Outcome In Tertiary Care Hospital Research Articles

Fighting XDR Typhoid: A Hospital Based Study on Clinical Aspects and Treatment Outcome in Tertiary Care Hospital

Objective: The main aim of this study is to find Clinical Aspects and Treatment Outcome in drug resistant Typhoid. Methodology: Total 120 patients participated in this study. Individuals who received a diagnosis of XDR S.Typhi through a blood culture test were identified from the registry of both healthcare facilities. The medical data of patients suffering from typhoid fever who received treatment as either a hospital inpatient or outpatient between April 1, 2022, and June 30, 2022, were examined for the purpose of screening for inclusion in this investigation. Only typhoid patients who tested positive for S.Typhi in a test to culture blood and the manifestation of insusceptibility to the five classifications of antimicrobials (ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, fluoroquinolone, and 3rd generation cephalosporin (ceftriaxone or cefixime) were examined for potential incorporation in this inquiry. Results: Among the 120 cases of XDR Typhoid, n= 35 (29.16%) were managed exclusively with azithromycin, while 40 (33.33%) were solely administered meropenem. The remaining 45(37.5%) received a combination of both azithromycin and meropenem. Two patients could not recover after receiving Azithromycin. Full recovery seen in Meropenem. Four patients couldn’t recover from combination therapy. Conclusion: Escalating antibiotic resistance in Salmonella enterica has rendered it a complex ailment to address. Measures ought to be implemented to enhance antibiotic prescription protocols and establish consistent recommendations for the management of highly resistant strains of Salmonella enterica.

Incidence of cervical spine injuries in paediatric patients and their outcome in tertiary care hospital

Objective: The incidence of mortality after cervical trauma in the pediatric population is very high. The purpose of this study was to determine the treatment given, morbidity and mortality of patients with cervical spine injuries, and their outcome after 6 months of management which includes both surgical and conservative treatment. Materials & Methods: A prospective study was conducted at Lady Reading Hospital, Peshawar with a total number of patients n = 187 included in our study. Patients were stratified according to their age, mortality, mechanism of injury (fall, motor vehicle accident, bicycle injuries, &sports-related injuries), level of cervical spine injury, presence of neurologic deficit, presence of bony injury (fractures, &dislocations), ligamentous injuries & SCIWORA. The primary outcome was the functional status at 6 months following treatment. Results: There were 78 females and 109 males. In comparison to the lower cervical spine (C3 – C7), which was involved in 86 patients (46%), the higher cervical spine level (C0 – C2) was involved in 101 patients (or 54%). The most frequent cause of cervical spine injuries in the older age range was a history of a fall, followed by a motor vehicle accident. Among the treatment groups, mortality was highest in patients who underwent surgery. Conclusion: Younger age groups, higher cervical spine levels, and mechanisms of injury such as high energy impact trauma were independent risk factors for increased mortality. Compared to incomplete neurological abnormalities, a complete neurological disability increases mortality.

A Study on Maternal Near Miss: The Submerged Iceberg, in a Tertiary Care Hospital of Central India

AbstractBackground: Maternal near miss is defined as “a woman who nearly died but survived a complication thatoccurred during pregnancy, childbirth or within 42 days of termination of pregnancy”. It shows the quality ofobstetric care of any country or society.Objective: To estimate the proportion of severe maternal morbidity /near miss and its maternal characteristic andperinatal outcomes in tertiary care hospital of central India.Methods: The present study was carried out at department of obstetrics and Gynecology at Sultania Zananahospital (SZH) Bhopal for 6 months. A validated semi-structured questionnaire was used to collect the informationregarding social demographic profile, ANC history and chief complaints was taken from the relatives i.e. eithermother in law or husband. Subsequent information was taken from the mother as she got well and finally gotdischarge.Results: majority of the mothers belonged to the age group 18-25% i.e. 58.73%.Around 55.5% of the near missmothers belonged to rural background. maternal near miss ratio 10.16 / 1000 live birth,the ratio of maternal deathto maternal near miss event was 1: 2.17. Hemorrhage and hypertension are the leading causes with 47.61 % and28.57% respectively. Preterm birth and still birth were more common in maternal near miss cases as compared togeneral obstetric admission.Conclusion: Achieving sustainable development goal for maternal mortality is still a far cry. As there is a huge gapof near miss cases to maternal death ratio of present study and ratios of developed countries.

