North Indian Hospital Research Articles

Assessment of Stigma among Caregivers of Armed Forces Professionals Suffering from Mental Illness

Abstract Background: Having a person with mental illness in the family invariably leads to stigmatic experiences to the family members. Perceived stigma in caregivers leads to social isolation, psychological distress, and suboptimal functioning. Additionally, perceived stigma among such caregivers is one of the barriers that prevent them from taking appropriate care of their dependents with mental illness. There has been little research in this field in the Indian armed forces population. Objective: The objective of this study was to assess the perceived stigma among caregivers of armed forces personnel suffering from mental illnesses. Methods: The calculated sample size was 139 but in our study period of time (December 1, 2019–February 28, 2020) we received the enough number of patients and we continued our study with 150 study subjects which is enough more than the 139. Hence, the total number of 150 caregivers visiting the psychiatry outpatient department of a tertiary care military hospital in North India along with their mentally ill dependents were included in the study after obtaining valid informed consent. The subjects were interviewed, their sociodemographic data were collected, and stigma scores were assessed on a 15-item Explanatory Model Interview Catalogue (EMIC) Stigma Scale. Results: Total stigma score ranged from 20 to 40 with a median of 31. Caregivers with lower level of education, lower income, rural residency, elder age, and diagnosis of psychosis/substance abuse in dependent were found to have higher scores of perceived stigma. Conclusions: Caregivers of patients with mental illnesses experience significant stigma which needs to be addressed so that they can provide optimum care to their mentally ill dependents. Limitation: As EMIC does not provide any standard cutoff for low or high stigma or to categorize persons as having stigma or not, it was difficult to compare results with other studies that used different tools to assess stigma.

Estimation of D-dimer, C-reactive protein and ferritin in Covid-19 survivors in a North Indian Hospital, Lucknow, India.

Estimation of D-dimer, C-reactive protein and ferritin in Covid-19 survivors in a North Indian Hospital, Lucknow, India.

High Flow Nasal Cannula Versus Conventional Oxygen Therapy and Incidence of Post-Extubation Airway Obstruction in PICU: An Open-Label Randomized Controlled Trial (HiFloCOT-PICU Trial).

To study the impact of high flow nasal cannula (HFNC) vs. conventional oxygen therapy (COT) (by simple nasal cannula) as respiratory support after extubation on the rates of post-extubation airway obstruction (PEAO) among mechanically ventilated critically ill children. This open-label randomized controlled trial was conducted in pediatric intensive care unit (PICU) of a tertiary care teaching hospital in North India over a period of 7 mo (11 August 2021 to 10 March 2022). Children aged 3 mo to 12 y who required invasive mechanical ventilation for > 72h and had passed spontaneous breathing trial (ready for extubation) were enrolled and randomized by computer generated block randomization to receive HFNC or COT after extubation. Primary outcome was rate of PEAO (assessed by modified Westley croup score, mWCS) within 48h of extubation; and secondary outcomes were rate and number of adrenaline nebulization, treatment failure (requiring escalation of respiratory support), extubation failure, adverse events, and length of PICU stay in two groups. During the study period, 116 children were enrolled (58 each in HFNC and COT groups). There was no difference in rate of PEAO (55% vs. 51.7%, respectively), need of adrenaline nebulization, extubation failure, adverse events, and duration of PICU stay in two groups. However, the HFNC group had significantly lower rates of treatment failure (27.6% vs. 48.3%, p = 0.02). The rate of PEAO was similar in HFNC and COT groups. However, HFNC group had significantly lower rate of treatment failure requiring escalation of respiratory support.

The etiological profile of chronic organic non-bloody diarrhea in India: Emergence of inflammatory bowel disease as a dominant cause.

