Multispecialty Tertiary Care Hospital Research Articles

Prevalence and demographic distribution of anaemia among those visiting a teaching hospital located in tribal predominant block of Jharkhand: Retrospective record based analysis.

Anaemia is a major public health concern in developing countries, with cases increasing rapidly among women, young girls, and children under age 5. This study aimed to estimate the prevalence of anaemia and to identify the age and gender distribution of anaemia among those attending IPD/OPD of a teaching hospital located in the tribal block. The study was conducted at a multispecialty tertiary care hospital in tribal predominant area, Jharkhand, India. A retrospective, chart-based study design was adopted to achieve the objectives. All inpatient case records available from the Department of Laboratory Medicine and the electronic hospital information system of the institute were reviewed between January 1, 2021, and January 31, 2024. A total of 15004 reports were screened for detecting anaemia, of them 7095 (47.3%) were males and 7909 (52.7%) were females. The overall prevalence of any grade of anaemia was found in 6579 (43.8%; 95% CI: 43.1-44.6). Univariate logistic regression analysis to predict status of anaemia among study participants showed the odds of being anaemic was 1.5 times (95% CI: 1.2-2.1) higher among those with age >60 years compared to those who were in the age group of 1-4 years. Females had 2.3 times (95% CI: 2.2-2.5) higher odds of having anaemia than males. This study shows that half of the patients attending hospital are anaemic and the burden increases as the age increases and highest among elderly >60 years. The results of our secondary data analysis should contribute to better screening and identifying the cases among people attending the hospital and also could aid planning services at the primary care level.

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.

Demographic Profile and Neuro-Ophthalmic Manifestations in Primary Intracranial Tumours in Adult Patients: An Observational Study from a Tertiary Care Health Centre in Eastern India

Abstract Purpose: To evaluate the demographic profile and neuro-ophthalmic manifestations of primary brain tumours in adult patients presenting to a tertiary care centre in eastern India. Methods: A hospital-based cross-sectional study was conducted on patients with primary intracranial tumours presenting to a tertiary care multi-specialty hospital in eastern India from January 2018 to October 2021. A complete neurosurgical, endocrinal, and ophthalmological evaluation was done in each patient. Results: A total of 106 patients with primary brain tumours were included in the study. The mean age of presentation was 40.98 ± 12.85 years. There were 50 (47.17%) males and 56 (52.83%) females. The tumour location was supratentorial (ST) in 72 (67.92%) patients and infratentorial (IT) in 34 (32.08%) patients. Pituitary adenoma was the most common tumour in the present study (32.07%). The most common tumour was pituitary adenoma in the ST location and cerebellopontine angle schwannoma in the IT location. Headache and hearing loss were the most common presenting symptoms in ST and IT tumours, respectively. Blurring of vision was the most common ocular symptom in 47.16% of cases. Hemianopic field defect was the most common field defect in our study and was seen in 47.72% of cases. Conclusion: Meticulous ophthalmological examination is essential in patients with intracranial tumours. Our study emphasises the importance of a detailed ophthalmological examination and knowledge of associated neurological manifestations in ST and IT tumours.

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.

Experiences of frontline nurses caring COVID-19 patients - A thematic analysis.

The COVID-19 pandemic exerts a considerable impact on the healthcare setting and healthcare provider's personal and social life. Adjusting to an entirely new working environment may have added challenges for the nurses without having infectious disease expertise. The study aimed to understand and describe the experiences of nurses taking care of COVID-19 patients in a tertiary care Hospital. The study was conducted in a tertiary care multispecialty hospital of Udupi District, Karnataka, India. A qualitative research approach with thematic analysis was used in this study. The inclusion criteria were staff nurses caring for COVID-19 patients for a minimum of 1 week. Samples were selected by purposive sampling technique, and the data saturation was achieved with 12 participants. Data were collected through in-depth, face-to-face interviews directed by a semi-structured interview guide. The interviews were audio-recorded and then transcribed verbatim. Thematic analysis derived from participant's responses. Data collection and data analysis were performed simultaneously. The data were analyzed using Kiger and Vapiro's six-step process of thematic analysis of qualitative data. Ten subthemes were grouped from the three major themes under "working in COVID-19 facility: A "challenging experience", "adaptive coping strategies", and "support during a pandemic" emerged based on the experiences of staff nurses working with the COVID-19 patients. Staff nurses in this study had challenging experiences attributed to several factors at the outbreak of the COVID-19 pandemic. Meanwhile, strategies to confront the difficulties were adopted by them to improve their well-being.

