Nehru Medical College Research Articles

Comparison of Treatment Outcome in EGFR Positive and Negative Patients with Non Small Cell Lung Cancer: A Longitudinal Study

Introduction: Lung cancer is one of the most common malignancies to occur worldwide. Two main subtypes of lung cancer include small cell lung cancer and Non Small Cell Lung Cancer (NSCLC). Patients with advanced stage NSCLC who achieve good response with Tyrosine Kinase Inhibitors (TKI) have been found to have Epidermal Growth Factor Receptor (EGFR) mutation. The first biomarker identified for targeted treatment in lung cancer was EGFR and patients of NSCLC with EGFR mutation have superior survival outcome when treated with targeted therapy as compared to conventional chemotherapy. Aim: To compare the outcome of targeted therapy to mutation to EGFR and conventional therapy in non mutant lung cancer patient of NSCLC. Materials and Methods: The present longitudinal study was conducted in the Department of TB and Respiratory Diseases, Jawaharlal Nehru Medical College and Hospital, Aligarh, Uttar Pradesh, India from July 2017 to November 2019 on a sample size of 80. Patients diagnosed with NSCLC and EGFR mutation status were included in the study. They were started on TKI if tumour was EGFR positive and on conventional chemotherapy (cisplatin plus paclitaxel) if no mutation was detected on histopathology. Among the study group, 35 patients were EGFR positive and started on geftinib (group I), 45 were EGFR negative and received platinum-based chemotherapy (group II). Outcomes were measured in terms of progression-free survival, Overall Survival (OS), and toxicities. Statistical analysis of data was done using Statistical Package for the Social Sciences (SPSS) version 20.0. Results: Among the study group, 35 patients were EGFR positive and started on geftinib (Group I), 45 were EGFR negative and received platinum-based chemotherapy (group II). The mean age of EGFR positive patients was 58.91 years and for EGFR negative patients was 60.11 years. In group I, there was no complete response while 28.5% had partial response, 45.5% had stable disease and 25.7% had progressive disease. In group II, 15.5% patients had complete response, 33.3% had partial response,17.7% had stable disease and 33.3% had progressive disease. Mean progression-free survival in group I (5.65 months) was significantly higher than group II (4.26 months). The mean OS in group I (7.85 months) was slightly higher than group II (6.72 months). Both haematological and non haemaotlogical toxicities were significantly higher in group II. Conclusion: Patients with EGFR positive expression subjected to Gefitinib had significant mean progression-free survival with an acceptable range of non haematological toxicities and no haematological toxicities, as compared to the EGFR negative patients on conventional chemotherapy.

Life-Satisfaction among Female Employees (A Study in Aligarh)

Occupational mental health is responsible for affecting the quality of personal life lead by the employees. Depression and anxiety are the most common psychosocial crisis that the female employees undergo both at home and at the workplace. Recent studies have proved that married woman with young children show more anxiety and depression. This study aimed at analyzing the level of life satisfaction among the female employees. A cross-sectional study was conducted from July 2019 to June 2020. Stratified random sampling was done in female employees in Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh. A pre-tested semistructured proforma was used. The study was being done on 378 participants . All the data were entered and analysed in SPSS-20.0 To find out the association between certain variables Chi-square/Fisher Test was used. It was found that Satisfaction with life is significantly associated with the occupation of the women.

Comparison of Intermediate Fidelity Simulation with PowerPoint Presentation and Video Lectures for Imparting the Skills of Normal Delivery to Undergraduate Students-A Research Protocol