Chronic non-bloody diarrhea may be attributed either to functional or organic diseases. The latter category may present with malabsorption syndrome if there is extensive involvement of the small bowel, whereas diseases of the large bowel may only present with diarrhea sans malabsorption. Indian data has predominantly focussed on the etiological spectrum of malabsorption syndrome in adults. The primary aim of the current study was to evaluate etiological spectrum of chronic organic non-bloody diarrhea in India. This prospective observational study was done at a tertiary care hospital in North India. Patients ≥ 18years presenting with chronic non-bloody diarrhea of > 4weeks duration were enrolled in the study after exclusion of patients with IBS and anal incontinence. During the study period of 12months, 100 patients with chronic organic non-bloody diarrhea were evaluated. A definite etiological diagnosis was made in 97 patients (97%). The mean age of the patients was 48 ± 16.7years (58% males). The median duration of diarrhea was 5.5months (interquartile range [IQR] 3.5, 11). Inflammatory bowel disease (IBD) accounted for 45% of the cases making it the predominant cause for organic diarrhea. GI infections and adult-onset celiac disease accounted for 18% and 9% of the cases, respectively. Pancreatic disease, benign or neoplastic, accounted for 6% of the total cases. Notably, gastrointestinal (GI) malignancies manifesting as chronic non-bloody diarrhea were diagnosed in 5% of the patients. Our data suggests a paradigm shift in the etiological spectrum of chronic organic non-bloody diarrhea in India with the emergence of IBD as the predominant cause displacing GI infections.

Clinical, Microbiological Profile and Antibiotics Use in Admitted Patients of Urinary Tract Infection

Urinary tract infections (UTI) can vary from simple cystitis to pyelonephritis with severe sepsis. The objective of this study is to provide information about the clinical and microbiological profile of admitted patients of urinary tract infection, patterns of organisms isolated, antibiotic sensitivity pattern and antibiotics use. It was a prospective observational study conducted on 40 patients age >14 years admitted with diagnosis of UTI based on clinical and microbiological criteria over 8 months at a tertiary care hospital in North India. Data was collected for the clinical, microbiological profile, empirical and definite antibiotics use with duration of stay and outcome of patients. Among 40 cases of UTI; male to female ratio was 1:1 with mean age of 51.3± 16.32 years. Fever was present in almost all (97.5%) of the patients and three-fourth (75%) of them had dysuria. Type-2 Diabetes Mellitus was most common (55%) underlying condition and mean HbA1c was 9.37±2.27 followed by obstructive uropathy (17.50%). Most of cases (82.5%) were of complicated UTI; where Pyelonephritis was 42%, Emphysematous Pyelonephritis 12.5% and Renal Abscess 7.5%. Most common (37.5%) organism isolated from urine/ pus culture was Escherichia coli. More than half of the patients (55%) were given empirical antibiotics injection piperacillin tazobactam and carbapenems was used in more than one third (35%) of patients. The mean duration of antibiotics use was 14.55±4.94 days. Two (5.0%) patients expired out during the study period. Uncontrolled Diabetes Mellitus remains the major underlying condition in cases of complicated UTI. E coli is the most common organism isolated from urine/ pus culture. Most of the patients had favourable outcome with guided antibiotics and interventions. Bangladesh Med J. 2023 May; 52(2): 15-19

Effect of laparoscopic cholecystectomy on 25-hydroxyvitamin D levels and bone mineral density in post menopausal women

Background Laparoscopic cholecystectomy (LC) is the gold standard management for benign gallbladder diseases. It has been observed that there is alteration in vitamin D levels and bone mineral density after cholecystectomy due to altered enterohepatic circulation. With increase in average age expectancy of the population, low levels of vitamin D levels and osteoporosis after cholecystectomies might cause increased health care burden. Methods A prospective observational study was planned between 1 January 2022 and 30 June 2023 in the Department of General Surgery at PGIMER Chandigarh, a tertiary care hospital in north India. One hundred and three post-menopausal women who underwent LC and met the inclusion and exclusion criteria were included in the study. All participants underwent estimation of vitamin D and bone mineral density preoperatively and third-post operative month (POM). Results The mean age of the patients was 58.46 ± 7.44. Pain abdomen was present in 68(66%) patients, 18 had epigastric discomfort and 17 had dyspepsia. The mean levels of vitamin D decreased from 21.92 at the baseline to 20.12 at third POM (p < .001). There was a significant change in t score Femoral Neck (−1.12 vs −1.15, p < .001) and Lumbar spine L1–L4 − 1.98 vs −1.98 (p = .033). z-scores of the femoral neck were −0.34 vs −0.54 (p < .001) and of lumbar spine L1–L4 were −0.95 vs 1.02 (p < .001). The decrease in fracture risk for the femoral neck (p = .344) and the lumbar spine (p = .223) was not statistically significant. Conclusion There is a significant decrease in vitamin D and BMD levels after LC in post-menopausal females.

Hepatitis B: A Pilot study on awareness and attitude among staff nurses and students of a teaching hospital in India.

