Multispecialty Tertiary Care Research Articles

Comparison of safety and efficacy of silodosin versus mirabegron in medical expulsive therapy for lower ureteric stone: a prospective, open label and randomized controlled trial

Background: Urolithiasis the most common condition affecting genitourinary tract and affect 5 to 10% of population worldwide. Almost all ureteric stones are symptomatic, and patients need to receive immediate evaluation and pain relief treatment. Passage of stone is facilitated by medical expulsive therapy (MET). Overall, 71-98% for stones in the distal ureter that are 5 mm or smaller passes with MET while 29-98% for stones in the proximal ureter that are 5 mm or smaller passes with MET. Silodosin (alpha-1 adrenergic receptor antagonist) and mirabegron (β-3 agonist) were compared for stone expulsion and analgesic effects for symptomatic relief. Methods: The study was conducted in the department of pharmacology and the department of urology at Dr. R. P. G. M. C., Kangra at Tanda Himachal Pradesh, India which is 700 bedded multispecialty tertiary health care from August 2023to May 2024 and follow-up was done for 4 weeks after initiation of treatment, to compare the safety and efficacy of silodosin versus mirabegron in medical expulsion therapy for lower ureteric stone of size≤10 mm in adults. Results: In our study patients in silodosin treatment arm had a smaller number of colick episodes (mean 1.65±1.02) during MET as compared to group (mean 2.23±1.07) receiving mirabegron (p=0.011). Patients in silodosin group had significantly lower analgesic requirement (mean 2.10±1.58) as compared to patients in mirabegron (mean 3.30±1.96) which is also statistically significant (p=0.002). Patients in silodosin group had highly significant lower time for stone expulsion (mean 10.0±5.3) as compared to that in patients in mirabegron group (mean 15.7±7.1) (p=0.0004). Overall, incidence of side effects was similar in both groups. Conclusions: Silodosin demonstrated superior efficacy over Mirabegron in terms of reducing colic episodes, analgesic requirement and stone expulsion time in the management of ureteric calculi. No significant adverse events were reported in either group during the study period

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.

Evaluation of Schneiderian First-rank Symptoms in Patients of Psychosis Attending a Tertiary Care Center from North India

Abstract Background: The Schneiderian first-rank symptoms (SFRS) have played an extremely important role in the diagnostic systems in psychiatry. However, all studies do not seem to support Schneider’s claim that FRS confer a clear indication of schizophrenia when no organic syndrome is present. Objectives: The objectives of this study were as follows: (1) to examine the presence of SFRS in untreated cases of psychosis, (2) to see the degree of improvement in SFRS with treatment over 12 weeks of short-term follow-up, (3) to see correlation of SFRS with sociodemographic and clinical parameters in our patients, and (4) to see the correlation of SFRS among diagnostic subgroups in our patients. Materials and Methods: Setting: Psychiatry department of a multi specialty tertiary care center in North India. Study Design: This was a short-term prospective study. After taking ethical clearance from the institutional ethics committee and written informed consent from all the patients, data sets were prepared for 60 patients of untreated psychosis. Data analysis was done using the SPSS version 20.0. Results: Voices discussing (83.33%) and voices commenting (80%) were the most commonly noted SFRS, and the mean number of SFRS in our sample was 3.34. Somatic passivity (f = 10.80, P = 0.0001) and thought insertion (f = 6.75 and P = 0.004) could significantly differentiate between schizophrenia and other diagnostic subgroups of untreated psychosis in our study. Conclusions: Only somatic passivity, delusional perception, and thought insertion were extremely specific in distinguishing the patients of schizophrenia from nonschizophrenic patients.

Profile of patients coming to the department of physical medicine and rehabilitation for locomotor disability certification: a 5-years observational study

Background: The persons with locomotor disability are eligible for various social welfare benefits from the Government under ‘The persons with disabilities (Equal opportunities, protection of rights and full participation) Act, 1995’ along with other causes of disabilities like blindness, hearing impairment etc. and recent enactment of the Rights of Persons with Disabilities (RPwD) Act, 2016. Understanding the utilization of services is crucial in enhancing assistance for individuals with certifiable disabilities. This study aimed to observe the clinico-demographic profile of patients coming to outpatient Department of Physical Medicine and Rehabilitations for locomotor disabilities certification and 5 years’ trend in the number of patients getting disability certificate. Methods: This retrospective study was based on the data taken at time of disability certification in a multispecialty tertiary care government medical college in Northern India. All persons with locomotor disability who were issued disability certificate between 2014 and 2018 were included in the study. Results: A total of 857 patients were issued disability certificates during the study period of 2014 to 2018. Among the 744 adult patients, only 149 (20%) were female. Most of them were urban residents. In locomotor disability, post-polio residual paralysis was the most common diagnosis encountered, followed by amputations and cerebral palsy. Most of the applicants were having a disability of 40-50%. Conclusions: Awareness has to be generated about the disability benefits and disability certification. Utilisation of services by females should be encouraged. Robust data and literature need to be built up for prevention and management of locomotor disability.