Introduction: In the modern era, which is heavily driven by multimedia, traditional ways of teaching medical students are insufficient. Techniques based on simulations might be crucial in closing this educational gap that exists. A curriculum built on the cognitive, psychomotor, and emotional learning domains, which were first introduced about 50-year-ago, is receiving more and more attention in medical education. The highest standards of care, patient safety and error prevention, patient autonomy, and resource allocation are the main goals of these reforms. Experiential (or “hands-on”) learning is becoming more and more popular in medical education, however, using real patients to conduct this type of learning raises ethical and legal issues and is less socially acceptable. With the help of simulation, learning possibilities like immersion, reflection, practice, and feedback can be offered without the hazards associated with a similar real-life experience. The precise artificial recreation of a difficult real-world process is called simulation. Need of study: Despite the many benefits of fidelity-based learning, it is not widely incorporated as an excellent learning tool in many institutions and Obstetrics and Gynaecology departments. Hence, authors plan to study the effectiveness of an intermediate fidelity simulator in improving the skills of normal delivery in medical students. Aim: To assess skill development and teaching for normal delivery through PowerPoint presentation and video lectures, then compare it with skill development through Intermediate fidelity simulation in undergraduate medical students. Materials and Methods: The cross-sectional, observational study after due ethical approval will be conducted in Department of Obstetrics and Gynaecology, Acharya Vinoba Bhave Rural Hospital, Jawaharlal Nehru Medical College, Sawangi (M), Wardha, Maharashtra, India from September 2022 to August 2023. An introductory lecture will be taken for a batch of 160 students of 3rd year. Pre-Objective Structured Clinical Examination (pre-OSCE) will be conducted and then two groups of students will be formed. Group A will be taught with video PowerPoint presentation-based lectures meanwhile intermediate fidelity will be used as a method for teaching normal delivery for Group B. Post-OSCE will be conducted for both groups. Results will be analysed using student’s paired t-test for statistical significance.

Comparison of Hearing Impairment among Healthy and High-risk Neonates at a Tertiary Care Hospital, Rajasthan, India: A Cross-sectional Study

Introduction: Hearing impairment is caused by damage in the inner ear (can be even birth defect), ear infection, ruptured eardrum and so on. It can be prevented using early detection thus, helps in avoiding severe psychosocial, educational, and linguistic repercussions. Infants, who are not diagnosed of hearing impairment before six months of age, will have delays in speech and language development. Aim: To determine the prevalence of hearing impairment in highrisk neonates and to establish the fact that, these neonates have higher prevalence of hearing impairment as compared to normal population. Materials and Methods: A cross-sectional study was conducted in the Department of Paediatrics at Jawaharlal Nehru Medical College and Hospital, Ajmer, Rajasthan, India. The duration of the study was six months, from December 2012 to May 2013. A total of 500 babies including 297 normal and 203 high-risk babies were enrolled into the study. All the neonates were screened using Behavioural Observation Audiometry (BOA) and Distortion Product Oto-acoustic Emission (DPOAE) preferably within three days of life. Those, who failed under this test, underwent for Brain stem Evoked Response Audiometry (BERA). Data was collected in the Microsoft Excel and analysis done by Statistical Package for Social Sciences (SPSS) version 23.0. Results: The mean age of the newborns on admission, was 3.86±4.25 days and the mean weight was 2560±510 g. Out of 500 newborns screened, 58 babies had abnormal results with the first screening test. When these 58 babies subjected to BERA, eight babies showed Hearing Loss (HL). Sepsis, Neonatal Intensive Care Unit (NICU) stay >5 days and use of aminoglycosides >7 days were the important risk factors associated with hearing impairment. Prevalence of hearing impairment in the present study was came out to be 16/1000. This finding was statistically significant with p-value<0.05. Conclusion: There was high prevalence of hearing impairment in high-risk newborns, majority of which were bilateral. The authors recommend multistage screening in all newborns at birth or within month’s time at all level of healthcare facility. Newborns with sepsis, NICU stay >5 days and use of aminoglycosides >7 days should have mandatory audiologic evaluation at discharge.

Knowledge of Emergency Colour Codes among Healthcare Workers in a Tertiary Care Hospital of Wardha, Maharashtra, India: A Cross-sectional Study