SURFACTANT THERAPY IN MECONIUM ASPIRATION SYNDROME AND ITS OUTCOME IN TERTIARY CARE HOSPITAL

Aims: To study the role of surfactant therapy in meconium aspiration syndrome and its outcome in tertiary care hospital. Objectives: To evaluate the efcacy of surfactant in the treatment of term and near term infants with meconium aspiration syndrome and their outcome in terms of duration and outcome of ventilation, duration of oxygen requirement,complications associated with meconium aspiration syndrome. Material and methods: 64 neonates admitted in NICU, King George Hospital, Visakhapatnam with symptoms of MAS were enrolled in the study, of them 32 were given surfactant and were taken as cases,32 were not given surfactant and enrolled as controls. Data on APGAR, need for resuscitation, baby weight, gestational age and laboratory prole were recorded. Those babies with downe's score >7 were given high dose(4ml/kg) of surfactant and were followed up. Results: There was a rapid fall in oxygenation index in 24hrs after administration of surfactant and improvement in PaO2/PAO2. In surfactant group mean duration of ventilation, oxygen supplementation after extubation and length of hospital stay were all signicantly low as compared to control groups. Conclusion: Surfactant administration improved PaO2/PAO2 signicantly in comparison to the control group with in 24 hours after delivery, indicating that surfactant aids in improving gaseous exchange at the alveolar capillary barrier in lungs.

Determinants of immediate adverse pregnancy outcomes: A hospital based study

Adverse pregnancy outcomes are a major public health problem which can lead to serious short and long- term health effect to the mother and the newborn. Hence, the objective of this study is to find out the determinants of immediate adverse pregnancy outcomes in tertiary care hospital in South India. The study comprised of antenatal mothers admitted for delivery in selected tertiary care hospital in Belgaum, Karnataka, India from 10th November, 2021 to 20th January 2022. All registered deliveries in the study period have been included, comprises of 101. Bivariate logistic regression was used to determine the factors associated with outcome variables. A significance level of 5% was used to decide the significance of statistical tests. The mean age in years (± SD) of the mother was 24.6 (± 3.9). The average cost invested for a family health check-up in a year was Rupees 18,099. The average birth weight of the newborn was 2.7 kg, while the minimum weight of the newborn was 1.4 kg, and the maximum weight was 3.8 kg. The average week of gestation for the first-time with respect to antenatal care visit of pregnant women was 9.6 weeks. The average weight of the women was 47.6 kg during first antenatal care visit and 61.5 kg during last antenatal care visit. Adverse outcomes reported were post-partum hemorrhage was 7.9%, low birth weight 26.7%, preterm delivery 28.7%, anemia 53.5%, neonatal physiological and jaundice 15.8%. However, use of mode of transportation during antenatal care visit was found to be significant factor for preterm delivery. Every fourth baby was low birth weight, and every fourth women have preterm delivery and every second woman was anemic. Socioeconomic, demographic and chronic illness was associated with immediate adverse pregnancy outcomes.

Pattern of Admission, Management and In hospital Outcome of ACS Patients during COVID-19 pandemic - A study in Tertiary Care hospital

Aim: This study aimed to evaluate the impact of coronavirus disease2019(Covid-19) outbreak on admissions for acute coronary syndrome (ACS) and related mortality, severity of presentation, major cardiac complications, and outcome in tertiary care hospital (NICVD). Method: This is a cross sectional observational study on ACS admitted patients during the 1st and 2nd phase of COVID-19 from 1st June to 31st August in the year 2020 and 2021 who were COVID negative (RT PCR). Using a control of ACS admitted patients during corresponding period of year 2019 from registry. Results: During the 1st phase of COVID (July to August 2020) 736 ACS patients were enrolled where as during 2nd phase (July to August 2021) 722 ACS patients were enrolled. Mean age were 52±8 vs 53±11 years. Demographic variables such as age, sex and risk factors are almost identical in all groups. Our study showed 46% decline in admission in ACS patients comparing same period of 2019. Though some inclination in 2021 still it showed 13% decline in ACS patient admission in comparison to 2019. There was substantial increase in percentage of patient suffering from STEMI in 2020(42% vs66% vs46%). Short time in hospital complications were more pronounced in 2020. During the study period average death rate was higher than the year 2019 (8.6% vs 5.8%). There was significant decline in numbers of interventions(CAG and PCI) for CAD during first phase of Covid which raised during second phase(429 vs 2151). Total number of interventions done of 1884 patients in 2019 whereas 2151 patients were undergone in the year 2021. Conclusion: The Covid-19 outbreak affects hospital admission for acute coronary syndrome. During the first phase of the pandemic, significantly less patients with ACS admitted, but those admitted presented with a higher mortality, more complications and a worse short time outcome. Therefore ,our data indicate that Covid- 19 had relevant impact on non-infectious disease status, such as acute coronary syndrome. Bangladesh Heart Journal 2022; 37(1): 65-71

