPCs and consented to participate. Data collection tools included demographic variables, clinical manifestation checklists, risk factors for PPCs, and an individualized nursing care plan. Over six weeks, patients were selected through convenience sampling and a 24-hour nursing care plan was implemented. Descriptive statistics were used for data analysis. Results: The study sample consisted predominantly of elderly patients (73.3% aged above 60 years), with males constituting 66.7%. Significant risk factors included smoking history (66.7%) and elevated BMI (53.3%). All surgeries were performed under general anesthesia, with 60% lasting over 3-4 hours. Nursing interventions included deep breathing and coughing exercises, frequent position changes, early ambulation, use of an incentive spirometer, prophylactic antibiotics, and strict aseptic techniques. Most severe PPC symptoms were absent; however, mild symptoms like elevated temperature and cough were observed in 20% of patients. Discussion: The results indicate that the comprehensive nursing care strategies effectively prevented most significant PPCs. The absence of severe symptoms suggests the success of interventions such as early mobilization and respiratory exercises. The occurrence of mild symptoms in some patients highlights the need for ongoing refinement of nursing protocols. Conclusion: Effective nursing care significantly reduces PPC incidence in high-risk postoperative patients. This study supports the development of best practice guidelines for nursing care, emphasizing individualized care plans to improve patient outcomes and ensure high-quality healthcare services.

Association between ocular pseudoexfoliation and cardiovascular disease status: An analysis in a multi-speciality Hospital

Association between ocular pseudoexfoliation and cardiovascular disease status: An analysis in a multi-speciality Hospital

A Study of the Effect of Treatment On the Clinical Profile, Pain, and Disability in Migraine Patients Seen in a Tertiary Hospital.

Migraine is a disabling disease that poses a significant societal burden. Migraine is a major cause of disability. Migraine is the eighth leading disease-causing disability in the population. To study the clinical profile and measure the pain and migraine-related disability of patients with all types of migraine using the McGill pain assessment scale and Migraine Disability Assessment (MIDAS) before and after 3 months of effect on the medication. A Prospective-Cross sectional study was carried out in a multispecialty hospital with male and female patients between 18 and 65 years. The data were collected from the patients directly through the questionnaire of McGill pain assessment scale-short form (SF) and MIDAS, which was provided before and after the medication. There were 165 subjects of which 52 were men and 113 were women. The mean age of all the subjects was 43 years. About 26.06% of the subjects had a family history of headaches. The scores of McGill pain and MIDAS assessment before and after medication were as follows: 0-15 were 30.90% and 73.33%, Score 16-30 were 54.54% and 18.18%, the score of 31-45 were 14.54% and 7.87% of the subjects. MIDAS grade I was 17.57% and 50.90%, Grade II 33.93% and 21.81%, Grade III 30.30% and 15.75% Grade IV 18.18% and 11.51% of the subjects. The calculated "t" value between the before and after medication values of McGill and MIDAS by paired 't-test was 13.85 and 17.49 respectively. As the calculated "t" value is more than the table value, the alternate hypothesis is accepted. This study confirms that there is a significant difference in disability levels before and after acute and preventative treatments when measured over 3 months. In addition, the preponderance of females was high, and the functional disability that affects work and social activity associated with migraine is moderate to severe.

Categories and Profiles of Uveitis in Vogt-Koyanagi-Harada Syndrome With Systemic Correlation: Inferences From a Tertiary Multispecialty Hospital.

