Rural Care Hospital Research Articles

Ultrasound Diagnosed Disorders of Subacromial Shoulder Pain Patients: A Retrospective Study at a Tertiary Care Rural Hospital, Mewat, Haryana

Introduction: Shoulder pain is leading cause of disability and pain among musculoskeletal pain patients. Ultrasound is coming in a bigger way for diagnosis and management of subacromial pain due to its low cost, easy availability and accuracy in detecting soft tissues pathologies and for planning further treatment. Aim: To assess the role of diagnostic Ultrasound (US) in subacromial shoulder pathologies evaluation in shoulder pain patients. Materials and Methods: This was a retrospective observational study conducted on 98 patients who presented with subacromial shoulder pain. Diagnostic ultrasound examination was done and patients were categorised based upon underlying pathology and analysed in terms of frequency. Results: Most common ultrasound findings in subacromial shoulder pain patients were subacromial bursopathy 46 (46.93%) followed by Rotator cuff pathology including tear 38 (38.77%), mixed pathology 9 (9.18%) and Acromioclavicular (AC) joint pathology 5 (5.10%). Isolated biceps pathology was not seen in our study rather biceps pathology along with other tendon and joint involvement was observed. Conclusion: The findings in the present study imply that diagnostic ultrasound of shoulder pain patients helps to stratify them into different categories for better understanding of underlying pathology and targeted treatment approach. Ultrasound shall be used as an outpatient primary diagnostic modality for evaluation of subacromial shoulder pain patients.

Cost analyses of hospital admissions among the elderly seeking care at a rural tertiary care hospital, South India.

Introduction:In a developing country like India, a proportionately higher number of elderly people live in the rural areas and many of them are financially challenged. Hospitalization and consequent cost thereto pose a heavy burden especially for the elderly.Objective:Among elderly in.patients at a tertiary care rural hospital to estimate the average number of episodes of hospitalizations, duration of stay in the hospital, and the direct and indirect costs associated with hospitalizations with 1 year as a reference period.Materials and Methods:A structured pre.tested questionnaire was used to capture the details regarding hospitalizations and the costs involved and also the hospital records were verified for the current hospital admission to finally arrive at the direct and indirect costs calculations. Quantitative details like age, episodes of hospitalization in the last 1 year, duration of hospitalization, hospitalization costs, etc., were summarized as median (inter.quartile range [IQR]). Costing analyses were noted separately as direct, indirect, and total costs and expressed in Indian National Rupees (INR).Results:The total number of episodes of hospitalization among the 150 study participants was 204 with a mean of 1.36 episodes per person in 1-year duration. The average total cost per episode of hospitalization was found to be INR 11,249 while the average total cost per person per day was INR 1,670.30. The median (IQR) direct and indirect costs were INR 6,222 (3,060-12,670) and INR 690 (200-700), respectively.Conclusion:Duration, as well as cost of hospitalization, has been found to be more among females in most age groups among elderly in.patients.

Study of serum nitric oxide (no) in type 2 diabetes mellitus patients having normoalbuminuria and microalbuminuria in Central India

Introduction: Nitric oxide (NO) is known as a mediator in a broad cluster of biological systems. NO is the endothelium-derived relaxing factor, which causes vasodilation by relaxing vascular smooth muscle. This role of NO plays an important role of diabetic nephropathy in Type 2 Diabetes Mellitus (DM) Aims: To assess serum nitric oxide levels among type 2 diabetes mellitus patients having normoalbuminuria and microalbuminuria. Setting and Design: This cross sectional study was carried out at Department of Biochemistry in a tertiary care rural hospital in Central India with 200 diagnosed patients of type 2 diabetes mellitus. Materials and Methods: 24 hr urine albumin was done in all the patients. Based on the concentration of albumin in urine, patients were categorised in two groups, group 1 had normoalbuminuria (i.e. Urine Albumin 20 to

Cardiovascular Risk Assessment and Profiling among Employees of Tertiary Care Rural Hospital: Central India

Cardiovascular Risk Assessment and Profiling among Employees of Tertiary Care Rural Hospital: Central India

A Novel Approach to ICU Survivor Care: A Population Health Quality Improvement Project.