Evaluating the Quality of Life of Beneficiaries After Providing Financial Aid by a Multi-specialty Tertiary Care Hospital.

Background Financial aid programs offered by multi-specialty tertiary care hospitals play a crucial role in ensuring equitable access to healthcare. This study investigates the effect of financial aid on the quality of life (QoL) of beneficiaries, aiming to provide a comprehensive understanding of the multifaceted relationship between healthcare support and overall well-being. Aim The study's objectives included assessing changes in pre- and post-aid QoL, identifying influencing factors, understanding beneficiary experiences, and evaluating the effectiveness of financial aid programs. Methods The study adopted quantitative assessments through QoL questionnaires developed based on the WHO BREF questionnaire and insights obtained through interviews. A representative sample of beneficiaries was selected, informed consent was obtained, and an institutional ethical certificate was also obtained. Results The findings overwhelmingly support the alternative hypothesis. The alternative hypothesis was that after receiving financial support, recipients' quality of life would increase. Quantitative analysis revealed a statistically significant enhancement in the QoL of beneficiaries across physical, mental, and social well-being domains. The quality of life scores of patients before and after receiving the support was statistically tested using a paired t-test, and the quality of life score has improved significantly with a p-value of 4.156 × 10-28 (p value<0.001). The comparison of quality of life scores of the control group with the patient's group before getting the support was tested using an independent sample t-test and found to be non-significant (p=0.496), while a similar comparison between the control group and the patient's group after receiving the support was found to be statistically highly significant with a p-value of 8.721 × 10-28 (p-value<0.001). Conclusions This research demonstrates the substantial impact of financial aid on the QoL of beneficiaries in a multi-specialty tertiary care hospital setting. It underlines the importance of addressing economic barriers and providing patient-centered, holistic support. These insights have broader implications for healthcare policy and practice, promoting a more comprehensive approach to patient well-being.

A hospital-based descriptive study of Ayushman Bharat-Pradhan Mantri Jan-Arogya Yojana: an analysis of 4844 claims

Background: Current study was undertaken to analyze Ayushman Bharat claims settled during the initial two years of launch of the scheme in an empaneled, public hospital in northern India. Objective was descriptive analysis of 4844 settled claims in terms of demographic characteristics of beneficiaries, procedures and packages availed by them in an empaneled public hospital during the initial two years of the launch of the scheme. Methods: A cross-sectional records study of 4844 settled claims was conducted in a public, empanelled 1015 bedded tertiary care multi-specialty hospital of north India. Anonymized data was collected from the transaction management module of AB-PMJAY scheme and hospitalization record of patients retrieved from medical records department. Results: The study revealed that around 4844 claims were settled during the initial two years (December 2018 to December 2020). Highest number of claims (43.33%) were availed under general medicine category. Chemotherapy packages availed under medical oncology were 37.45% of all claims. Interventional cardiology packages were the costliest. Conclusions: The study provides an insight into the frequency of various claims, their costs, disease/procedural burden of beneficiary patients of AB-PMJAY. It will provide policy feedback and help in future planning and implementation of the scheme.

Varicella zoster virus outbreak in a long-term care unit of a tertiary care hospital in northern India.

Nosocomial outbreak of varicella zoster virus (VZV) has been reported when susceptible individuals encounter a case of chicken pox or shingles. A suspected VZV outbreak was investigated in a 50-bedded in-patient facility of Physical Medicine and Rehabilitation in a tertiary care multispecialty hospital. A 30-year-old female patient admitted with Pott's spine was clinically diagnosed with chicken pox on 31 December 2022. The following week, four more cases were identified in the same ward. All cases were diagnosed as laboratory-confirmed varicella zoster infection by PCR. Primary case was a housekeeping staff who was clinically diagnosed with chicken pox 3weeks prior (9 December 2022). He returned to work on eighth day of infection (17 December 2022) after apparent clinical recovery but before the lesions had crusted over. Thirty-one HCWs were identified as contacts a and three had no evidence of immunity. Two of these susceptible HCWs had onset of chickenpox shortly after first dose of VZV vaccination was inoculated. All cases recovered after treatment with no reported complications. VZV infection is highly contagious in healthcare settings with susceptible populations. Prompt identification of cases and implementation of infection prevention and control measures like patient isolation and vaccination are essential for the containment of outbreaks.