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.

Colistin resistance in carbapenem non-susceptible Acinetobacter baumanii in a tertiary care hospital in India: clinical characteristics, antibiotic susceptibility and molecular characterization.

Acinetobacter baumanii (AB) is a bacterium of concern in the hospital setup due to its ability to thrive in unfavorable conditions and the rapid emergence of antibiotic resistance. Carbapenem resistance in this organism is disheartening, further clouded by the emergence of colistin resistance. The present prospective study aims to note the epidemiology, molecular profile, and clinical outcome of patients with colistin resistance AB infections in a multispecialty tertiary care setup in Odisha, Eastern India. All AB strains received from March 2021 to February 2022, identified by Vitek2 (Biomerieux) and confirmed by oxa-51 genes, were included. Carbapenem and colistin resistance were identified as per CLSI guidelines. Known mutations for blaOXA-23-like, blaIMP, blaVIM, blaKP, lpxA, lpxC, pmrA, pmrB, and plasmid mediated mcr (mcr1-5) were screened by conventional PCR techniques. The clinical outcome was noted retrospectively from case sheets. Data was entered in MS Excel and tabulated using SPSS software. In the study period, 350 AB were obtained, of which 317(90.5%) were carbapenem resistant (CRAB). Among the CRAB isolates, 19 (5.9%) were colistin resistant (ABCoR). The most valuable antibiotics in the study were tigecycline (65.4% in ABCoI; 31.6% in ABCoR) and minocycline (44.3% in CI; 36.8% in CR). There was a significant difference in mortality among ABCoI and ABCoR infections. bla OXA was the predominant carbapenem resistance genotype, while pmrA was the predominant colistin resistant genotype. There were no plasmid mediated mcr genes detected in the present study.

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.

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.

High-performance work systems and employee attitudes: evidence from Indian healthcare industry

PurposeBy following the “employee-centric” approach, this study aims at identifying the impact of high-performance work systems (HPWS) on specific employee attitudinal outcomes such as work engagement, job satisfaction and affective commitment in the Indian healthcare industry.Design/methodology/approachThe target population for this study includes the nurses working in large private multi-specialty tertiary care hospitals in India. Partial Least Squares Structural Equation Modelling (PLS-SEM) techniques are used on a sample of 152 nurses working in two large specialty hospitals.FindingsIn the Indian healthcare industry context, the nurse's perception of HPWS has shown a significant positive effect on their attitudinal variables such as work engagement, job satisfaction and affective commitment. When checked for mediation of work engagement and job satisfaction variables in HPWS – affective commitment relationship, nurse's job satisfaction partially mediated the relationship, but nurse's work engagement has shown no mediation effect.Originality/valueThis is one of the pioneering studies conducted in the Indian healthcare industry context, especially on the nurse's sample in identifying the impact of high-performance work systems on their attitudinal outcomes. Underscoring the paucity of HPWS research in the Indian healthcare industry, this study's findings will be an addition to the HPWS literature and also to the nursing research in the Indian healthcare settings.

Usage and cost-effectiveness of anti-psychotics in psychiatry OPD among various clinical conditions: A prospective observational study in a tertiary care center.

Psychotropic medications are prescription drugs that are commonly used to control some symptoms associated with many different types of mental ill health. Although they cannot cure a patient illness, they can assist with the management of some extremely distressing symptoms and this in turn can facilitate individuals in leading a more fulfilled life. This study attempts to collect the demographic details of the outpatient in the psychiatric department and to describe the usage, prescribing trends and cost-effectiveness of antipsychotics in psychiatry OPD among various clinical conditions to older and younger patients with psychiatry disorders. This study was a prospective observational study, conducted over a period of 6 months from November 2021 to April 2022 in the Department of Psychiatry, Chidambaram Government Medical College and Hospital, a 1400 bedded multi-specialty tertiary care teaching hospital, Tamil Nadu Dr. M.G.R. Medical University Chennai, Tamil Nadu. The recruitment of subjects was carried out with the help the physicians who had the knowledge of patient's history and caregivers consenting to the study protocol and patients with case sheets carrying antipsychotics prescription. A total number of 150 cases were enrolled in this study. All psychiatric OPD cases were studied and the results were taken. Based on the inclusion and exclusion criteria, 93 were the anti-psychotics prescribed cases and 57 were the non-anti-psychotics prescribed cases. Out of 93 patients, 69.89% (65 patients) were male and 30.10% (28 patients) were female. Out of non-psychotic 57 patients, 27 were male patients and 30 were female patients. Out of the 93 OPD patients, 40% of the patients have psychological based symptoms followed by 17% of patients have behavioral symptoms. 86.02% of patients received atypical antipsychotic medications in comparison with 36.55% of patients received the typical antipsychotic medications. In this study, we had observed the usage and types of anti-psychotic drugs to control and minimize the different psychotic symptoms among the OPD patients. Maximum antipsychotics studied were cost-effective and cheaper in Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) as compared to Intas, Torrent, Sun, Linux, Cipla, Abbott, Alkem, and Sanofi.