Deliver a novel interdisciplinary care process for ICU survivor care and their primary family caregivers, and assess mortality, readmission rates, and economic impact compared with usual care. Population health quality improvement comparative study with retrospective data analysis. A single tertiary care rural hospital with medical/surgical, neuroscience, trauma, and cardiac ICUs. ICU survivors. Reorganization of existing post discharge health care delivery resources to form an ICU survivor clinic care process and compare this new process to post discharge usual care process. Demographic data, Acute Physiology and Chronic Health Evaluation IV scores, and Charlson Comorbidity Index scores were extracted from the electronic health record. Additional data was extracted from the care manager database. Economic data were extracted from the Geisinger Health Plan database and analyzed by a health economist. During 13-month period analyzed, patients in the ICU survivor care had reduced mortality compared with usual care, as determined by the Kaplan-Meier method (ICU survivor care 0.89 vs usual care 0.71; log-rank p = 0.0108) and risk-adjusted stabilized inverse probability of treatment weighting (hazard ratio, 0.157; 95% CI, 0.058-0.427). Readmission for ICU survivor care versus usual care: at 30 days (10.4% vs 26.3%; stabilized inverse probability of treatment weighting hazard ratio, 0.539; 95% CI, 0.224-1.297) and at 60 days (16.7% vs 34.7%; stabilized inverse probability of treatment weighting hazard ratio, 0.525; 95% CI, 0.240-1.145). Financial data analysis indicates estimated annual cost savings to Geisinger Health Plan ranges from $247,052 to $424,846 during the time period analyzed. Our ICU survivor care process results in decreased mortality and a net annual cost savings to the insurer compared with usual care processes. There was no statistically significant difference in readmission rates.

Association of Intrapartum Risk Factors and Infant Clinical Indicators with Culture Confirmed Early Onset Neonatal Sepsis in a Secondary Care Rural Hospital in India.

The aim of this study is to determine the association of intrapartum risk factors and infant clinical indicators using the National Institute for Health and Care Excellence (NICE) criteria with culture-positive early-onset neonatal sepsis (EONS) from a rural secondary healthcare facility where intrapartum prophylactic antibiotics are routinely administered to high-risk mothers. A single-center prospective observational study was conducted between July 2017 and September 2018. All intramural neonates with at least one NICE criteria at less than 72 h of life, were included. Univariate logistic regression and multivariable logistic backward elimination analyses were conducted to investigate individual risk factors and predictive models for culture proven EONS. Of 236 newborns who were at risk for EONS by NICE criteria, 32 (13.8%) had positive blood cultures. Klebsiella species (n = 13, 39.4%) and Acinetobacter species (n = 11, 33.3%) were the most common isolated bacteria. In univariate analysis, the number of infant clinical indicators were associated with culture positive EONS (OR 1.36; 95% CI 1.01-1.81), but not the number of intrapartum risk factors (OR 0.76; 95% CI 0.4-1.29). The multivariate logistic regression with backward elimination procedure suggested that a model including absolute neutrophil count [adjusted OR (aOR) 0.81; 95% CI 0.72-0.92], C-reactive protein (aOR 1.24; 95% CI 1.08-1.43) and the number of clinical indicators (aOR 1.29; 95% CI 0.93-1.80) could be useful to predict culture positive EONS in our setting. In this maternal and neonatal cohort, infant clinical indicators rather than intrapartum risk factors were associated with culture confirmed EONS.