Introduction: An emergency refers to any crisis caused by humans or natural disasters that requires prompt and effective action to protect life and property. Consequently, a wellcoordinated and carefully planned emergency response is crucial. Medical emergency codes are utilised globally to alert hospital staff about various emergencies. Aim: To assess the knowledge of healthcare workers regarding emergency colour codes in a tertiary care hospital. Additionally, it aims to develop standardised operating procedures and policies based on these codes and provide guidance on their implementation in hospitals for different emergency situations. Materials and Methods: This cross-sectional study was conducted at Jawaharlal Nehru Medical College, Wardha, Maharashtra, India, from December 2021 to May 2022. A total of 100 healthcare workers aged >18 years, employed at a tertiary care hospital, were included in the study. A survey was conducted using a structured questionnaire to assess the knowledge of the participants. The questionnaire consisted of two sections: the first section collected demographic information such as age, gender, qualifications, and profession, while the second section consisted of nine items to evaluate knowledge related to the role of emergency response codes in managing hospital emergencies. Descriptive statistics, including percentages and frequencies, were used to present the results. Results: In the present study, out of 100 study subjects, the maximum percentage (40%) belonged to the age group of 36- 55 years, while the minimum percentage (18%) belonged to the age group of 18-25 years. Among the participants, 25% were male and 75% were female. A significant proportion (92.7%) of the population demonstrated knowledge of the codes for handling hospital emergencies. Specifically, 98% of participants were familiar with the use of code red for fire emergencies, and 88% understood the process of activating code red. All participants had a basic understanding that code blue is used for cardiac arrest, and 85% had knowledge of paediatric emergency codes. Additionally, 96% were aware of the indications for Cardiopulmonary Resuscitation (CPR), and 100% knew the abbreviation for CPR. Conclusion: The present study revealed that 96% of the population had good knowledge, while 4% had average knowledge regarding the codes for handling hospital emergencies. Implementing standardised operating procedures and ensuring staff awareness of all emergency response codes used in the hospital are recommended.

A Study on Self Medication Practices During Covid-19 Pandemic

Self Medication(SM) “involves the use of medicinal products by the consumer to treat self recognized disordersor symptoms, or the intermittent or continued use of a medication prescribed by a physician for chronic orrecurring diseases or symptoms”. The objective of this study was to determine practices of Self Medication. Thepresent study was conducted in the field practice areas of the Department of Community Medicine, JawaharlalNehru Medical College, Aligarh Muslim University, Aligarh, from August 2021 to July 2022. It was a communitybased cross-sectional study.A total of 424 people was included.Simple Random Sampling was done. Individuals≥18 years of age from families of RHTC and UHTC,those who experienced an episode of illness after start ofCovid-19 pandemic and those who gave consent were included in the study. Patients who were bed-ridden and/or suffering from mental illness and those who did not give consent were excluded from the study. Data entryand analysis was done in IBM SPSS v 26.0. Relevant statistical tests were applied wherever required. Nearlyhalf of the study population practised Self Medication as a form of treatment at least once in the preceding 12months.The major source of information for the choice, dosage and duration of the medicines consumed for SelfMedication in our study was found to be the pharmacist ( 69.0%). It was followed by prior experience (31.0%) andprevious prescription (15.2%). In our study analgesics and antipyretics were found to be consumed by the highestpercentage of study participants. People should be made aware of the risks of Self Medication and should beguided on responsible Self Medication. Awareness campaigns may be organised in this regard

Role of Environmental Factors and Hygiene in Skin Diseases

According to a study,skin pattern in a population is generally determined by different ecological and otherfactors.The vicious cycle of ignorance, poverty, and disease is still the bane of many developing countries andplays a prominent role in the prevalence of many skin diseases. The skin disease may be accompanied by greatmorbidity, disfigurement, and distress, leading to a major source of social stigma.The body is liable to variousskin infections and it may hamper the physical well-being of the individual.Due to ignorance or lack of propereducation, personal hygiene may not be taken care properly.The present study was conducted to find out the roleof environmental and hygienic factors in common skin diseases.The present study was conducted to find out thesocio-demographic factors associated with common skin diseases . This study was conducted in the field practiceareas of the Urban and Rural Health Centres, Department of Community Medicine, Jawaharlal Nehru MedicalCollege, Aligarh Muslim University, Aligarh,Uttar Pradesh.It was community based and cross-sectional study.The study period was one year i.e. from June 2016 to May 2017.Inclusion criteria: All individuals of the household.Exclusion Criteria: All who did not gave consent.This study found the association of skin disorder prevalence with presence of dampness in the living environmentof the population.This study reported that prevalence of skin diseases was significantly more in both urban andrural areas with poor personal hygiene, compared to the individuals having average and good personal hygiene.And this association is statistically significant for both areas.This study reported that quality of life of ruralpopulation was affected more with the distribution of skin diseases among them.