Hepatitis B is a serious public health concern and health care professionals especially nurses are at higher risk of acquiring this infection. Basic knowledge, awareness and a positive attitude are required to prevent this disease. The present pilot study was conducted to assess awareness and attitude regarding hepatitis B among staff nurses and nursing students of a teaching hospital in north India. A total of 205 subjects who gave consent to participate were included in this descriptive study. A self-structured pre-tested close ended questionnaire comprising of two parts was used to collect information from the study subjects. First part collected information on demographic details of the study subject and second part assessed subjects' awareness and attitude on various aspects of hepatitis B infection including vaccination. Chi-square test and multiple linear regression analysis was used for statistical analysis. The mean age of the study subjects was 25.8±5.6 years. Awareness regarding HBV infection was present among 92.6% (190) of subjects. Long-term effects of hepatitis B were known to 58.4% (119) of subjects and 79.1% (162) of subjects reported taking universal precautions. Half of the subjects (105), were getting regularly tested for hepatitis B antigen.The odds of getting regularly tested for hepatitis B antigen were 3.26 times greater in female subjects and 3.45 times greater in subjects who were GNMs. Low awareness levels were reported regarding some important aspects of hepatitis B among study subjects though more than 90% were aware of it. There is an urgent need for education and training programs for nurses designed to increase their knowledge about HBV infection.

Patterns, outcomes, and preventability of clinically manifest drug-drug interactions in older outpatients: a subgroup analysis from a 6-year-long observational study in North India.

Older adults are vulnerable to adverse drug reactions (ADRs) and drug-drug interactions (DDIs). Evidence on clinically manifest DDIs in older outpatients is scanty. The present study aims to report clinically manifest DDIs, their risk factors, and preventive measures. A subgroup analysis of a 6-year (2015-2021) long prospective study was conducted in a tertiary hospital in North India. Older outpatients with ADRs constituted the study participants. Among 933 ADRs reported in 10,400 patient registrations, clinically manifest DDIs were involved in 199 (21.3%). DDIs accounted for 29.9%, 26.5%, and 21.3% of drug-related metabolic, vascular, and nervous system disorders, respectively. Movement disorders (n = 18), hypotension (n = 16), and hypoglycemia (n = 15) were the most common manifestations. Eighty-six percent of DDIs were of the pharmacodynamic type, and 13.1% were immune-mediated. Around 35% of DDIs resulted in hospitalization, with hyponatremia, movement disorder, and renal impairment as the common reasons. Older adults with Parkinsonism, infection, coronary artery disease, neuropsychiatric disease, and diabetes mellitus, respectively, had 3.28, 2.85, 1.97, 1.76, and 1.80 times higher odds of DDIs. Those receiving ≥ 10 drugs had 5.31 times higher odds of DDIs compared to individuals receiving 1-4 drugs. "Avoiding the causative drug," "optimal monitoring of the patient," and "start-low and go-slow" policy together could prevent 85% of DDIs. In conclusion,every fifth case of ADRs and nearly one third of ADR-related hospitalizations in older adults are related to DDIs. Movement disorder, hypotension, and hypoglycemia are the common manifestations. A holistic approach with drug omission, optimal patient monitoring, and slow titration of therapy can prevent significant DDIs in older adults.

Hormonal harmony disrupted: hypothyroidism and diabetes mellitus in interstitial lung disease. An observational study.

Interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD) are chronic respiratory diseases that affect the lungs and airways. ILD encompasses approximately 200 different conditions with known and unknown causes. Various comorbidities, such as cardiovascular, psychological, obstructive sleep apnea, and gastrointestinal disorders, are often associated with them. However, little is known about the relationship and prevalence of hypothyroidism and diabetes mellitus (DM) in ILD and COPD. Therefore, understanding these connections is crucial for proper treatment. This cross-sectional, prospective observational study was conducted at a tertiary care hospital in North India. After obtaining informed consent, we consecutively enrolled 100 patients with ILD and 100 patients with COPD who reported to the Respiratory Medicine Outpatient Department. We collected demographic, clinical, and medical data from the patients and conducted appropriate statistical analysis to determine the prevalence of hypothyroidism and DM in patients with ILD. ILD patients exhibit a significantly higher prevalence of hypothyroidism (24% versus 4%) and DM (24% versus 4%) compared to those with COPD (p<0.05). Additionally, the study showed that ILD patients also had a significantly higher prevalence of self-reported gastroesophageal reflux disease (30%), had a higher body mass index, and consulted a pulmonologist earlier than COPD patients after the onset of symptoms (p<0.05). Therefore, it is important to screen for hypothyroidism and DM in ILD patients due to their high prevalence and potential impact on disease progression and management. Additionally, evidence suggests a bidirectional relationship between these conditions, making it essential to screen patients with hypothyroidism and DM for ILD if there is any suspicion. These screening measures could contribute to the early detection and management of these comorbidities, thereby improving the overall outcome for ILD patients.