Depression, Anxiety and Stress among the general population in the time of COVID-19 lockdown: A cross-sectional study protocol

The incidence of Depression, Anxiety and stress among the general population is steadily increasing due to outbreak of COVID-19 across the globe. Beyond the risks of COVID-19, concerns have been expressed to have mental effect on the general population due to COVID-19 lock down. The emotional impact is more among individuals with pre-existing medical diseases like hypertension, Coronary Artery Disease, Diabetes (DM) and psychiatric illness. The lockdown results in health anxiety, this can manifest as maladaptive behaviours (repeated medical consultations, avoiding health care even if genuinely ill, hoarding particular items); at a broader societal level, it can lead to mistrust of public authorities and scapegoating of particular populations or groups. There are very few data from India studying mental impact of lockdown due to COVID 19 among general population. In our study, we will assess DAS among rural population who are accompanying the Non-COVID 19 patients at a tertiary care rural hospital of central India in the era of lock down.

Emergence of Colistin Resistant Gram-Negative Bacteria in a Tertiary Care Rural Hospital in 2019

Background: Colistin-resistant Gram-negative bacteria is a rapidly emerging global threatgenerated a sense of public alarm.
 Objective: To combat this challenge a study was designedto evaluate the fast spreading infections by colistin-resistant pathogens in the tertiary care rural hospital of Bangladesh.
 Materials and Methods: To study isolation ofpathogenic gram-negative bacilli,clinical sample (n-640) of hospitalized patients of Khwaja Yunus Ali Medical College Hospital in Enayetpur, Bangladesh during the 1st quarter of the year 2019 were used. The bacterial isolates were screened for meropenem and colistin-resistance.
 Results: A total of 156 bacterial isolates were studied which included Escherichia coli (n-112), Klebsiella pneumoniae (n-14), Pseudomonas aeruginosa (n-27), and Salmonella typhi (n-3). Antibiotic sensitivity testing showed that 32/156(20%) and 119/156 (76%) isolates were resistant to meropenem and colistin, respectively. whereas 50/156 (32%) isolates were resistant to both antibiotics. Escherichia coli, K. pneumoniae, pseudomonas aeruginosa, and Salmonella typhi isolates respectivelywere 112/156 (72%), 14/156 (9%). 27/156 (17%), and 3/156 (2%).
 Conclusion: Colistin is typically used as salvage therapy, or last-line treatment, for MDR gramnegative infections.But there is worrisome therapeutic scenario in our study finding of colistin resistance is 76% in Gram-negative bacteria of the clinical isolates. The restricted and rational use of colistin drug is the need of hour.
 KYAMC Journal Vol. 11, No.-2, July 2020, Page 87-90

Histomorphological Spectrum of Ovarian Lesions at a Rural Care Hospital in Gurugram

Background: The ovaries are paired intrapelvic organs of female reproductive system. It is unique in the variety of lesions that can arise from ovary as it is complex in its embryology, histology and steroidogenesis. The ovary consists of totipotent sex cord cells and multipotent mesenchymal cells. They are common site of non-neoplastic and neoplastic lesions. Some non-neoplastic lesions of the ovary usually present as a pelvic mass and mimic an ovarian neoplasm and thus posses a great challenge to gynecological oncologist and pathologist. Therefore their proper recognition and classification is important for appropriate therapy. Material and Methods: A prospective clinicopathological study of 58 cases of non-neoplastic and neoplastic lesions of ovary was conducted in Department of Pathology, FMHS, SGT University, Gurugram over the period of one years from June 2018 to June 2019. The materials for this study were oopherectomy specimen, ovarian cystectomies as well as hysterectomy with unilateral/bilateral salphingoopherectomy received from department of Obstetrics and Gynecology. The non-neoplastic and neoplastic lesions from representative sections were studied and classified according to World Health Organisation (WHO) and correlation of histopathological patterns with age, bilaterality, morphology and grading of the tumour was done. Results: A total of 58 cases were studied out of which 31 (53.45%) cases were non-neoplastic and 27 (46.55%) cases were neoplastic. Among the 31 nonneoplastic cases, the most common lesion found was simple cyst with 13 (41.94%) cases followed by corpus luteal cyst with 6 (19.35%) cases. Among the 27 neoplastic ovarian lesions, 17 (62.96%) cases were benign tumour, 2 (7.4%) cases were borderline tumour and 8 (29.64%) cases were malignant tumour. These tumours were classified according to WHO classification and categorised in three main groups. Surface epithelial tumours constituted the majority with 17 (62.98%) cases, followed by germ cell tumours which constituted 8 (29.62%) cases and sex cord stromal tumours constituted 2 (7.4%) cases. Conclusion: Ovarian cancers are called as “silent killer” as in most of the primary ovarian tumour they remain asymptomatic until the advanced stage. However, histomorphological study of tumour is still the gold standard method, these observations and results proved to be valuable base line information regarding frequency and pattern of ovarian tumours.