Study of salivary gland tumors and its management outcome in tertiary care hospital in Chennai

Background: Salivary gland tumors can arise from either the major salivary glands (parotid, submandibular and sublingual) or the minor salivary glands which are located throughout the submucosa of the upper aerodigestive tract. They can show a striking range of morphological diversity between different tumor types and sometimes within an individual tumor mass. Aim of the study was to study the role of fine needle aspiration cytology (FNAC) in the diagnosis of salivary gland tumors.Methods: This study was conducted comprising 34 patients attending the department of general surgery at Rajiv Gandhi government general hospital, MMC from January 2019 to December 2020 period of 24 months. A standard protocol was followed consisting of detailed history and physical examination, radiological evaluation followed by fine needle cytological examination. Histopathological examination was done in all the excised tumors for final diagnosis.Results: FNAC was done only in 20 out of 29 parotid tumors of which 12 were benign, 5 were malignant and 3 were inconclusive. In the present study superficial parotidectomy was done in 24 cases. Total parotidectomy was done in 3 out of 5 cases. Two patients refused surgery. Following surgery, 5 patients developed transient facial nerve paralysis and one patient developed permanent facial nerve paralysisConclusions: In tumors of the parotid gland, post-operative facial nerve palsy was rarely noticed. The best means of reducing iatrogenic facial nerve injury in parotid surgery remains an understanding of the anatomy coupled with a gentle technique.

Audit of Neonatal Outcome in Tertiary Care Hospital.

Background: Every year, 2.7 million stillbirths occur worldwide, mostly in developing countries. The United Nations Sustainable Development Goals (SDGs) include reducing childhood mortality under five years of age. Perinatal death audit is an intervention to reduce preventable neonatal mortality. The aim of this study was to determine the Perinatal Mortality Rate (PMR) and the factors responsible for perinatal deaths at a Tertiary Care Hospital in Karachi-Pakistan.
 Methodology: This was a prospective study of all the stillbirths and early neonatal deaths in Abbasi Shaheed Hospital Karachi, Gynecology Unit I. Details of each perinatal death were filled in the standard form. We used Aberdeen Obstetric classification to classify causes of perinatal deaths.
 Results: There were 1627 deliveries and 43 perinatal deaths during the study period. Our study's perinatal mortality rate was 27.14/1000 births, and the stillbirth rate was 13.25/1000 births. Antepartum hemorrhage (APH), pregnancy-induced hypertension (PIH) and anemia were the common causes of perinatal deaths.
 Conclusion: Antepartum hemorrhage, pregnancy-induced hypertension and anemia are the leading causes of perinatal deaths. Most of these complications can be reduced by educating women and providing effective antenatal care.

Efficacy of bubble continous positive airway pressure in newborns with respiratory distress and its outcome in tertiary care hospital, Tirupathi

Background: Respiratory distress is one of the commonest emergency occurring mostly within the first 48-72 hours of life. Bubble continuous positive airway pressure (bCPAP) is essential to manage acute respiratory distress in neonates. Method: A Hospital based prospective observational study was done at SNCU at Department of Pediatrics, Sri Venkateswara Ramnarayan Ruia Government General Hospital, Tirupati from October 2017 to September 2018. Efficacy of bCPAP was judged based on Downe /SAS scoring. Results: Out of 171 babies who were managed with bCPAP, it proved effective in 118 babies (69%). The results analyzed based on gender and gestational age were found statistically significant difference (p 0.05). The mean age for initiation of treatment is 9.39±15.022 hours. Overall Mean duration on bCPAP was 24.24±18.22. The success rate was more in babies with RDS 68.2%. There was a significant improvement in Downe/SAS scores in babies with RDS, Pneumonia, MAS and TTNB. The complications were more in failure group. Study of mortality rate was more in the failure group 81%and the survival rate was more in success group 100%. Conclusion: CPAP appears to be the best option to manage infants with respiratory distress at SNCUs of peripheral levels.

Prevalence of diphtheria in a tertiary care hospital of Western part of India – A clinicoepidemiological study

Background: Diphtheria, a very common vaccine-preventable disease, is still persistent in India without much decline in the past decade. Objective: The objective of this study was to study the clinicoepidemiological profile of diphtheria in children up to 12 years of age, their outcome in tertiary care hospital of Western Gujarat. Materials and Methods: This prospective observational study was conducted among 164 children admitted in the tertiary hospital of Western Gujarat, who were diagnosed with during the period of July 2016–August 2018. Results: It was observed that the highest prevalence of diphtheria was seen in the age group of 5–9 years. There was slight male preponderance with 1.5:1. The majority of patients were referred from rural areas. Immunization status was the most determining feature as 68 patients out of the study population were unimmunized at the time of admission. Conclusion: The rise in the prevalence in more advanced age group of 8–12 years might be due to waning immunity and emphasizes on the need for increasing primary immunization coverage along with both booster doses in areas having less adequate health-care facilities or poor access.