Burden of Chronic Kidney Disease of Undetermined Aetiology (CKDu) in a Tertiary Care Public Hospital in North India.

Chronic kidney disease of undetermined aetiology (CKDu) is an important public health problem. Indian data are mostly based on studies from rural regions in south and east India. We examined the burden and profile of CKDu in patients attending a tertiary care hospital in north India. We assessed records of consecutive new CKD patients registered in a nephrology clinic from January 2015 to June 2022. Patients were classified as having CKDu based on predefined inclusion and exclusion criteria. Clinical and laboratory parameters at presentation and kidney biopsy when done were noted. Records of 32,369 patients with CKD were screened, and 29,663 were included (2,706 excluded due to inadequate data). A total of 370 (1.2%) patients were categorized as CKDu. Mean age was 41 ± 14.7 years, 58.1% being male. Of them, 158 (42.7%) patients were in CKD stage 3, 89 (24.1%) in stage 4, 84 (22.7%) in stage 5, and 39 (10.5%) were dialysis dependent at presentation; 232 (62.7%) patients had proteinuria &lt;0.5 gm/day and 138 (37.3%) between 0.5 and 1 gm/day. Renal histology was available for 65 CKDu patients: 62 had chronic tubulointerstitial nephritis (CTIN) and 3 had non-specific changes. When defined using strict criteria with intensive diagnostic workup, burden of CKDu is low in our hospital-based cohort of CKD patients. CTIN is the predominant histopathological finding in kidney biopsy.

Incidence of and risk factors for small vulnerable newborns in north India: a secondary analysis of a prospective pregnancy cohort

Globally, recent estimates have shown there have been 3·6 million stillbirths and neonatal deaths in 2022, with nearly 60% occurring in low-income and middle-income countries. The Small Vulnerable Newborn Consortium has proposed a framework combining preterm birth (<37 weeks of gestation), small for gestational age (SGA) by INTERGROWTH-21st standard, and low birthweight (<2500 g) under the category small vulnerable newborns (SVN). Reliable data on SVN from sub-Saharan Africa, central Asia, and south Asia are sparse. We aimed to estimate the incidence of SVN and its types, and quantify risk factors, both overall and trimester-specific, from a pregnancy cohort in north India. In the GARBH-Ini (Interdisciplinary Group for Advanced Research on Birth Outcomes-DBT India Initiative) pregnancy cohort, 8000 participants were enrolled with less than 20 weeks' gestation between May 11, 2015, and Aug 8, 2020, at a secondary-care hospital in north India. The cohort was followed up across the antenatal period for a detailed study on preterm birth. We conducted a secondary analysis of cohort data for the outcome of SVN, classified into its types: preterm-SGA, preterm-nonSGA, and term-SGA. We estimated the relative risk and population attributable fraction of candidate risk factors for SVN (modified Poisson regression) and its types (multinomial regression). 7183 (89·9%) of 7990 participants completed the study. Among 6206 newborns included for analysis, the incidence of SVN was 48·4% (35·1% term-SGA newborns [n=2179], 9·7% preterm-nonSGA newborns [n=605], and 3·6% preterm-SGA newborns [n=222]). Compared with term-nonSGA newborns, proportions of stillbirths and neonatal deaths within 72 h of birth among SVN were three times and 2·5 times higher, respectively. Preterm-SGA newborns had the highest incidence of stillbirth (15 [6·8%] of 222) and neonatal deaths (six [4·2%] of 142). Low body-mass index (BMI <18·5 kg/m2) of participants at the start of pregnancy was associated with higher risk for preterm-SGA (adjusted relative risk [RR] 1·61 [95% CI 1·17-2·22]), preterm-nonSGA (1·35 [1·09-1·68]), and term-SGA (1·44 [1·27- 1·64]), with population attributable fraction ranging from 8·7% to 13·8%. Pre-eclampsia (adjusted RR 1·48 [95% CI 1·30-1·71]), short cervical length (1·15 [1·04-1·26]), and bacterial vaginosis (1·13 [0·88-1·45]) were other important antenatal risk factors. In a comprehensive analysis of SVN and its types from north India, we identified risk factors to guide prioritisation of interventions. Complemented with risk-stratification tools, this focused approach will enhance antenatal care, and accelerate achievement of Sustainable Development Goals-namely, to end preventable deaths of newborns and children younger than 5 years by 2030 (target 3·2). Department of Biotechnology, Government of India and Grand Challenges India-Biotechnology Industry Research Assistance Council, Government of India. For the Hindi translation of the abstract see Supplementary Materials section.