The role of financial assessment as a part of corporate social responsibility with special reference to philanthropic responsibility of a multispeciality tertiary care hospital

Abstract Background: Corporate social responsibility (CSR), which includes the healthcare industry, has now taken a significant place within commercial practices. Multispecialty tertiary care hospitals, being major healthcare providers in their communities, have a significant role to play in fulfilling their philanthropic responsibilities and giving back to society. One crucial way in which these hospitals can make a positive impact is through the implementation of financial assessment programs. Objective: This study focused to investigate the significance and impact of financial assessment as a component of CSR in the context of a multispecialty tertiary care hospital. The research explores the hospital’s philanthropic responsibilities towards providing financial aid and support to patients in need. Materials and Methods: The study used a mixed-methods approach, combining qualitative and quantitative data collection methods to gain comprehensive insights. Interviews from 5 departments with beneficiaries (n = 40), surveys, and financial data analysis were used to assess the hospital’s CSR initiatives, focusing on financial assessment programs. Data were analyzed in SPSS version 20.0. Results: The philanthropic variables taken into account in the current study were socioeconomic status, help from external sources, ownership factors, income, and liabilities of beneficiaries. These socioeconomic characteristics were examined using the data gathered, and a significant correlation with the discount percentage was found with a P &lt; 0.05. Conclusion: The findings concluded that financial assessment programs in the multispeciality tertiary care hospital are playing an effective role in ensuring equitable access to healthcare and fulfilling its philanthropic responsibilities of CSR.

Geospatial Analysis of Parental Healthcare-Seeking Behavior in the Vicinity of Multispecialty Hospital in India.

The healthcare-seeking behavior of vulnerable groups, such as children under five, depends on a multitude of factors, including the caregiver's decision making. Approximately 60% of Indians seek care from private hospitals. Recent health policy in India has favored the establishment of multispecialty hospitals. However, it remains unclear to what extent this policy has changed the number of Indians seeking healthcare from these government-established multispecialty hospitals. The study aims to assess the health-seeking behavior of parents of children under five in the vicinity of a public multispecialty tertiary care hospital. This was a community-based cross-sectional survey with geospatial mapping conducted among the parents of children under five using a semi-structured questionnaire in Epi-collect mobile app. The study site was an urban slum in a catchment area [within five kilometers (km)] of a multispecialty tertiary care public hospital in the central Indian state of Chhattisgarh. The study was conducted for one year duration from February 2019 to January 2020. A questionnaire was administered to the parents of the children under five (N = 353) after their household confirmation from the nearby Anganwadi center, the community level service providing center under the Integrated Child Development Scheme by the Ministry of Women and Child Development (WCD). The questionnaire included sections for demographic characteristics, the illness pattern among their children, health-seeking decision-making, and more. Descriptive analysis was presented with numbers and percentages. Univariate analysis was used to assess the association between sociodemographic variables and health-seeking characteristics. Statistical significance was considered at p value less than 0.05. We used geospatial mapping using coordinates collected and compiled using the Microsoft Excel version 2021 and analyzed using QGIS (Quantum Geographic Information System) software. Among the parents interviewed patients (N = 353), maternal literacy rates were over 85%. Approximately 54% of the families were below poverty line. Among 95.2% of the families, mothers were part of decision-making regarding their children's health-seeking. Over 92% of the families opted for consultation in a nearby private hospital or dispensary. Geospatial mapping of private hospitals was a favored place for healthcare-seeking by mothers, irrespective of their socioeconomic status or education rather than multispecialty hospital. The majority of the parents in the vicinity of public multispecialty hospitals seek care from private clinics for ailments for children under five. The establishment of public multispecialty tertiary care hospitals, which are mandated for tertiary level of care and research, cannot replace primary-level healthcare institutions, showed that private hospitals were the favored places healthcare seeking by mothers. These primary-level institutions are critical for the management of common ailments for children under five near home and reducing the financial burden on the family, even in the vicinity of a multispecialty hospital.

