Rural Tertiary Care Hospital Research Articles

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

A case series of ovarian ectopic pregnancy at a rural tertiary care hospital

Ovarian ectopic pregnancy (OEP), is one of the variants of the non-tubal ectopic pregnancy, which varies one in 7,000–16,000 deliveries, and its prevalence is 1-3% among ectopic pregnancy. OEP is a complication which occurs when implantation and embryo development happens outside of the uterus. Usually, 91% of OEP terminates with rupture before the end of 1 trimester and it can lead to pregnancy complications such as hemorrhage and hypovolemic shock. Clinical presentation of OEP is lower abdominal or pelvic pain, or both. In addition to this, other symptoms include nausea, vomiting, and constipation.In this, we present 3 cases of OEP who reported to our hospital as adnexal mass for evaluation, who came with acute abdomen and was subsequently confirmed at surgery and proven on histopathology or USG detected adnexal mass with hemoperitoneum with suspicion of ectopic pregnancy. Judicious use of ultrasound in an appropriate clinical setting can thus prevent mishaps and enable better management of such conditions.

A two year retrospective study of ovarian tumours in a rural tertiary care hospital

Introduction: The classification of ovarian tumours, both benign and malignant, into numerous categories is a proof for the ever expanding number of new lesions being added every year. This heterogeneity of ovarian lesions is the initiating factor to conduct this retrospective study to evaluate the frequency and age distribution of ovarian lesions in our tertiary centre. Materials and Methods: This is a retrospective study conducted in the Department of pathology, Government Thiruvarur medical college, Thiruvarur, Tamil Nadu between the period Jan ‘2016 to Dec’2017.The clinical details along with the gross and histopathological diagnosis cases with ovarian lesions were compiled and analysed to arrive at the percentage of distribution of various lesions. Results: Out of 144 cases studied, benign, borderline and malignant ovarian tumours were 79.85%, 3.47% and 16.65% respectively. Benign tumours peaked between third and fourth decades, while malignant tumours were seen commonly after fifth decade. Surface epithelial tumours were common (84%) followed by germ cell tumours (7.64%) and sex cord stromal tumours (4.16%). Serous cystadenoma was more common than mucinous cystadenoma followed by mature cystic teratoma. Serous cystadenocarcinoma was the most common malignancy in our study. Keywords: Surface epithelial tumour, Germ cell tumours, Sex cord stromal tumours.

Pattern of adverse drug reactions in rural tertiary care medical college and hospital of Himachal Pradesh: A retrospective observational study

Introduction: Adverse events can lead to admission in hospital, prolongation of hospitalization, increase in investigations as well as treatment costs, deformities, danger to life and even death. Objective: The aim of this study was to conduct adverse drug reactions (ADRs) monitoring in various departments of a tertiary care teaching hospital. Methods: A retrospective observational study was conducted on ADRs reported in adverse drug monitoring center of our hospital from April, 2016 to December, 2016. Data such as age, gender, diagnosis, drug intake, types of ADRs, treatment and outcome of the reactions were collected. Each reported patient was assessed individually. Causality assessment was done on Naranjo’s probability scale. Modified Hartwig’s criteria were used to assess the severity of ADRs. Results: A total of 173reports were studied. 65(38%) patients were males and 108 (62%) were females. The majority of ADRs were due to cancer chemotherapy agents in 87(50%), followed by anti-tubercular drugs in 22(13%), antimicrobial agents in 22 (13%) and anti-retroviral drugs in 16(9%).Out of total 574 events 192(34%)complaints comprised of gastro-intestinal manifestations. On Naranjo’s probability scale, 111(64%) reactions were probable, 54 (31%) as possible and 8 (5%) as certain. According to Modified Hartwig’s criteria 130 (75%) reactions were mild, 29 (17%) were moderate and 14(8%) were severe. Conclusion: Health-care providers will have to do vigilant monitoring and reporting of ADR´s. Keywords: Pharmacovigilance, Adverse drug reactions, Chemotherapy, Causality assessment, Tertiary care teaching hospital.