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Drug utilization pattern in outpatient departments of a tertiary care rural teaching hospital, Central Gujarat

Background: Drug utilization studies would benefit to measure various dimensions such as medicine use and drug prescribing pattern. Aim and Objective: This study aims to study drug utilization pattern in the outpatient departments of a tertiary care rural teaching hospital in Central Gujarat. Materials and Methods: This prospective, cross-sectional, observational study was conducted in the 500 outdoor patients of any age and either sex from various departments of Dhiraj Hospital, Piparia. Various aspects of drug utilization were studied. Results: In total, 811 drugs were prescribed. Of the 811 drugs, 87.79% drugs were prescribed by brand names while only 12.21% were prescribed by their generic names. Only 30.01% prescribed drugs belonged to the essential medicine list and 35.55% were rational. Of the drugs prescribed, 89.14% were fixed-dose drug combinations. Out of all drugs, 56.75% were found to be most appropriate for dose, frequency of administration, and duration of therapy, whereas 33.40% and 9.85% were found to be appropriate and inappropriate, respectively. In dosage form and route of administration, 90.15% were found to be appropriate and 9.85% were inappropriate, respectively. Conclusion: Drug utilization studies would help rational use of medicines and provide better patient health care.

Sociodemographic determinants in prevalence of anemia in adolescents of rural area of Maharashtra

Introduction: Anemia is one of the most important health problems throughout the world. The prevalence of anemia among adolescents is 27% in developing countries, and 6% in developed countries. Aim: This study aims to assess the prevalence of anemia among adolescents of the age group of 10–15 years in rural population. Objectives: The objective is to study the prevalence of anemia in adolescents in the age group of 10–15 years. To correlate anemia with the socioeconomic status (SES) of adolescents. Materials and Methods: The study was a cross-sectional study of the Department of Pediatrics, AVBRH, Sawangi (Meghe), Wardha, which is tertiary care rural hospital catering western zone of Maharashtra. A total number of 1010 adolescents from the age group of 10–15 years of both sexes were included in the study. Results: In our study, we found that 61.19% of the total individuals were found to be anemic. The prevalence of anemia was 53.79% in boys and 71.7% in girls. Anemia was very common in adolescents from lower classes of SES. Conclusion: Adolescent nutrition should be viewed more seriously with adequate improvement in the standards of living, supplementary programs and timely health education.

Nerve Conduction Studies of Peripheral Motor and Sensory Nerves in the Subjects With Prediabetes