BLIND-SIDED BY BLACK FUNGUS: CRAO IN CAM

Importance: There has been an outbreak of COVID-19 associated rhino-orbito-cerebral mucormycosis (CAM) in many parts of developing world. The clinical prole, mortality rate, risk factors associated with it has been studied. A case series highlighting association of Central Retinal Artery Occlusion (CRAO) in CAM has not been reported yet. To report a case series of Central Retinal Artery Occlusion (CRAO) in 15 pati Objective: ents with history of COVID19 infection associated mucormycosis (CAM). This is a retrospective observational study of Design: 15 cases of rhino-cerebroorbital mucormycosis (ROCM) which presented to our tertiary referral centre between March 2021 and June 2021. All patients had unilateral or bilateral CRAO. Tertiary care multispecialty hospital in western India. Setting: Participants: All patients diagnosed with CAM and having unilateral or bilateral CRAO. Main outcome measure: The COVID-19 disease induced inammatory homeostasis changes that predispose to thrombotic disease in both venous and arterial circulation in CAM. Overall prognosis appears to be poor with mortality rate of 14- 50% in various studies. Fifteen patients were studied of Results: which 13 were male and rest females. The mean age of patients was 55.6 + 12.13 years (Range: 39 –78 years). Majority had uncontrolled Type 2 Diabetes Mellitus. Tissue and radiological diagnosis of mucormycosis was made in all patients. Twelve patients had unilateral CRAO and 3 patients had bilateral CRAO. Diabetes and systemic ster Conclusions and relevance: oids have proven to be risk factors for development of CRAO in CAM. Early ophthalmic screening should be initiated in COVID-19 patients with systemic co-morbidities, to reduce the immediate and late sequelae.

Psychopathology and Pattern of Remission of Cannabis-Induced Psychotic Disorder.

Objective: To analyze the psychopathology and pattern of remission in cannabis-induced psychotic disorder with treatment.Methods: This was a prospective cohort study of a group of patients admitted with new-onset psychosis, cannabis use, and no evidence of other drug abuse from January 1 to June 31, 2019, to the psychiatry inpatient department of a multispecialty tertiary care hospital in Kerala, India. Patients were evaluated at admission and after 1 week in the hospital and 1 month after discharge using the Structured Clinical Interview for the Positive and Negative Syndrome Scale and the Clinical Global Impressions-Severity of illness scale.Results: Fifty-six male subjects were recruited for the study. The mean age of the subjects was 22.2 years, and the majority were active smokers of nicotine and cannabis. Total duration of abuse and family history of substance use in first-degree relatives correlated with severity of psychosis. Hostility, excitement, and grandiosity were the predominant positive symptoms, and these symptoms showed a steady reduction toward the end of the study. The most frequent negative symptoms were emotional withdrawal, passive or apathetic social withdrawal, and difficulty in abstract thinking, and these symptoms also showed significant improvement (P < .001 for all). For symptoms such as somatic concern and guilt feelings, significant treatment response was noted only in the initial week (P < .001).Conclusions: Cannabis-induced psychosis in the Indian setting presents with predominant positive symptoms and minimal affective symptoms. The steady improvement noted with complete cessation of cannabis indicates a possible contributory role for cannabis in precipitating psychosis.

Determinants Of Under-Nutrition Among Under Five Children in The Urban Slum of Ahmedabad, India

Background: Optimal infant and young child feeding practices (IYCF) are effective public health intervention to enhance child survival, nutrition and development. There is also documented evidence regarding the protective effect of optimal IYCF practices against diarrhoea and ARTI. The objective is to assess knowledge and practices regarding IYCF among study participants &amp; to explore the association of feeding practices of mothers with the morbidities (infections) in their children. Methodology: The present study was a hospital based cross-sectional study, carried out during September 2019 to March 2021. A total of 380 mothers of children less than two years attending OPD of Institute of child health, Nirmal hospital private limited, a tertiary care multi-specialty hospital was interviewed using pre-designed and pretested questionnaire. Results: Feeding practices during early days of life to be reasonably good among study participants with almost 2/3rd of the study participants practicing them. Mean number of morbidity episodes requiring consultation were significantly lower in the children whose mothers practiced optimal IYCF practices. Conclusion: Poor feeding practices in children had significant association with morbidity episodes of diarrhoea and ARTI in children.