Tinea genitalis in a rural tertiary care hospital of Western U.P. India

Introduction: Genital dermatophytosis is also known as tinea genitalis and pubogenital tinea, and it is one of the superficial fungal infections caused by dermatophytes. The classical clinical presentations in an immunocompetent person consist of an erythematous annular plaque with slightly raised scaly centrifugally advancing border and central clearing. The lesions in patients with HIV/AIDS or immunosuppressed individuals, can be extensive and without central clearing. Purpose: The present study was conducted to know the current scenario and possible mode of transmission of tinea genitalis in males and females and to isolate the causative dermatophyte. Materials and Methods: Patients with dermatophytic lesions in genital area and KOH, and/ or culture positive were enrolled in the study. Samples were collected from the active borders of the lesions after cleaning it with 70% ethyl alcohol and were inoculated on Sabouraud Dextrose Agar (SDA), supplemented with chloramphenicol and cycloheximide. None of the patients had any immunosuppression except 2 (0.72%) had diabetes mellitus and one (0.36%) patient gave history of atopy. Result: Out of a total 276 samples, 274 (99.27%) were Trichophyton interdigitale, and two male patients (0.72%) had tinea genitalis due to Trichophyton rubrum. History of use of topical steroid was present in 202 (73.18%) patients. Conclusion: Patients coming with tinea cruris should also be examined for the presence of tinea genitals, because according to our statistics 22.14% of them also had concomitant tinea genitals. History of having used topical corticosteroids should always be taken from them, because it results in extensive, atypical and extension of the lesions to the neighbouring anatomical sites. Keywords: Tinea genitalis, Trichophyton interdigitale, Topical steroids.

To study the management of primary pterygium by surgical excision with conjunctival autograft with limbal stem cells in a tertiary care hospital in hilly area of North India

Aim: The aim is to study the management of primary pterygium by surgical excision with sutureless conjunctival autograft with limbal stem cells. Materials and Methods: Patients with advanced pterygium were recruited from eye outpatient department (OPD) of rural tertiary care hospital of central India from January 2016 to October 2016. Informed written consent was taken before enrollment. The total 54 eyes (of 42 patients) were operated for pterygium with conjunctival autograft with limbal stem cells. Graft margins were buried around 0.25mm below the host conjunctiva. Results: The mean age of the patients was 48.71 ± 12.87 years. The male patient were 30 (38 eyes, 71.43%) and females were 12 (16 eyes, 28.57%). The most common age group of presentation was 40 to 60 years (28 patients, 66.67%), followed by 61 to 80 years (10 patients, 23.81 %) and lastly age less than 40 years (4patients, all female, 9.52%). At the follow up of 6 months 1 eyes showed recurrence and at 1 year 1 eyes showed recurrence. The recurrence was 3.70 percentage at 1 year of follow up. The recurrent pterygium were reoperated with pterygium excision with mitomycin C (0.02). The patients with recurrence have completed 2 months follow up without any signs of recurrence. In 28 patients (51.85%) showed improvement in visual acuity (2 or more lines) on Snellen chart. Conclusion: Management of primary pterygium by surgical excision with sutureless conjunctival autograft with limbal stem cells is a effective surgical technique in preventing recurrence of pterygium and good cosmetic appearance of eyes after pterygium surgery. The author recommends use of Mitomycin C (MMC) or 5 Fluorouracil (FU) only in selected cases pterygium like extensively infiltrating pterygium or recurrent pterygium. Keywords: Conjunctival autograft, Pterygium surgery, Stem cells.

Phenotypic methods for detection of metallobetalactamase in Meropenem resistant Pseudomonas aeruginosa and molecular detection of blaIMP & blaVIM genes carrying strains

Introduction and Objectives: Pseudomonas aeruginosa is one of the major organisms responsible for nosocomial infections such as pneumonia, UTIs, surgical site infections, and bloodstream infections.1 High intrinsic and acquired resistance to many antimicrobial agents have allowed P. aeruginosa to persist in both community and hospital settings. This study was done to find the prevalence rate of Meropenem resistant Pseudomonas aeruginosa carrying metallobeta lactamase producing genes. Materials and Methods: The study included a total of 100 non-duplicate clinically significant, random bacterial isolates obtained from a North Indian rural tertiary care hospital (Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, India) from various clinical specimens, over a period of one year (January2012 to December 2012) . Identification of organisms was done using the standard microbiological techniques as described by Colle et al 1996.7 The antimicrobial susceptibility testing was performed by Kirby Bauer disc diffusion method. To detect MBL producing isolates phenotypicaly, Disc potentiation test (DPT) and Double disc synergy test (DDST) were performed. PCR was performed on Meropenem resistant isolates to detect blaIMP and blaVIM genes. Results: Out of 100 examined isolates, 36% isolates were resistant to Meropenem. Out of these Meropenem resistant strains, 44.4%(16) P. aeruginosa isolates were MBL producers as detected by DDST method and 69.44%(25) isolates were MBL producers phenotypically by DPT method . PCR revealed prescence of bla VIM gene in 16.66%(6) of Meropenem resistant Pseudomonas aeruginosa isolates and 38.88% (14) isolates were found to be carrying bla IMP gene . Three isolate were shown to carry both blaIMP and blaVIM genes. Conclusion: Resistance of P. aeruginosa isolates to Meropenem due to MBL enzymes is increasing in rural area. Resistance due to MBL has clinical significance, rapid detection of MBL producing strains followed by