Background: Prediabetes is a condition in which the fasting blood glucose is elevated above normal levels but not high enough to be classified as diabetes mellitus. There is clear association between sensory polyneuropathy and diabetes mellitus. But association of neuropathy in prediabetes is still not clear. Forty years ago, Ellenberg suggested that neuropathy may indeed occur in prediabetes. Methods: In the present study, we attempted to study the changes in nerve conduction studies in the patients with glucose intolerance, i.e. impaired fasting blood glucose or impaired glucose tolerance in a tertiary care rural hospital. The study included 65 cases (prediabetic) and 65 controls. Nerve conduction studies were performed on right tibial nerve and right sural in lower limb, with surface recording, using the standardized technique. Results: The compound muscle action potential (CMAP) and nerve conduction velocity (NCV) of right tibial nerve were significantly reduced in the cases as compared to controls and were found to be statistically significant suggesting motor axonal neuropathy. The sensory nerve action potential (SNAP) and NCV of right sural nerve were significantly reduced in the cases as compared to controls which were found out to be statistically significant suggesting that cases had sensory axonal neuropathy. Conclusion: All the patients of prediabetes should also be screened for neuropathy. We conclude prediabetic stage is risk factor for development of neuropathy, with hyperglycemia being acting via same mechanism as in cases of diabetes. Prediabetes patients are at risk of developing full blown neuropathy. Early metabolic aberrations as seen in impaired glucose tolerance may lead to changes in the nerve conduction. J Endocrinol Metab. 2019;9(5):147-150 doi: https://doi.org/10.14740/jem602

“INTRAABDOMINAL HYPERTENSION AND ABDOMINAL COMPARTMENT SYNDROME IN EMERGENCY LAPAROTOMY PATIENTS IN TERTIARY CARE RURAL HOSPITAL”

Background: Although initially recognized over 150 years ago, the patho-physiologic implications of elevated intra-abdominal pressure (IAP) have essentially been rediscovered only within the past two decades. The aim of the study was to evaluate the incidence, morbidity and mortality of intra abdominal hypertension and abdominal compartment syndrome in emergency laparotomy patients in tertiary care rural hospital.
 Method: IAP measurement was done in all patients undergoing emergency laparotomy with manometry technique (U tube technique) using per- urethral foley's catheterization.
 Results: Our study population was a group of patients who underwent laparotomy for various indications which included traumatic as well as non-traumatic causes. In total, 104 patients, with 30 females and 74 males were included in the study population who fulfilled the study criteria. The mean ± SD age in our study were 40.2±13 years with 20-30yrs being the most common age group. Most of the studies on IAH and ACS analyse either trauma or ICU patients. Little has been reported on ACS in general surgical population. Our study population was a group of patients who underwent laparotomy for various indications which included traumatic as well as non traumatic causes, hence a predominance of general surgical patients.
 Conclusions: Findings suggest that the incidence of ACS in our study is 3.84 % and found to be more common in trauma patients. There is significant association between increased Intra-abdominal pressure at 6 and 24 hours after laparotomy and organ dysfunction. The total mortality rate in ACS group was 75%. There is significant association between increased Intra-abdominal pressure and mortality.

Prevalence of multi-drug resistant (MDR) pulmonary tuberculosis in a tertiary care rural hospital in Western Maharashtra, India

Prevalence of multi-drug resistant (MDR) pulmonary tuberculosis in a tertiary care rural hospital in Western Maharashtra, India - IJMR- Print ISSN No: - 2394-546X Online ISSN No:- 2394-5478 Article DOI No:- 10.18231/j.ijmr.2019.052, Indian Journal of Microbiology Research-Indian J Microbiol Res

Study of morbidity pattern and outcome of patients admitted in paediatric intensive care unit in a tertiary care rural teaching hospital