Infant And Young Child Feeding Practices and Infections Pattern in Children Up To 24 Months Age Attending Outdoor Patient Department of a Tertiary Care Hospital of South Gujarat

Background: Optimal infant and young child feeding practices (IYCF) are effective public health intervention to enhance child survival, nutrition and development. There is also documented evidence regarding the protective effect of optimal IYCF practices against diarrhea and ARTI. Objectives: 1) To assess knowledge and practices regarding IYCF among study participants. 2) To explore the association of feeding practices of mothers with the morbidities (infections) in their children. Methodology: The present study was a hospital based cross-sectional study, carried out during September 2019 to March 2021. A total of 380 mothers of children less than two years attending OPD of Institute of child health, Nirmal hospital private limited, a tertiary care multi-specialty hospital were interviewed using pre-designed and pretested questionnaire. Results: Feeding practices during early days of life to be reasonably good among study participants with almost 2/3rd of the study participants practicing them. Mean number of morbidity episodes requiring consultation were significantly lower in the children whose mothers practiced optimal IYCF practices. Conclusion: Satisfactory knowledge and practices were observed among study participants regarding various infant and young child feeding practices. Poor feeding practices in children had significant association with morbidity episodes of diarrhea and ARTI in children.&#x0D;

Changing Trend in the Antibiotic Resistance Pattern of Klebsiella Pneumonia Isolated From Endotracheal Aspirate Samples of ICU Patients of a Tertiary Care Hospital in North India.

Introduction Klebsiella pneumonia is one of the most prevalent bacteria that cause nosocomial infections, particularly in critically ill patients in the intensive care unit (ICU). Multi-drug-resistant Klebsiella pneumoniae (MDRKP) has become an urgent risk to public health as its prevalence has sharply surged around the globe in recent decades. Therefore, this research was conducted to evaluate shifts over a four-year period in drug susceptibility patterns among Klebsiella pneumoniae isolates from mechanically ventilated intensive care unit patients. Materials and methods This is a retrospective observational study conducted in a tertiary care multi-specialty hospital and teaching institute in North India and was approved by the institutional ethics committee. The research comprised Klebsiella pneumoniae isolates from endotracheal aspirates (ETA) of patients on mechanical ventilation admitted to the general intensive care unit (ICU) of our tertiary care facility. The data from January to June 2018 and January to June 2022 were collected. According to the antimicrobial resistance profile of the strains, they were categorized as susceptible, resistant to one or two antimicrobial categories, multidrug-resistant (MDR), extensively drug-resistant (XDR), or pan-drug-resistant (PDR). The criteria for MDR, XDR, and PDR were proposed by the European Centre for Disease Prevention and Control (ECDC). IBM Statistical Package for the Social Sciences (SPSS) for Windows, Version 24.0, Armonk, NY, IBM Corp., was used for data input and analysis. Results A total of 82 cases of Klebsiella pneumonia were included in the study. Of these 82 isolates, 40 were isolated over a period of six months from January to June 2018, and the remaining 42 were isolated from January to June 2022. Among the 2018 group, five strains (12.5%) were classified as susceptible, three (7.5%) as resistant, seven (17.5%) as MDR, and 25 (62.5%) as XDR. The highest percentages of antimicrobial resistance in the 2018 group were observed with amoxicillin/clavulanic acid (90%), ciprofloxacin (100%), piperacillin/tazobactam (92.5%), and cefoperazone/sulbactam (95%). In comparison, the 2022 group showed no strain as susceptible; nine strains (21.4%) were classified as resistant; three strains (7%) as MDR; and 30 strains (93%) were classified as XDR. There was a significant increase in resistance to amoxicillin, from 10% in 2018 to nil in 2022. Overall, the rate of resistant Klebsiella pneumonia (K. pneumonia) increased from 7.5% (3/40) in 2018 to 21.4% (9/42) in 2022, while XDR Klebsiella pneumonia among the mechanically ventilated ICU patients significantly increased from 62.5% (25/40) in 2018 to 71% (30/42) in 2022. Conclusion K. pneumoniae antibiotic resistance is a real threat in Asia and requires close monitoring to be controlled. More careful attempts should be made to create a new generation of antimicrobials since the prevalence of resistance to existingmedications is rising. Antibiotic resistance should be monitored and reported by healthcare institutions regularly.