Imatinib Mesylate Causes Potential Cardiac Dysfunction in Patients With Chronic Myeloid Leukemia: the Results of a Case-control Study.

Unlike second-generation tyrosine kinase inhibitors, effects of imatinib on the cardiovascular (CV) system are debatable. The current case-control study aimed to evaluate the CV effects of imatinib in patients with chronic myeloid leukemia (CML) using non-invasive 2D-echocardiography testing. Patients with CML ≥ 13 years attending the adult haematology clinic of a tertiary care hospital in north India were prospectively enrolled over 1.5 years. The study population (n = 110) consisted of 35 newly diagnosed patients (treatment-naïve group) and 75 patients under imatinib therapy ≥ 1 year (treated group). All the eligible patients were subjected to 2D-echocardiography to calculate pulmonary artery systolic pressure (PASP), left ventricular ejection fraction (LVEF) and deceleration time (DT). These parameters were compared between the two groups. P-value < 0.05 was considered statistically significant. The median age of study population was 40 years (range, 13-73) and M:F ratio was 1.14:1. Both the groups had similar demographics at the diagnosis including CV risk factors. The median PASP of the treated group was 2 mm Hg higher than the treatment-naïve group (25 vs 23 mm Hg, p-value = 0.919). The median LVEF of the treated group was 3.2% lower than the treatment-naïve group (58.5% vs 61.72%, p-value = 0.577). The median DT of the treated group was 7 ms shorter than treatment-naïve group (211 vs 204 ms, p-value = 0.411). Imatinib causes potential cardiac dysfunction in patients with CML. Large scale prospective follow-up trials in the same cohort of patients are needed to validate the findings of our study.

Assessment of safety and adverse events following COVID-19 vaccination and their predictors in first 30 days among healthcare workers of a tertiary care teaching hospital in North India

BackgroundThe COVID-19 vaccines were rolled out as an emergency measure, with an expedited approval to contain the pandemic. The objective of this study was to assess the incidence, pattern and severity of AEFIs reported following COVID-19 vaccination and their predictors among the healthcare workers. Materials and methodsA prospective cohort study enrolling healthcare workers of a tertiary care Institute in North India receiving COVISHIELD™ from February to May 2021 was carried out to assess the incidence, pattern and severity of AEFI over the next 30 days. Both active and passive surveillance methods were used for AEFI recording. Bivariate analysis was performed to ascertain the predictors of AEFIs. ResultsA total of 836 healthcare workers who received the first dose of COVISHIELD™ were included in the study of which 201 (24.0 %) experienced one or more AEFIs. Majority of AEFIs were of minor grade (99.8 %) and resolved spontaneously. Majority (96.0 %) had onset of the AEFIs within 48 hrs of vaccination. Serious AEFIs, leading to hospitalization was noticed in 2(0.2 %) participants, both females, with suspicion of immunization stress related response (ISRR). Both of them recovered without any sequelae. No deaths were recorded. Factors found to be significantly associated with the occurrence of AEFIs in the participants were female gender (p = 0.02), monthly income > 20,000 INR (p = 0.007), presence of any chronic illness (p < 0.0001), history of allergic reaction to any drug/vaccine (p = 0.01), history of COVID-19 infection (p < 0.00002) and history of hospitalization due to COVID-19 (p < 0.0002). ConclusionMajority of the AEFIs observed were of minor grade with spontaneous resolution of the symptoms indicating safety and well tolerability of the vaccine. Female gender, higher income, history of allergy and co-morbidities, history of COVID-19 infection and history of hospitalization were found to be major predictors for the development of adverse events and require more watchful vaccination.

A Comparative Study of Community-acquired Acute Kidney Injury and Hospital-acquired Acute Kidney Injury from a Tertiary Care Hospital in North India.