Nutritional Status and Anganwadi Services Utilization Among Under 5 Children in Aligarh: A Cross Sectional Study

Child health should be of prime concern. Their protection is the greatest investment for the country’s economicand political stability. This cross sectional study was conducted at the Anganwadi centres under registered areasof the Department of Community Medicine, Jawaharlal Nehru Medical College Aligarh Muslim University,Aligarh. The study was conducted from July, 2017 to June 2018 among 400 children of age 3-6 years registeredat the Anganwadi centres of field practice area. It was found that although the age group distribution amongregistered population was almost equal, majority of the children were found to suffer from stunting. along withthis, children belonging to lower middle class socio economic status had the most registeration under ICDS scheme.The statistical association between underweight, stunting and socio-economic status was found to be statisticallysignificant (p<0.05) while it was not associated with wasting (p>0.05). It can be understood that socio economicstatus also has role to play in access of these services. It is therefore necessary that people are made aware of ICDSprogram and motivated to reap benefits of the same for improved nutritional outcome of their children.

Feeding Practices affecting Nutritional Status of Anganwadi Children

Each Anganwadi unit covers a population of about 400 to 800 and mini Anganwadi center about 150 to 400. Thework of Anganwadi centers is supervised by Mukhyasevikas. Field supervision is done by the Child DevelopmentProject Officer (CDPO).Nutrition-related factors contribute to about 45% of deaths in children under 5 years ofage.This study was conducted to find the factors affecting nutritional status of children at anganwadi centres inAligarh.This study was conducted(cross sectional) at the Anganwadi centres under registered areas of the Departmentof Community Medicine, Jawaharlal Nehru Medical College Aligarh Muslim University, Aligarh. The studywas conducted from July, 2017 to June 2018. All children of age 3-6 years registered at the Anganwadi centresof field practice area. INCLUSION CRITERIA:Child of 3 years to 6years (36 months to 71 months) of age andChild whose caregiver gave consent for the study.EXCLUSION CRITERIA:Child not registered at Anganwadicentre,Non-cooperative caregivers,Caregiver and child not present in three visit periods. Ethical clearance wasobtained from Institutional Ethics Committee, JNMC, AMU, Aligarh.Informed verbal consent was taken fromcaregiver before interview.It was found among the feeding practices that nutritional status was found to be associated with duration ofexclusive breast feeding, age of start of complementary feeding, and total duration of breast feeding.

Frequency and Patterns of Bacteraemia in Children with Sickle Cell Disease: A Prospective Cohort Study

Introduction: Sickle Cell Disease (SCD) is one of the most common inherited haemoglobinopathies and is associated with high morbidity and mortality, particularly in early childhood among the affected population. Infection is a significant contributor to morbidity and mortality in SCD. Aim: To investigate the frequency and pattern of bacteraemia in children with SCD. Materials and Methods: This prospective cohort study was conducted in the Department of Paediatricss at Acharya Vinoba Bhave Hospital, Sawangi (M), Wardha, Maharashtra, India, a tertiary care hospital attached to Jawaharlal Nehru Medical College from October 2019 to September 2021. A total of 70 patients with SCD, aged upto 18 years, who presented with fever on two separate occasions and were admitted to the hospital, were included in the study. Blood culture, complete blood counts, and C-reactive Protein (CRP) tests were conducted to detect bacteraemia immediately after admission and when required. Quantitative data was analysed using mean, median, and standard deviation. Results: In the present study, out of 70 patients, 40 (57.14%) were male and 30 (42.86%) were female. A total of 54 (77.14%) were homozygous and 16 (22.86%) were heterozygous for SCD. A total of 30 (42.86%) patients belonged to the 6-10 years age group. Fever and pallor were the most common clinical findings. The rate of bacteraemia was found to be 15.71%. Gramnegative organisms were more frequently isolated compared to gram-positive isolates. The most common organism isolated in sickle cell patients was Klebsiella species (36.36%). Conclusion: Bacteraemia was observed in only approximately 15.71% of the patients. Gram-negative bacteraemia was more prevalent in patients with SCD. Patients with acute chest syndrome were more susceptible to bacterial infections. Mortality was higher in sickle cell patients from whom organisms were isolated in blood cultures.

What Providers Seek to Do with ‘Questions’ in Patient-Provider Interaction

ABSTRACT This paper analyzes patient-provider interaction (PPI). More precisely, it deals with the form-function relationship in questions used in counselor-patient interaction. The study is based on naturally occurring primary data collected at the Department of Pediatrics and the Department of Community Medicine, Jawaharlal Nehru Medical College and Hospital (JNMCH), located in Aligarh Muslim University, India. The data are composed of audio-visual recordings of Hindi-Urdu interaction between 8 counselors and 27 patients. We identified compliance and condescension as the two unique functions the counselors seeks to accomplish and/or fulfill through the use of questions in their interaction with the patients. We also found four other functions – information seeking, recall, greeting, and diagnosis, which are sought by the counselors through their use of questions. The findings also suggest that these functions maintain and promote what can be termed as a counselor-centered interaction, and thus reflect asymmetrical power relationship between counselors and their patients.