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.

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.

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.

P399 Diagnostic value of Candida coloni zation index and serum Candida mannan antigen for candidemia in febrile episodes of pediatric lymphoreticular malignancies

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PMObjective: To evaluate the diagnostic performance of Candida colonization index and serum Candida mannan antigen predicting candidemia in febrile episodes of pediatric lymphoreticular malignanciesMethodsIt was a prospective observational study done for 18 months, from November 2018 to April 2020 at the pediatric oncology unit of a multispecialty tertiary care center. Based on our patient load, duration of the proposed study, and available resources, a sample size of 49 (n = 49) was decided and 100 febrile episodes in children with lymphoreticular malignancy were studied. Children below 12 years, receiving chemotherapy for hematological malignancy having oral or axillary temperature ˃38.3°C for ˃1 h were included in this study. Children receiving the antifungal treatment in last 7 days were excluded from the study. Blood collected on day1 and day4 was cultured in BACTEC-9120. For colonization, swabs and samples were collected and cultured on SDA on day1, day4, and day8. All Candida isolates were subcultured on SDA and subjected to Gram's stain, germ tube test followed by Microscan identification. DNA sequencing followed by phylogenetic analysis was done for all the isolates of Candida recovered from blood. Antifungal susceptibility of yeast stains was done. Serum collected on day1 was used for C. mannan antigen detection using ELISA system.ResultsPrevalence of candidemia was 5%. Non-albicans Candida spp were isolated from blood cultures on day 4. Candida colonization decreased from day1 to day8. Colonization index (CI) day1 showed 80% sensitivity 98.9% specificity, and 98.9% negative predictive value. Significant colonization (CI ≥0.5) was seen in a larger proportion of cases that developed candidemia. There was a significant association of Candida colonization (CI ≥0.5) with occurrence of candidemia on day1 and day4. A total of 4 (80%) of candidemia episodes were positive for serum mannan antigen while 1 (20%) was negative. Mannan antigen was detected earlier with 80% sensitivity, 92.6% specificity, and 98.9% negative predictive value. All Candida isolates were sensitive to fluconazole, amphotericin-B, and caspofungin.Receiver operator characteristic curves for diagnostic performance of various parameters in predicting candidemia show the following trends:Best parameter in terms of AUROC is the CI (Day 1).Best parameters in terms of sensitivity are the CI (Day 1), CI (Day 4), and mannan antigen level.Best parameter in terms of specificity is the CI (Day 8).Best parameter in terms of positive predictive value is the CI (Day 1).Best parameters in terms of negative predictive value are the CI (Day 1), CI (Day 4), and mannan antigen level.Best parameters in terms of diagnostic accuracy are the CI (Day 1), CI (Day 8).ConclusionThe CI can predict candidemia but the threshold value needs to be explored in pediatric patients with lymphoreticular malignancies. Mannan antigen detection gives early results with a high negative predictive value.

The pattern of inpatient psychiatry admissions at a general hospital psychiatry unit in South India: A retrospective study.

Mental illnesses are becoming a major health issue across the world. The availability of inpatient facilities for mentally ill patients is very much limited in developing countries such as India. This study was aimed to explore the pattern of psychiatric admissions at a general hospital psychiatry unit (GHPU) in South India. The study was conducted at a multispecialty tertiary care hospital in South India. A retrospective, chart-based study design was adopted to achieve the objectives. All inpatient case records available from the department of psychiatry, the medical records department, and the electronic hospital information system of the institute were reviewed between April 2006 and March 2016. A total of 3082 patients were admitted as psychiatry inpatients during the 10-year study period, representing an average of 308.2 admissions per calendar year. The majority of inpatients were male (n = 1824; 59.2%). Concerning diagnostic categories, mood disorders were accounted for 33.6% of admissions, followed by psychotic disorders (26.4%) and substance use disorders (19.3%), respectively. The median length of hospital stay was 14 days (range 0-163 days). A statistically significant seasonality pattern was noticed for mood disorders (December to February) and anxiety and neurotic disorders (August to October). It is obvious that treatment-seeking attitude among individuals with mental illnesses is increasing and the awareness regarding treatment aspects is also increasing among the general public. Hence, there is a need to improve the existing resources to facilitate intensive management for better treatment outcomes and this, in turn, will enhance the quality of life of mentally ill individuals.