Effect of maternal height on neonatal outcomes in tertiary care hospital: a retrospective study

Background: Global or regional evidence showed maternal height as a strong predictor of child survival. However, there is limited information that confirms the intergenerational effect of short maternal height on the risk of offspring mortality in Bangladesh. Therefore, this study aimed to examine the association of maternal height with neonatal morbidity and outcome.Methods: In this analysis authors took data of 100 women who delivered in Kempegowda Hospital in the year 2018 including anthropometry of the mother at admission, anthropometry of the newborn, NICU admissions. Neonatal outcome was assessed by birth weight, anthropometry and NICU admissions against maternal stature which was stratified into 4 groups.Results: Comparison of mean birth weight, head circumference and length showed significant relation with maternal height (p<0.001).Conclusions: Findings should draw the attention of the programme and policymakers to focus on improving maternal nutrition for better offspring nutrition, health and survival.

Treatment outcome of tuberculosis patients under directly observed treatment short-course and factors affecting the outcome in tertiary care hospital

Background: Revised National Tuberculosis Control Programme (RNTCP) based on Directly Observed Treatment Short-course (DOTS) strategy has been made available in entire country by March 2006. Given high rate of unfavourable treatment outcomes reported in some provinces, there is a need to analyse outcomes and identify possible trends and associated risk factors that can help for improvement in RNTCP.Methods: After getting Institutional Ethics Committee (IEC) approval, total of 76 cases diagnosed and treated for Tuberculosis (TB) under Category I of RNTCP were recruited from January to March 2017. All patients were followed up for six months from date of initiating the treatment. The data was obtained from TB treatment register, by patient visit and regular follow-up. The information collected include age and gender of patient, category of treatment, date of treatment initiation, initial sputum conversion, outcome of treatment and date of outcome.Results: Out of total 76 patients, 64 (84.21%) were cured, 5 (6.57%) were lost to follow-up, 4 (5.26%) were failed to treat, 1 (1.32%) patient was died, 1 (1.32%) patient had completed treatment but status was unknown and 1 (1.32%) patient was not evaluated because of transfer. Overall treatment outcome of TB patients under DOTS was matching goal of RNTCP with cure rate of 84.21%.Conclusions: Efforts by DOT providers, adequate patient education, motivating ones in need can bring positive outcomes. In this region, DOTS center is at good working condition in terms of functionality as well as ethically. Gender, age group, residence and initial culture colony did not significantly affect treatment outcome.

A study to evaluate acute pancreatitis using modified CT severity index and correlating with clinical outcome in tertiary care hospital

A study to evaluate acute pancreatitis using modified CT severity index and correlating with clinical outcome in tertiary care hospital

Effects of Amniotic Fluid Index <5 cms on Perinatal Outcome in Tertiary Care Hospital

Effects of Amniotic Fluid Index <5 cms on Perinatal Outcome in Tertiary Care Hospital

Overview of Referred Obstetric Patients and Their Outcome in Tertiary Care Hospital

Overview of Referred Obstetric Patients and Their Outcome in Tertiary Care Hospital

Profound Hyponatremia: Prevalence, Underlying Disorders and Outcome in Tertiary Care Hospital

Profound Hyponatremia: Prevalence, Underlying Disorders and Outcome in Tertiary Care Hospital

Study on organophosphate poisoning analysis and pharmacotherapeutic outcome in tertiary care hospital

Background: Organophosphate (OP) poisoning is the most common cause of poisoning and suicides in rural India as it is easily available and more often used in agriculture as a pesticide. In the present days, death due to OP is mainly due to draught, scarcity of rains and debt. Methods: The main objective of the study was to know the sociodemographic patterns, mode of presentation and outcome of treatment in the OP poisoning case that were admitted and treated in the tertiary care hospital attached to SIMS Shimoga. The study was a retrospective which included 120 patients at the point. Results: It was found that OP poisoning was commoner in males than in females. The male: female ratio was 1.5:1. OP associated deaths were the more common in agriculture based socioeconomic group than others mainly due to easy accessibility. Muscarinic manifestations were the common presentation in most of the patients. It was found that in the majority of the cases atropine and pralidoxime were the commonly used antidotes and recover rate was 93%. Conclusion: Consumption of large doses of OP and delayed treatment due to late admission were associated with increased mortality. Awareness programs regarding safe use and strict policies governing the availability of OP will help in saving many lives due to OP poisoning.