Background: The care of the critically ill children remains one of the most demanding and challenging aspects in the field of paediatrics. The main purpose of Paediatric Intensive care unit is to prevent mortality by intensively monitoring and treating critically ill children who are considered at high risk of mortality. In the developing countries, there is a scarce data on paediatric critical care. Evaluation of the outcome of medical interventions can assess the efficacy of treatment. This helps in better decision making, improving the quality of care and modifying the future of management if required. This study will also help to study the causes of morbidity and mortality among paediatric age group in our hospital. Aims and Objectives of the study is to evaluate the morbidity pattern and outcome of admissions in the PICU of a rural teaching hospital, and to take measures to prevent morbidity and mortality by improving critical care facilities.Methods: This was a retrospective study, the cases admitted in paediatric ICU in our teaching hospital in last two and a half considering the estimated sample size. Data will be collected from PICU and Medical record Department. Details will be studied with the help of medical record and will be analysed and interpreted according to the medical record details.Results: During a period of 30 months of the study, total of 417 patients were admitted in our PICU. Of the total cases studied, Maximum i.e. 180(43.2%) had age below 1 year. The minimum – maximum range of age was between 1 day to 18 years. About 228(54.7%) cases were males and 189(45.3%) were females. The most common diagnosis was LRTI which was observed in 61(14.7%) of cases. The most common system involved was respiratory system which was observed in 101(21.8%) cases. Of total cases studied, 357(85.6%) were discharged, 36(8.6%) had DAMA (discharge against medical advice) and 24(5.8%) expired.Conclusions: Mortality was low in our PICU. We conclude based on the present study that in our rural set up PICU, with better treatment protocols, skilled expertise/ Paediatric Intensivist we have chances to facilitate the care of critically ill patients giving desirable outcome.

Drug utilization study in geriatric patients visiting the outpatient department in tertiary care rural hospital.

Aim & Objective:The study aimed to evaluate the disease pattern, drugs used & the prescribing patterns to the geriatric patients at rural hospital. Materials and Methods: A total of 300 patients were enrolled in the prospective, cross sectional study. The demographic details, drugs used condition for which the drugs were prescribed and other related factors; names by which they were prescribed, use of fixed dose combinations were recorded and subjected to analysis. Observation and Results: Enrolled patients belonged to the age between 65 to 74 years, who presented with cardiovascular (21.22%) followed by musculoskeletal conditions (17.44%). Medicines were mostly prescribed by brand names 72.11%, Ranitidine was most frequently prescribed followed by Aceclofenac. About 20.35% were prescribes as FDCs for ex; Aceclofenac + Paracetamol was most commonly prescribed FDC followed by Amoxicillin + Clavulanic Acid. Conclusion: Cautious use of medicines in geriatric patients is essential which can be provided by rational prescribing.

Prevalence of Poisoning Cases at Tertiary Care Rural Hospital of Vidarbha Region of Maharashtra: An Autopsy based Cross-sectional Study

Prevalence of Poisoning Cases at Tertiary Care Rural Hospital of Vidarbha Region of Maharashtra: An Autopsy based Cross-sectional Study

Asymptomatic bacteriuria & urinary tract infections in pregnancy: A study in a tertiary care rural hospital

Introduction: Urinary tract infections (UTI) are one of the common infections during pregnancy. If not treated, these can cause serious complications to both mother and foetus. This study was carried to determine the prevalence of UTI in pregnant women and to identify the common uropathogens causing UTI. Materials and Methods: Midstream urine specimens were collected from 180 pregnant females. The specimens were examined microscopically and by culture. A colony count of 105 CFU/ml of urine of a single uropathogenic bacterium in culture is considered significant and such patients, either symptomatic or asymptomatic, are considered to have a urinary tract infection. Results: Urine specimens of 33 females (18.33%), all of whom were asymptomatic, showed significant growth of uropathogenic organisms confirming the diagnosis of UTI. The commonest pathogen isolated was E. coli (54.55%), followed by Klebsiella species (24.24%), S. aureus (12.12%), Pseudomonas spp, Pseudomonas aeruginosa and C. albicans (3.03% each). Conclusion: In this study, the prevalence of UTI in pregnancy was found to be 18.33%. As most of these cases present without any symptom, its early detection by screening for it with appropriate laboratory tests is vital. This would help clinicians to start appropriate antibiotic treatment at an early stage which in turn will help to minimize complications associated with UTI. Keywords: Urinary tract infections, Asymptomatic bacteriuria, Pregnancy, Cystitis, Pyelonephritis.