Efficacy of Escitalopram versus Desvenlafaxine in Treatment of Depression: A Comparative Study from a Rural Tertiary Care Hospital

Efficacy of Escitalopram versus Desvenlafaxine in Treatment of Depression: A Comparative Study from a Rural Tertiary Care Hospital

Outcome of Neglected Elbow Dislocation Treated with Open Reduction at Rural Tertiary Care Hospital in Nepal.

Chronic unreduced dislocation of elbow is a rare injury. Treatment options include open reduction internal fixation with K wire, replacement arthroplasty, excisional arthroplasty, arthrodesis, and hinged external fixator. The aim of this study is to determine the outcome of open reduction internal fixation with trans-olecranon K wire for neglected elbow dislocation. This is a retrospective study done in three rural hospital of Karnali. Hospital records were reviewed from July 2015 to May 2018 to identify 11 cases who underwent open reduction internal fixation for neglected elbow dislocation. Pre and Postoperative outcome was assessed using range of motion and Mayo Elbow Performance Index. Data analysis was done using SPSS version 17. The average age of patient was 22.7 years (range 9-50 years). Non dominant hand was involved in 54.55%. The average preoperative elbow extension was 5.9 degree whereas postoperative extension was 15.9 degree. The average preoperative and postoperative elbow flexion was 24.5? and 113.6? respectively. Preoperative and postoperative Mayo elbow performance index was 18.6 and 86.3 respectively. Outcome was excellent in four patients, good in five patients and fair in two patients with one case having superficial infection. Open reduction and internal fixation with trans-olecranon k wire is an effective treatment method for neglected elbow dislocation. Postoperatively, elbow function is better with minimal complications.

A Clinicopathological Evaluation of Breast Carcinoma in a Rural Tertiary Care Hospital

A Clinicopathological Evaluation of Breast Carcinoma in a Rural Tertiary Care Hospital

A Study of Prevalence of HIV and Hepatitis B among Blood Donors in Tertiary Care Hospital, Kolar, Karnataka

Background: Blood transfusion is usually lifesaving but can cause disease if not tested properly for the presence of micro –organisms before transfusion. Most common diseases transmitted through blood are hepatitis, HIV, syphilis, malaria, Hepatitis B, and Hepatitis C. The present study was undertaken to assess seroprevalence and trends of HIV and HBV (Hepatitis B Virus) in our rural tertiary health care hospital. Methods: All the blood donors (voluntary donor’s and replacement donors) donating blood in the blood bank were considered as the study population. During the study period 79162 units were collected from the healthy donor’s aged between 18 to 60 years. Results: A total of 35 938 donors were screened for HIV and HBsAg over a period of 5 years of these, 33.853 (94.2%) donors were males and 2085 (05.8%) were females. 117 donor samples were positive for HIV (0.30%) and 359 donor samples were positive for HBsAg accounting to 0.99% of seroprevalence. Conclusion: Seroprevalance of HIV was 0.30% and HBV 0.99%). There was a gradual declining trend in both HIV and Hepatitis B. Strict selection of blood donors and following NACO approved standard testing procedures and having a quality control for each test has helped to reduce seroprevalance of HIV and Hepatitis B

Evaluation of Tumour Volume as a Prognostic Factor in Carcinoma Buccal Mucosa.

(1) To determine tumor volume by clinical measurement, imaging and histopathological examination in patients with squamouscarcinoma of buccal mucosa. (2) To correlate tumor volume with lymph-node metastasis and loco-regional control. Retrospective Observational Study. Rural tertiary care hospital. 75 Patients undergoing surgery for T2 (68%) and T3 (32%) Oral squamous carcinomas were included in this observational study. Tumor volume-a product of maximum length, breadth and thickness, was determined clinically and by imaging. Tumor volume on histopathology was documented and correlated with lymph-node metastasis. After 13months minimum follow-up, tumor volume was correlated with loco-regional control. Recurrences were analysed with regard to tumor volume, depth of invasion, lymph-node metastasis and resection margins. Average tumor volume was 7.1cm3among T2 and 14.4cm3among T3. 25% of T2 tumors had metastatic lymph-nodes compared to 33.3% in T3. There was positive correlation between tumor volume and lymph-node metastasis. Lymph-node metastasis was absent when tumor volume was < 8cm3. There were 4 local and 2 regional recurrences in this study. Average histopathological tumor volume among patients who had local recurrence was 12.95cm3. Regional recurrences occurred in tumors staged N2b and N3b on histopathology. Average depth of invasion in patients with recurrence was 10.33mm.. Tumor volume represents actual tumor load and correlates with lymph node metastasis and prognosis in oral cancers. Depth of invasion and tumor thicknessinfluence staging and prognosis. Large volume tumors have poor oncological outcome.