Approach of an Academic Ophthalmology Department to Recovery During the Coronavirus Pandemic.

IntroductionA methodology for safe recovery of an ophthalmology department during a pandemic does not currently exist. This study describes successful recovery strategies for an urban, multi-specialty ophthalmology department serving a high-risk patient population.MethodsThe study took place at a large multi-specialty tertiary care academic ophthalmology department in a metropolitan city during a seven-month period (March–October 2020). Five recovery ad hoc committees were charged with formulating metrics and initiatives to manage clinical volumes while maintaining safe practices, providing patient access, and minimizing financial damage. A six-tier system was created to resume non-urgent appointments in May 2020. Educational and research activities were maintained through the development of virtual curricula and research platforms.ResultsThe number of clinical and surgical visits per month in 2020 compared to 2019 and the time to reach ≥95% of pre-COVID patient volumes were monitored. In October 2020, ≥95% of pre-COVID volumes were attained (11,975 vs 12,337 patient visits in October 2019; 266 vs 272 surgical cases in October 2019). Despite significant financial losses, the department surpassed December 2019 collections in December 2020. No faculty, staff, or trainees received furloughs or pay cuts. There was no COVID-19 transmission between faculty, staff, and patients.DiscussionWith strategic implementation of recovery strategies following CDC safety measures, it was possible to safely deliver care to patients with urgent and non-urgent eye conditions. Patient volumes were fully recovered in an ambulatory urban healthcare setting within a high-risk COVID-19 population within seven months while educational and research missions were successfully sustained.

Evaluation of retinal nerve fiber layer, ganglion cell layer, and optic nerve head morphological parameters in patients with obstructive sleep apnea and comparison with normal population.

Purpose:To compare the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and optic nerve head (ONH) morphological parameters between obstructive sleep apnea (OSA) patients and age-matched controls using spectral domain optical coherence tomography (SD-OCT).Methods:This case control study was conducted in a multi-specialty tertiary care hospital from 2014 to 2016. Patients diagnosed to have OSA by overnight polysomnography were included in the study. Fifty eyes of 25 OSA patients with clinically normal optic disc were compared with 50 eyes of age-matched controls. The study population underwent detailed ophthalmological evaluation including SD-OCT.Results:There was significant thinning of the superior, inferior, and average RNFL in the OSA group when compared to controls. GCL analysis also showed a significant thinning of the six sectors as well as average and minimum ganglion cell layer + inner plexiform layer in OSA patients. The optic nerve head rim area was significantly decreased in OSA patients when compared to controls.Conclusion:OSA patients even with clinically normal optic disc showed significant decrease in the RNFL thickness, GCL thickness, and rim area when compared to age-matched controls. Hence, these patients constitute a high-risk population who need to be regularly screened and followed up for ocular co-morbidities.

Comparison of Cardiac Risk Scores among the East Mediterranean and South Asian Population.

Cardiovascular disease (CVD) is a global burden particularly in developing countries necessitates the periodical monitoring for these vulnerable population. This study aimed to compare four tools to measure the CVD risk between the East Mediterranean and South Asian population. This retrospective analysis included 139 patients from East Mediterranean (n=90) and South Asians (n=49) ethnicity who were admitted during the one-year period in a multi-specialty tertiary care hospital located in Tabuk, Saudi Arabia. Four different tools currently in use across the world were used to analyses the CVD risk. Atherosclerotic Cardiovascular Disease (ASCVD) from American College of Cardiology/American Heart Association (ACC/AHA) was found to be significant (P=0.0000) than World Health Organization/International Society of Hypertension (WHO/ISH) and Framingham Risk Score (FRS) European SCORE (Systematic Coronary Risk Evaluation) memo card from European Society of Cardiology risk prediction charts. Meanwhile, FRS looks equally good as it detects 44.89% of South Asian study population with >10% CVD risk while ACC/AHA detects 46.93%. The present study recommends ACC/AHA cardiac risk estimator to identify the CVD risk in East Mediterranean population. However, the South Asian population needed a population-based tool to assess the accurate CVD risk.