Retinopathy of prematurity: Risk factors and associated co-morbidities

To estimate the prevalence of ROP and identify risk factors and co-morbidities associated with it. This cross-sectional study was performed, enrolling all premature babies admitted to the NICU of Jawaharlal Nehru Medical College and Hospital, A.M.U., Aligarh, Uttar Pradesh over 18 months. Various risk factors and co-morbidities for ROP were assessed using univariate and multivariate analysis. Out of the studied 164 infants, 29 infants (17.68%) developed ROP in one or both eyes; 51.72% (15/29) had stage 1, 31.03% (9/29) had stage 2, 10.35 % (3/29) had stage 3, and 6.90% (2/29) babies had aggressive posterior retinopathy of prematurity (APROP). On univariate analysis, we observed a significant association between ROP and gestational age, low birth weight, multiple gestations, mechanical ventilation, history and duration of oxygen supplementation, history of blood transfusion, respiratory distress syndrome, apnea and sepsis. However, after multivariate analysis, only low birth weight, oxygen therapy, respiratory distress syndrome and apnea were found to have a significant association with ROP. A prevalence of 17.68% emphasises the importance of neonatal screening in this region. Low birth weight, oxygen therapy, apnea, respiratory distress syndrome pose significant risk factors for ROP. Supplemental oxygen should be weaned off as early as possible,

Socio-demographic and Clinical Profile of Suicide Attempters attending a Tertiary Care Hospital: A Cross-sectional Study

BACKGROUND: Suicide attempts are one of the most common psychiatric crises. Suicide attempts are thought to be the most accurate determinants of completed suicide. A variety of circumstances causes suicide attempts. Although mental illness and extreme stress have long been linked to suicide, the socio-demographic and clinical features of those who attempt suicide can also reveal suicidal intent.OBJECTIVES: The aim of the study was to explore the socio-demographic factors and the clinical profile of suicide attempters.METHOD: The present study was conducted in the Department of Psychiatry, Jawahar Lal Nehru Medical College and Hospital, Aligarh, Uttar Pradesh. Suicide attempters referred for psychiatric evaluation from various hospital departments from December 2018 to November 2019 were evaluated after proper stabilization. Details including socio-demographic data and psychiatric diagnosis were tabulated and analyzed using SPSS-16.RESULT: In our study, out of 80 subjects, maximum suicide attempters (71.2%) belonged to the age group of 18-30 years, most of whom were females (51.2%), mostly married (65%), followed the Hindu religion (66.3%), equally distributed in a rural and urban area (50%), literate (76.2%), unemployed (56.2%), of the lower middle class (48.8%), living in a nuclear family (46.2%). Of all the methods, the most commonly used method was ingestion of insecticides/ pesticides (38.7%), and most attempters had interpersonal issues with their spouse (38.8%) and had some psychiatric comorbidity (56.3%).CONCLUSION: Suicide attempts are common among the young population. Poisoning is the most popular mode, with Organophosphorus compounds being the most common in our study. As a result, patients require psychiatric care. Self-harm can be reduced by promoting healthy coping strategies and reducing stress. In a nation like India, where established mental health facilities are rare and stigmatized, it is also essential to convey enough information to people from lower socio-economic backgrounds.

Impact of Subclinical Hypothyroidism on Clinical, Biochemical, Hormonal and Anthropometrical Profile in Polycystic Ovarian Syndrome