Pattern of pediatric renal diseases in a rural tertiary care hospital

Background: Spectrum of renal disease varies in different population, geographical location, and by environmental factors. The purpose of this study was to find out the occurrence of different pediatric renal diseases at a teaching hospital in the rural part of Maharashtra, India.Methods: All cases of renal diseases from one month to 12 years of age, admitted to the wards during the period of July 2018 to December 2019, were included in the study. Detailed clinical and laboratory evaluations were performed on all patients. Diseases were categorized as per standard definitions and managed with hospital protocols.Results: Renal diseases accounted to be 235 cases (2.8%) of total pediatric admissions during study period, of which (61.3%) were male and (38.7%) female. Nephrotic syndrome (NS), was the most common disorder (34%) followed by congenital anomalies of the kidney and the urinary tract (CAKUT) (24.7%), urolithiasis (11%), urinary tract infection (10.63%), chronic kidney disease (CKD) (7.66%) and acute kidney injury (AKI) (3.83%). The causes of AKI were dehydration, urosepsis, septicemia, and acute glomerulonephritis (AGN). Mortality was found in 3.4% of cases and the etiologies were AKI, NS and CKD.Conclusions: A substantial number of children are hospitalized with renal and urinary tract diseases. NS and congenital defects were the leading renal disorders in this study. These patients need comprehensive services for early identification and management.

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.

Clinicopathological profile of sinonasal masses-a tertiary care centre study in rural India

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; A variety of mass lesions occur within the paranasal sinus (PNS) and nasal cavity and thus it becomes mandatory for otorhinolaryngologist to elicit detailed history and thorough examination before reaching a final diagnosis. This is retrospective study of all sinonasal masses who were undergone surgical management in the institute of rural India and so in the environment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a retrospective observational study of 70 patients with sinonasal masses treated at a rural tertiary care hospital in rural western Maharashtra from period of Jan 2016 to May 2018. History, clinical assessment and histopathological examination (HPE) was done in all cases as per hospital record supplemented by radiological investigation as per requirement. The patients were grouped as per their histopathological diagnosis as non-neoplastic/inflammatory and neoplastic.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total of 70 patients were analysed age ranging (11-70 years). Majority of the patients were in the age groups 21-40 years (47%). There were 43 (61%) male and 27 (39%) female with M:F ratio 1.6:1. On HPE, 50 (71%) cases were non neoplastic/inflammatory and 20 (29%) cases were neoplastic lesions. HPE revealed that 50 (71%) cases were non neoplastic and 20 (29%) cases were neoplastic lesions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Sinonasal masses have various differential diagnoses. They are fairly common with male predominance. Benign conditions show a peak during 2&lt;sup&gt;nd&lt;/sup&gt; to 4&lt;sup&gt;th&lt;/sup&gt; decade of life while malignancy increasing with the age after 4th decade. In non-neoplastic lesion, Allergic nasal polyp is the commonest histological pattern seen while in malignant lesions squamous cell carcinoma is noted with 100% male predominance.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

English

English

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.

A Study on Mycological Profile of Superficial Mycoses in a Rural Tertiary Care Hospital of Eastern India

Background: Superficial mycosis is a very common fungal infection worldwide of the skin, hair and nails by dermatophytes, non dermatophytes and yeasts. Though they do not cause mortality, but are important agents causing morbidity, cosmetic disfigurement and recurrence leading to a major public health problem. Aim: Determine the clinico-mycological correlation and prevalence of dermatophytosis. Material and Methods: A six months observational cross sectional study was conducted from July 2019-December 2019 on 156 clinically diagnosed cases of superficial mycosis with no systemic complaints. Specimens were examined macroscopically as well as microscopically by KOH and culture. Result: Dermatophytosis was more in the males

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.&#x0D; 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.&#x0D; 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.&#x0D; 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%).&#x0D; 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.&#x0D; KYAMC Journal Vol. 11, No.-2, July 2020, Page 87-90