Practice of Intraoperative Fluid Administration during Major Abdominal Surgeries: A Retrospective Cohort Study at a Tertiary Care Hospital in Southern India

Introduction: Optimal intraoperative fluid therapy can reduce postoperative complications and improve patient outcomes. The Enhanced Recovery After Surgery (ERAS) protocols emphasise fluid restriction. However, the recent randomised clinical trial (RELIEF trial) found a higher incidence of Acute Kidney Injury (AKI) with restrictive fluid therapy. Both excessive and restricted fluid therapy have adverse consequences. Despite various guidelines on perioperative fluid therapy, there is still wide variation in practise. Aim: To describe the volumes and types of intravenous fluids used during major abdominal surgeries and evaluate the association of intraoperative fluid administration with postoperative complications. Materials and Methods: This retrospective cohort study was conducted in a multispecialty tertiary care hospital in Thiruvalla, Kerala, India. The study collected data on volumes and types of fluid used in adults undergoing major abdominal surgeries over a one-year period. The incidence of postoperative complications, specifically Postoperative Ileus (POI), Surgical Site Infections (SSI), cardiac complications, and respiratory complications, was noted. The factors affecting intraoperative fluid intake were assessed using the Wilcoxon signed-rank test. Logistic regression was performed to determine associations between preoperative and intraoperative variables and postoperative complications. Adjusted Odds Ratios (OR) and Confidence Intervals (CI) were calculated. Results: The study included 133 patients with complete data. The mean age of the cohort was 62±18 years, and 69 (52%) patients were males. Patients received a median (IQR) total intraoperative fluid of 3000 (2000-4000) mL with a median infusion rate of 8.77 (6.39-12.35) mL/kg/hr. The majority (132 patients, 99%) received balanced salt solution (ringer lactate) as the main crystalloid. The volume of intravenous fluids infused intraoperatively was significantly greater in emergency surgeries (p-value=0.007), open surgical approaches (p-value &lt;0.001), and surgeries under regional anaesthesia (p-value=0.012). The most common complication in this cohort was POI (38%), which had a significant association with the duration of the surgery (p-value=0.002). Cardiac complications were linked to the volume of intraoperative fluid intake (p-value=0.022), while respiratory complications were predominantly linked to upper abdominal surgeries (p-value=0.049). Conclusion: The volume of intraoperative fluids administered in major abdominal surgeries varies with the type of surgery (elective versus emergency, open versus laparoscopic) and anaesthesia (regional/general) and significantly impacts patient outcomes after surgery.

Correlation of Mother’s Knowledge on Child Nutrition, Feeding Practices and Nutritional Status of Children in Karnataka, India: A Cross-sectional Study

Introduction: Malnutrition is a critical health problem in many countries, including India. The main reason for this is incorrect dietary habits that lead to illness and infections in early childhood. Inadequate food intake can hinder the growth and development of children. Childhood malnutrition can impair psychological and intellectual development, which can subsequently result in low school performance and behavioural disturbances. Therefore, child nutrition is of utmost importance. The knowledge and feeding practices of mothers can significantly influence child nutrition. Hence, it is essential to study the knowledge, feeding practices, and nutritional status of children as influenced by their mothers. Aim: To was to determine the correlation between the knowledge of mothers regarding child nutrition, their feeding practices, and the nutritional status of children. Materials and Methods: A cross-sectional correlational study was conducted in a 1050-bed multispecialty tertiary care hospital in Mangaluru, Karnataka, India, from December 30, 2021, to August 30, 2022. A total of 150 children under the age of five, visiting the hospital accompanied by their mothers, were selected as study participants using a non probability convenience sampling technique. Data was collected using a demographic proforma, a structured knowledge questionnaire on child nutrition, a structured checklist on feeding practices, and anthropometric measurements of children, which were taken using a digital weighing scale and stadiometer. Descriptive statistics including mean, frequency, percentage, Karl Pearson’s correlation coefficient, and World Health Organisation (WHO) Anthro software were used for statistical analysis. Results: The majority of the study participants, 96 (64%), had average knowledge regarding child nutrition, while all of them had good child feeding practices. Regarding the nutritional status of the children, the majority fell under the normal category based on weight for height (123, 82%), weight for age (118, 78.67%), and height for age (104, 69.33%). The study also revealed a significant correlation between the knowledge of mothers, feeding practices, and nutritional status of children (p-value &lt;0.05). Conclusion: The study concluded that although majority of the study participants had a normal nutritional status and their mothers had average knowledge, regular awareness programs could be conducted, and the nutritional status of children needs to be regularly monitored.