In this observational study, clinical characteristics, etiologies, and outcomes of patients admitted to the hospital with community-acquired acute kidney injury (CAAKI) have been compared in contrast to those who hospital-acquired Acute Kidney Injury (HAAKI). This was a prospective study of adults aged 18 years or above diagnosed with acute kidney injury (AKI) over a period of 17 months at a tertiary care hospital. 230 patients had AKI with the mean age of the study population being 45.33 ± 12.68 years. 178 (77.4%) patients were enrolled from medical unit, 25 (10.7%) from surgical unit, and 27 (11.7%) from obstetrical unit. The observed incidence of AKI was 15/1000 admissions. About 58.2% had CAAKI and 96 (43.7%) had HAAKI. Out of 230 patients, 170 (73.9%) patients were male and 60 (26.1%) were female. Sepsis was the most common (52.1%) etiology of AKI among the medical cases. Urosepsis, scrub typhus, and pneumonia were the most common causes of AKI. Sixty percent of AKI was Kidney Disease Improving Global Outcomes Stage 1 or 2 and 40% was in Stage 3. Oliguria was seen in 56.5%, hyperkalemia in 34.7%, fluid overload in 6.1%, and metabolic acidosis in 22.6%. The majority of patients had multiple organ involvement (52.1%) at the time of enrollment. About 116 (50.4%) had lung injury requiring mechanical ventilation and 95 (41.3%) were on inotropes. Mortality occurred in 19.5%. Anemia, the use of vasopressor drugs, and the need for intensive care support were independent predictive factors for mortality. AKI was common in hospitalized patients and leads to significant inhospital mortality. AKI is largely a CAAKI, and the lesser extent is due to HAAKI. Many causes are potentially preventable. Early fluid resuscitation, effective antibiotics, appropriate antidotes, and timely referral of established AKI patients to centers with dialysis facilities can improve AKI outcomes.

Clinical Spectrum of Atopic Dermatitis in Pediatric Age Group from a Tertiary Care Center in India: A Cross-sectional Study

Introduction: Atopic dermatitis (AD) is a chronic, inflammatory, relapsing skin disorder with early age of onset in infancy and early childhood. A gradual increase in the prevalence of AD has been observed recently, especially in low-income countries like ours. Objective: We aimed to study the epidemiology and clinical profile of AD among pediatric age group in a tertiary care hospital in North India. Materials and Methods: A hospital-based cross-sectional study was conducted over 1 year in the department of dermatology and sexually transmitted diseases in a tertiary care center in India. All children diagnosed with AD, aged 0–18 years, were recruited, and their clinical and demographic data were recorded. Results: In the 62 children having AD, the mean age was 7.7 ± 6.3 years. Majority of children belonged to the age group of 1–5 years. The mean age of onset of AD was 2.3 ± 2.2 years. A personal history of atopy was present in 53.2% of children, whereas 48.3% of children had a family history of atopy. Acute AD was the most common clinical type that was noted in 43.5%. Hyperlinearity of palms, keratosis pilaris, pityriasis alba, and periorbital darkening were found in 59.6%, 33.8%, 24.1%, and 29% of children, respectively. Conclusion: The prevalence of AD is low in developing countries like India, but it is slowly rising due to rapidly evolving urbanization and environmental changes. Disease manifestation is usually mild to moderate in Indian patients; hence, vigilant eyes and high clinical suspicion are required for accurate diagnosis and efficient management of AD in Indian settings.

Antibiotic Susceptibility and Genetic Diversity of Helicobacter pylori from a Tertiary Care Hospital in North India

Antibiotic Susceptibility and Genetic Diversity of Helicobacter pylori from a Tertiary Care Hospital in North India

Socio-demographic and behavioural profile of HIV positive patients visiting ICTC at a tertiary care hospital in North India

Socio-demographic and behavioural profile of HIV positive patients visiting ICTC at a tertiary care hospital in North India

Assessment of the Efficacy of an Automated AMBU Bag Operating Device (RC Device) in Patients Requiring Mechanical Ventilation: A Pilot Study