Objectives: To determine the correlation of subclinical hypothyroidism (SCH) with polycystic ovarian syndrome (PCOS) and to assess its impact on the clinical, biochemical and hormonal features in polycystic ovarian syndrome. Background: PCOS is one of the most common endocrinopathies seen in women of the reproductive age group with a prevalence ranging from [Formula: see text] to [Formula: see text] globally (Joshi et al., 2014) and [Formula: see text] to [Formula: see text] (Malik et al., 2014) in the Indian population. Thyroid disorders are quite commonly seen in PCOS patients, SCH are seen in up to [Formula: see text] of this population (de Medeiros et al., 2018). Its association with PCOS has been insufficiently explored and therefore this study was designed to better understand the correlation. Methodology: This was a cross-sectional study conducted from November 2019 to 2021 in the Department of Obstetrics and Gynecology of Jawaharlal Nehru Medical College and Hospital, Aligarh, India, on 150 PCOS women in the age bracket of 18–35 years. They were divided in two groups: one with normal thyroid levels and the other with SCH. Measurement of clinical, anthropometrical, biochemical and hormonal profile was made in both groups and comparison was made using appropriately matched tests of significance and coefficient of correlations. Results: Notable findings included a positive and statistically significant correlation between SCH and menstrual cycle irregularities ([Formula: see text], [Formula: see text]), infertility ([Formula: see text], [Formula: see text]), body mass index ([Formula: see text], [Formula: see text]), waist to hip ratio ([Formula: see text], [Formula: see text]), testosterone([Formula: see text], [Formula: see text]), total cholesterol ([Formula: see text], [Formula: see text]), triglyceride values ([Formula: see text], [Formula: see text]), fasting insulin ([Formula: see text], [Formula: see text]) and HOMA-IR ([Formula: see text], [Formula: see text]). A positive but statistically insignificant correlation was found with hirsutism ([Formula: see text], [Formula: see text]), luteinizing hormone ([Formula: see text], [Formula: see text]), follicle-stimulating hormone ([Formula: see text], [Formula: see text]), prolactin levels ([Formula: see text], [Formula: see text]), high-density lipoprotein ([Formula: see text], [Formula: see text]), low-density lipoprotein ([Formula: see text], [Formula: see text]) and fasting blood sugar values ([Formula: see text], [Formula: see text]). No statistical significance with systolic blood pressure ([Formula: see text], [Formula: see text]) and diastolic blood pressure ([Formula: see text], [Formula: see text]) was found. Conclusion: The study showed a significant correlation between SCH and multiple variables in PCOS and thereby necessitating thyroid screen in PCOS population.

Study of Risk Factors in Patients of Pelvic Inflammatory Diseases

Number of risk factors has been associated with pelvic inflammatory disease, such as age, previous sexually transmitted infection, previous PID, multiple sexual partners, or an intrauterine contraceptive device. Women who use an intrauterine device for contraception are at least 2-4 times more likely to develop PID than non-users. Women who have had PID are twice as likely to develop the infection as those who have never had it. A history of a prior uncomplicated gonococcal infection is more common among women with PID than among women without disease. The present cross- sectional study was conducted in J.N. Medical College and Hospital (J.N.M.C.H.), Aligarh Muslim University, Aligarh. Permission for doing the study was taken by the Board of Studies in the Department of Community Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh. The study was carried out for a period of one year, from 1st August 2001 to 31st July 2002. The present study was carried out among ever married females in the reproductive age group of 15 to 49 years. Women, who gave positive history of PID, were asked to give their consent for the study. Their refusal was taken as exclusion criteria. Females with PID who were menstruating or who had taken antibiotic within the previous month were also excluded from the study. A total of 350 ever married females were selected from the Gynaecology OPD of J.N. Medical College Hospital (n=170), Urban Health Training Centre (n=100) and Rural Health Training Centre (n=80).A detailed clinical history and clinical examination were recorded on a pre-formed and pre tested proforma. All the females under study were subjected to per vaginal examination. The percentage of those female was more who used any cloth during menstruation. Out of 350 patients, 7.4% ga ve history of T.B, 24% gave history of previous episodes of PID, 12.0% gave history of MTPs/D&Cs. 5.1% had adopted IUCDs as a method of family planning.1.71% cases gave history of removal of IUCDs because of some complications. 75.0% of 80 cases (who adopted family planning) used IUCDs, OCPs and ligation. IUCDs, OCPs, ligation and irregular use of condoms probably increase chances of PID.

Clinical Profile of Patients Presenting With Sepsis to the Emergency Department of a Tertiary Care Hospital in Wardha During the COVID Pandemic (June 2020-June 2021).