Introduction Vogt-Koyanagi-Harada (VKH) syndromeis a granulomatous, autoimmune panuveitis, affecting the eyes, ears, skin, and meninges. It can cause choroiditisand can progress to the retina and optic disc causing visual loss. Imaging using fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), and enhanced depth imaging-ocular coherence tomography (EDI-OCT) is required for clinical evaluationand management. Steroids and immunosuppression are the treatment modalities used. Aim The aim of this study is to report the correlation and severity of uveitis in relation to systemic manifestations. Method A retrospective study including 100 patients with VKHsyndrome was carried out. They were classified based on clinical manifestations and investigations such as FFA, ICGA, B-scan ultrasonography (USG), and ocular coherence tomography (OCT). Patients were characterized as complete, incomplete, and probable VKH syndrome. Laboratory investigations were performed, and statistical analysis was done. Results Probable VKH syndrome was found to be the most common form of presentation in our study population. Defective vision was the most common complaint amongthe patients. Extraocular manifestations included tinnitus, vertigo, alopecia, headache, fatigue, and vitiligo and were seen in 33% of the patients. Disc edema and serous retinal detachment were seen in 85% of the patients. Improvement was noted in 25% of the patients with the use of corticosteroids. Conclusion Response to treatment with systemic corticosteroids and immunosuppression in the acute phase of uveitis is better compared tochronic uveitis. The ophthalmologist is usually first consulted in VKHsyndrome due to presenting ocular complaints. A multidisciplinary approach is key to providing holistic management.

An Observational Study on TAT for Initial Assessment of Patients by Emergency Department at Multi-speciality Hospital, Dehradun

Now a days hospitals are facing one of the biggest problem related with first/initial encounter with patients. Due to increased patients flow it is not easy for hospitals to provide first/ initial assessment on time specially when it comes for emergency department. Patients coming to emergency department are most important patients for a hospital as they are more critical or need immediate treatment as compared to general OPD patients. Maximum of them required admission, surgical treatment so their initial assessment should be as soon as possible. If TAT for ED will increase than there will be longer stay of patient in emergency department which in turn will decrease patient satisfaction level. This project shows the root causes and remedies for delayed TAT for initial assessment of patients in ED.

A Study on the Etiology and Clinical Manifestations of Community-Acquired Pneumonia in Adults in Western India.

Community-acquired pneumonia (CAP) is an acute lung infection affecting the alveoli in individuals who have not had recent exposure to healthcare settings. It is characterized by newly detected pulmonary infiltration on a chest X-ray or computed tomography scan, accompanied by at least two of the following symptoms: a new or worsening cough, shortness of breath, increased sputum production, fever or hypothermia, pleuritic chest pain, hypoxia, confusion, or an abnormal WBC count (either leukopenia or leukocytosis). It is a major contributor to global mortality and morbidity, especially in elderly populations. This study aims to investigate the etiology of CAP in our region and analyze the clinical characteristics of patients diagnosed with CAP. This prospective, hospital-based study was conducted at Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, a 2,011-bed multispecialty hospital. The study included 100 patients over 18 years old, diagnosed with CAP, and hospitalized between January 2023 and January 2024. All patients underwent a thorough clinical assessment, and sputum cultures were collected on the day of admission. Patients under 18 years old, those who had been hospitalized within the preceding two weeks, individuals with pneumonia caused by tuberculosis oraspiration pneumonia, patients with compromised immune systems, and pregnant women were excluded. The study included 100 patients with a mean age of 53.13 years (±18.31). The most common age group was 59-68 years, which included 25 (25%) cases, followed by the 69-78 yearage group with 18 (18%) cases and the 18-28 yearage group with 15 (15%) cases. The majority were male, with 61 (61%) cases. Common symptoms included fever in 78 cases (78%), chest pain in 69 cases (69%), dyspnea in 65 cases (65%), and cough in 51 cases (51%). Sputum cultures showed growth in 65 cases (65%), with Klebsiella pneumoniae being the most prevalent pathogen in 28cases (43%), followed by Streptococcus pneumoniae in 18 cases (28%). Together, these two pathogens accounted for 46 out of 65 positive samples (70%). This study highlights the clinical profile and rising etiology of K. pneumoniae in CAPin adults in Western India, particularly in the elderly. These findings underscore the need for periodic updates on CAP etiology to inform empirical treatment strategies effectively. Future research should use advanced diagnostics and diverse samples to refine CAP management, with continuous monitoring to update treatment protocols.