Abstract Background Providing efficient mechanical ventilation using artificial manual breathing unit is a tiring and laborious task for healthcare providers. The current pilot study was planned to assess the efficacy of an automated artificial mechanical breathing unit (respiration control [RC] device) in patients requiring mechanical ventilation in a tertiary care hospital in North India. RC device is an automated bag valve mask ventilator developed in collaboration with Gyrodrive Machineries (P) Ltd. India and Postgraduate Institute of Medical Education and Research, Chandigarh. Materials and Methods Ten adult patients from the emergency and trauma section requiring mechanical ventilation who were unable to obtain ventilators in the intensive care unit were enrolled in the study. The vital parameters of the patients and the respiratory parameters from arterial blood gas were recorded at given time periods. Results All 10 patients recruited in the study were ventilated using the RC device for at least 24 hours. The mean age of the patients was 32.3 ± 4.3 years. The mean Glasgow coma scale was 7.2 ± 2.0 (range: 3–10). The heart rate, systolic blood pressure, and diastolic blood pressure remained within normal limits. There were no episodes of desaturation in any of the patients. The patients' care provider rated their satisfaction with the device as excellent in two patients and good in eight patients. Conclusion RC device has shown a promising result in providing satisfactory care among trauma patients and may be used in providing routine mechanical ventilation among these patients.

Comparison of Dialysis Catheter Insertion and Complications Under Ultrasound Guidance with or without Fluoroscopic Assistance: A Randomized Study.

Fluoroscopy is considered to be the gold standard and an essential requirement for catheter insertion. However, there is a paucity of data regarding the outcomes in ultrasound (USG)-guided insertion with and without fluoroscopy. We compared the complications of USG-guided tunneled dialysis catheter (TDC) insertion with and without fluoroscopy assistance. This was a single-center randomized controlled trial (RCT) done in a tertiary hospital in North India. After screening 153 patients, 149 were enrolled: 87 were randomized into USG-guided insertion without fluoroscopy (group A) and 62 were randomized into USG-guided insertion with fluoroscopy (group B). All insertions were done in a dedicated procedure room by trained nephrologists. Outcomes were analyzed at baseline and at 1-month follow-up. Mechanical complications as well as infective and thrombotic complications were compared between both the groups. TDC insertion was successful (100%) in all the study participants (N = 149). One hundred twenty-nine catheters (86.5%) were inserted in the first attempt, 19 (12.5%) in the second attempt, and one catheter insertion required three attempts for insertion. The mean age of study participants was 43 years (±16.5), and males constituted 63% of the study cohort. Baseline laboratory characteristics of the two groups were comparable. The mean time of catheter insertion was 41.26 min (standard deviation [SD] 11.8) in group A and 47.74 min (SD 17.2) in group B (P = 0.007). The mean score of ease of catheter insertion, exit site bleed, infective and mechanical complications were not different between the two groups. Our study concluded that fluoroscopy has no additional advantage in reducing mechanical, infective, or thrombotic complications. In experienced hands, USG-guided TDC insertion without fluoroscopy assistance is as good as the insertion done with fluoroscopy assistance, with a shorter procedure time.

Characteristics of Patients Attending the Child and Adolescent Psychiatric Outpatient Clinic of a Tertiary Care Hospital in North India

Background: The psychiatric morbidity profile of children and adolescents is very different from that of adults. Failure of early identification and timely intervention of psychiatric disorders adversely affects the developmental trajectory of children to becoming a healthy adult. Objectives: To study the clinico-demographic profile of patients attending the child &amp; adolescent psychiatric OPD and to estimate the frequency of various psychiatric disorders among them. Methodology: In this retrospective file review study, all patients attending the child and adolescent psychiatry clinic of a tertiary care hospital between Jan 2018- June 2022 were taken. Data collection was done using a semi-structured proforma and ICD-10 was used to make psychiatric diagnoses. Statistical analysis was done by using SPSS 16 (Version 25.0). Results: The total number of cases visiting child psychiatry OPD during the study period was 1199 with an average of 240 cases per year. The mean age was found to be 12 years, with gender distribution revealing male preponderance (58.4%). Around 64% of the participants were 63.8%) were in the age range 10 to 15 years. Most subjects (59.4%) were Hindu by religion and hailed from urban areas (52.4%). Epilepsy (23.9%) was the most prevalent psychiatric disorder, followed by intellectual disability (16.8%), anxiety disorder (14.1%), hyperkinetic and conduct disorder (8.8%), and schizophrenia &amp; other psychotic disorders (10.3%). Conclusion: This study is one of the few ones conducted in a tertiary care hospital in North India. Children in poor nations receive less mental health and psychiatric care than adults do. Our research indicates that Indian clinics may need to improve their offerings for conditions like depression, specific learning disorders, communication disorders, and hyperkinetic disorders. The study also emphasizes the need for more child psychologists special educators, and strengthened counseling services in schools