BackgroundSepsis is defined as life-threatening organ dysfunction due to a dysregulated host response to infection. Septic shock, multi-organ dysfunction, and death occur in severe cases with reduced blood flow to vital organs. Sepsis contributes to 15-20% of all global deaths. Through this study, we intend to evaluate the clinical profile and study the common blood investigatory panels along with organisms causing sepsis in patients presenting with sepsis in the emergency department during the COVID pandemic. In addition, the study was also done to estimate the prevalence of sepsis and compare patients having sepsis with serum lactate, sepsis with Systemic Inflammatory Response Syndrome (SIRS) criteria, and sepsis with quick Sepsis Related Organ Failure Assessment (qSOFA) score.MethodObservational retrospective study to evaluate patients presenting with sepsis diagnosed by the Third International Consensus Definitions for Sepsis and Septic Shock” criteria presenting to the emergency department of Acharya Vinoba Bhave Rural Hospital (AVBRH) affiliated to Jawaharlal Nehru Medical College (JNMC), Wardha during COVID pandemic (June 2020-June 2021).ResultsThe majority of the patients presented with fever (42%), and very few presented with altered mental status (8%). Seventy-four percent of the study population did not show any bacterial growth on blood culture, but out of the remaining 26%, blood culture, Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pnemoniae were the significant microbes. Amongst qSOFA, SIRS criteria, and serum lactate as a screening tool for sepsis, SIRS is the most sensitive for screening sepsis patients.ConclusionStaphylococcus aureus, Pseudomonas aerugenosa, and Klebsiella pneumoniae were the major contributors in the development of sepsis in COVID-19-associated infection. The presence of raised leukocyte counts and serum lactate should alarm clinicians of possible sources of infection. The timely initiation, rapid de-escalation of empirical antibiotics, and strict compliance with infection control practices should be accomplished to reduce the occurrence of multidrug resistance organisms.

A RETROSPECTIVE STUDY: ANALYSIS OF ADVERSE DRUG REACTION IN PEDIATRIC PATIENTS IN A TERTIARY CARE HOSPITAL

Objective: The objective of this study was to analyze various parameters such as admission type, demographics, type of reaction, organ system classification, drugs involved, action is taken, reaction outcome, causality assessment, severity assessment, and the preventability of Adverse drug reactions (ADRs) in pediatric patients. Methods: This retrospective observational study was conducted during the period of September 2017 to June 2020 (34 months) at the ADR monitoring center, Department of Pharmacology, Jawaharlal Nehru Medical College, Ajmer, Rajasthan. All spontaneously reported ADRs were evaluated using various parameters such as type of reaction, causality assessment, preventability, and severity. Results: In the present study, 72 (7.27%) ADRs were reported in relation to 65 pediatric patients. In this study, more ADRs were reported in male (53.85%) as compared to female (46.15%) pediatric patients. The majority of ADRs were considered type B (63.89%), probable (87.5%), moderate (51.39%), and definitely preventable (88.89%) in nature. The majority of ADRs were reported due to antimicrobial classes of drugs, including anthelmintic drug (Albendazole), followed by glycopeptide antibiotic (Vancomycin) and third-generation cephalosporin antibiotics (Ceftriaxone, Cefotaxime, and Cefixime). The organ systems most commonly affected were skin and subcutaneous tissue disorders (47.22%), followed by general disorders and administration site conditions (20.83%) and gastrointestinal disorders (16.67%). Conclusion: The present study 30 different types of suspected ADRs that were reported with multiple frequencies, with included 34 different categories of drugs and combinations of drugs. The majority of patients recovered, with associated ADR, after necessary medical intervention and management. Our purpose is to minimize the incidence rate of ADRs in the pediatric population.

Prevalence of Psychosocial Problems among Female Employees (A Study in Aligarh)

Occupational mental health not only creates an impact on the professional life and performance given by an employee but it is also responsible for affecting the quality of personal life lead by the employees.Depression and anxiety are the most common psychosocial crisis that the female employees undergo while trying to give their best performance both at home and at the workplace. Recent studies have proved that married woman with young children show more anxiety and depression. This study aimed at analyzing the impact of the Psychosocial problems faced by female employees. In this regard, the objective of this study was set to assess the prevalence of psychosocial problems among female employees. A cross-sectional study was conducted from July 2019 to June 2020. Stratified random sampling was done in female employees in Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh. A pre-tested semi-structured proforma was used. The study was being done on 378 participants. All the data were entered and analysed in SPSS-20.0 To find out the association between certain variables Chi-square/Fisher Test was used. Among the study participants, 26.7% of working female employees falls below 25th percentile of psychological well-being. This indicates that majority (73.3%) of the female employees have higher psychological well-being. 24.6% of working female employees falls below 25th percentile of Social Well-being. This indicates that majority (75.4%) of the female employees have higher SWB. Only 40% of the doctors scored above 25th percentile of Social Well-being which is the least in terms of the percentage among all the occupational categories of the working women. Among the nursing officer, more than three-fourth (n=166; 78.7%) scored above 25th percentile on PWB scores whereas, 21.3% (n=45) of nursing officer scored below 25th percentile. The Psychological Well-Being is significantly associated to the occupation of the women. The Social Well-Being is significantly associated with Occupation of the women.