Prediction of Low Birth Weight by Quadruple Parameters in High-Risk Pregnancies.

Aneuploidy screening is done in the early second trimester of pregnancy among all pregnant women as compulsory, with a special focus on those who had abnormal ultrasound parameters, higher dual marker risk, or other comorbidities. Recently, all individual quad markers of conventional trisomy screening have been suggested as useful in predicting adverse pregnancy outcomes (APO) such as preeclampsia, preterm labor, small for gestational age, and placental abruptions. However, similar studies on Indian pregnant women are limited. Hence, this study was intended to find the relation of quadruple markers with any other APO than aneuploidy. A retrospective study was conducted in a Tertiary Care multi-specialty hospital in North India. Data from 252 pregnant women's quadruple test was analyzed. The association of abnormal value of quadruple markers (human chorionic gonadotropin [HCG]/alpha-fetoprotein/uE3/Inhibin A) with adverse outcomes was evaluated. Multiple logistic regression analysis and classification and regression tree were used to predict the significant risk factor in high-risk pregnancies. In the study, a total (n = 252) of pregnant women, 190 were screened as high-risk pregnancies, whereas the remaining 62 were reported as low-risk using trisomy screening in the quadruple test. Baby birth weight was observed to be significantly associated with Inhibin-A, and HCG (P < 0.001), whereas Corrected (Corr)-multiple of median (MoM)-HCG (>1.415) and Inhibin-A Corr-MoM (>364.175) were the suitable predictor for the LBW. Both parameters were significantly higher in the high-risk group as compared to the low-risk group (each P < 0.05). Abnormal deviation of biochemical markers from aneuploidy screening assessment could help predict other perinatal adverse outcomes such as low birth weight babies.

Assessment of health-related quality of life in cancer patients undergoing treatment using Health Utilities Index (HUI-3®) in East Delhi, India.

Health-related quality of life (HRQOL) is a construct that focuses on the capacity for living afforded by the health status of a patient. Measurement of HRQOL allows a composite estimation of the capacity for living of a patient and can help capture the suffering experienced by the patient due to adverse effects of therapeutic interventions. This study was conducted to understand the health-related quality of life of cancer patients undergoing various modalities of treatment to generate evidence source for need-based intervention, to assess patients diagnosed with cancers, using Health Utilities Index - 3 (HUI-3®) and assign them single-score values to gauge HRQOL and to measure the various domains of HRQOL and change in HRQOL after a period of three months of treatment. A descriptive, longitudinal study was conducted amongst patients aged more than 18 years, who were diagnosed with cancer at a tertiary care multispecialty hospital in New Delhi. They were administered a standardized HUI-3 Questionnaire® and their responses were recorded, simultaneously. Statistical significance for change in HRQOL score was assessed with paired t-test. Multivariate linear regression was used to identify the various correlates of HRQOL. The mean (± standard deviation) overall HRQOL score for all participants was 0.71 (± 0.262) [range=-0.09 to 1.00]. A follow-up assessment was carried out after three months and changes in health scores were subsequently recorded. A significant decrease in mean overall HRQOL score was seen for the entire group after three months of having been administered treatment. Single-attributes of emotion and ambulation were maximally affected amongst cancer patients after three months of treatment. On linear regression analyses, baseline HRQOL was a significant correlate of HRQOL at follow-up after three months. ">Addressing the HRQOL of a cancer patient before starting treatment would address morbidity that might be present even after three months.