A RETROSPECTIVE STUDY OF ADVERSE DRUG REACTION IN MULTIDRUG-RESISTANT TUBERCULOSIS PATIENTS AT TERTIARY CARE HOSPITAL

Objective: The objective of the study was to the analysis of different parameters including admission type, demographics, type of reaction, the seriousness of reaction, classification of organ system, drugs involved, action taken and outcome of reactions, causality assessment, severity assessment, and the preventability of ADRs for multidrug-resistant tuberculosis patients. Methods: This retrospective observational study was conducted during the period of September 2017 to June 2020 (34 months) at ADR Monitoring Centre, Department of Pharmacology, Jawaharlal Nehru Medical College, Ajmer, Rajasthan. All spontaneously reported ADRs were evaluated using various parameters such as type of reaction, causality assessment, preventability, and severity. Results: In the present study, 92 (9.29%) ADRs were reported in relation to 68 MDR-TB patients. The majority of ADRs were considered probable (73.92%), moderate (41.30%), and definitely preventable (42.39%) in nature. In our study, most of the suspected drug names were included: 23 (25%) pyrazinamide, followed by 22 (23.91%) kanamycin, 12 (13.04%) cycloserine, and 11 (11.96%) linezolid. The majority of ADRs were non-serious (67.39%) in nature. ADRs were most commonly reported, with 17 (18.48%) reporting ototoxicity and 17 (18.48%) reporting joint pain, followed by 4 (4.35%) reporting burning feet syndrome, 4 (4.35%) reporting generalized itching, and 4 (4.35%) reporting psychosis. Conclusion: Our study included 36 different types of suspected ADRs that were reported with multiple frequencies due to 16 categories of drugs and combinations of drugs. The majority of patients were recovering and recovered from concerns associated with ADR after necessary medical intervention and management. Our purpose is to rationale the use of medicines for drug safety as well as patient safety.

Comparative Evaluation of Dexmedetomidine, Ketamine & their Combination for Epidural Analgesia in Orthopedic Surgeries of the lower Limb

Background: Epidural anesthesia is a perioperative pain control treatment that has a variety of applications in anaesthesiology. It could be used as as a primary anaesthetic, although it's most usually utilised as an adjuvant for management of pain. It could be a one-time shot or a continuous infusion for a long-drawn therapeutic intervention. Apart from the potential for significant analgesia, its use minimises the need for other anaesthetics and analgesics, lowering the risk of adverse effects. It has also been proven to lower the level of cortisol, to facilitate the resumption of bowel function, reduce the risk of Pulmonary embolism and deep vein thrombosis in the post-operative phase, while minimizing the duration of institutional stays.
 Aim: Comparison and Evaluation of the effect of the drugs dexmedetomidine , ketamine & them together as a combination in addition to bupivacaine, as an adjuvant for intermittent epidural top ups for lower limb orthopaedic surgeries .
 Study Design: Prospective observational study.
 Place and duration of Study: The study will be conducted over a period of 2 years and 6 months in the department of anaesthesiology, Jawaharlal Nehru medical college and Acharya vinoba bhave rural hospital, wardha.
 Methodology: Our prospective, comparitive observational study included 90 patients randomly assigned into 3 sets of 30 each, one was administered dexmedetomidine epidurally, one was given ketamine and one was given their combination epidurally [1]. The quality and duration of analgesia provided by all 3 groups were then compared to find out which of them provides better and prolonged pain relief. Along with analgesia, the other parameters assessed were hemodynamic response, sedation and any other side effects.
 Expected Results: We're attempting to establish the hypothesis that the combination of both the drugs is better than dexmedetomidine or ketamine administered individually. It has been proved in various researches that epidural ketamine prolonged the duration of analgesia, [2] but it was less than epidural dexmedetomidine. We expect that the combination would decrease the postoperative rescue analgesics requirements and less hemodynamic alterations hence providing greater patient satisfaction as compared to the two drugs separately.