Tertiary Care Hospital In South India Research Articles

Assessment of Vitamin D Deficiency Prevalence among Type 2 Diabetes Mellitus Patients in a South Indian Tertiary Care Hospital

Assessment of Vitamin D Deficiency Prevalence among Type 2 Diabetes Mellitus Patients in a South Indian Tertiary Care Hospital

Unraveling Sepsis Epidemiology in a Low- and Middle-Income Intensive Care Setting Reveals the Alarming Burden of Tropical Infections and Antimicrobial Resistance: A Prospective Observational Study (MARS-India).

Our study addresses the sepsis research gap in lower middle-income countries, notably India. Here, we investigate community-acquired sepsis comprehensively and explore the impact of tropical microbiology on aetiology and outcomes. MARS-India was a prospective observational study from Dec-2018 to Sep-2022 in a tertiary-care hospital in South India. Adult patients within 24hrs of ICU admission meeting the Sepsis 3.0 definition were enrolled, with 6-months follow-up (http://clinicaltrials.gov number NCT03727243). Over 4000 patients were screened on ICU admission, with 1000 unique patients meeting the inclusion criteria. Median age was 55 years (IQR: 44-65) with a male preponderance (66%). Almost half the cohort resided in villages (46.5%) and 74.6% worked in the primary sector. Mortality in-hospital was 24.1%. Overall, ∼54% had confirmed microbiological diagnosis. Over 18% had a viral cause of sepsis. Surprisingly, we identified leptospirosis (10.6%), scrub typhus (4.1%), dengue (3.7%) and Kyasanur forest disease (1.6%) as notables causes of sepsis. All these infections showed seasonal variation around the monsoon. In community-acquired infections we observed substantial resistance to 3rd generation cephalosporins and carbapenems. In India, sepsis disproportionally affects a younger and lower socio-economic demographic, yielding high mortality. Tropical and viral sepsis carry a significant burden. Analyzing local data, we pinpoint priorities for public health and resources, offering valuable insights for global sepsis research.

A retrospective study of the incidence, patterns, and risk factors of retinopathy of prematurity in infants with birth weight >1500 g in a South Indian tertiary care hospital

Abstract: OBJECTIVE: The objective of the study was to determine the incidence, patterns, and risk factors for the development of retinopathy of prematurity (ROP) in infants weighing >1500 g at birth. MATERIALS AND METHODS: A retrospective analysis was done of the ROP screening records between April 2019 and March 2022. All the infants with birth weight >1500 g who underwent ROP screening were included. Data collected included demographic details, details of the risk factors (respiratory distress syndrome [RDS], hypoxia, anemia, septicemia, patent ductus arteriosus, congenital heart disease [CHD], i.e., atrial septal defects or ventricular septal defects, and multiple gestations), and ocular examination findings. Statistical analyses included calculation of mean, range, Chi-square test, and bivariate logistic regression for associations of risk factors with ROP. RESULTS: ROP was noted in 16.6% of the 336 eyes of 168 infants. The mean birth weight and mean gestational age (GA) of the infants were 1850 ± 33 g and 33.33 weeks ± 1.71 weeks, respectively. Eighteen eyes (32.1%) had Stage I, 17 eyes (30.35%) had Stage II, and 11 eyes (19.64%) had Stage III ROP in Zone II. Aggressive ROP was seen in 8 eyes (14.28%) and stage 5 ROP in two eyes (0.59%). Male gender, GA, CHD, and RDS showed a statistically significant association with the development of ROP in these infants. CONCLUSION: ROP was seen in 16.66% of our subjects. Treatment was required in 6.25% of infants. Risk factors for the development of ROP were low gestational age, male gender, the presence of RDS, and congenital heart disease.

Development of a machine learning-based model for the prediction and progression of diabetic kidney disease: A single centred retrospective study

BackgroundDiabetic kidney disease (DKD) is a diabetic microvascular complication often characterized by an unpredictable progression. Hence, early detection and recognition of patients vulnerable to progression is crucial. ObjectiveTo develop a prediction model to identify the stages of DKD and the factors contributing to progression to each stage using machine learning. MethodologyA retrospective study was conducted in a South Indian tertiary care hospital and collected the details of patients diagnosed with DKD from January 2017 to January 2022. Bayesian optimization-based machine learning techniques such as classification and regression were employed. The model was developed with the help of an optimization framework that effectively balances classification, prediction accuracy, and explainability. ResultsOf the 311 patients diagnosed with DKD, 227 were selected for the study. A system for predicting DKD has been created for a patient dataset utilizing a variety of machine-learning approaches. The eXtreme gradient (XG) Boost method excelled, achieving 88.75% accuracy, 88.57% precision, 91.4% sensitivity,100% specificity, and 89.49% F1-score. An interpretable data-driven method highlights significant features for early DKD diagnosis. The best explainable prediction model uses the XG Boost classifier, revealing serum uric acid, urea, phosphorous, red blood cells, calcium, and absolute eosinophil count as the major predictors influencing the progression of DKD. In the case of regression models, the gradient boost regressor performed the best, with an R2 score of 0.97. ConclusionMachine learning algorithms can effectively predict the stages of DKD and thus help physicians in providing patients with personalized care at the right time.

Fasciotomy in Snake Bite Victims and Renal Outcome in a Tertiary Care Hospital

Background: Snake bite is a neglected tropical disease. More than 50% of death due to snake bite in the world occurs in India. Acute kidney injury (AKI) is the cause of morbidity and mortality in viper bite. The compartment syndrome is a rare manifestation of snake bite. There is paucity of data on the role of fasciotomy in viper bite.Methods: A prospective observational study was done in patients admitted to a tertiary care hospital in southIndia, with snake bite-associated acute kidney injury, from March 2018 to March 2020.Results: Sixteen % of patients underwent fasciotomy following snake bite. We compared the renal outcome of 21 patients, who had undergone fasciotomy following snake bite, with 65 patients with dialysis-requiring acute kidney injury following snake bite. The patients in the fasciotomy group had a lower peak serum creatinine (5.3 mg/dl), needed less number of dialysis sessions (3.9) and were on lesser number of days (6.1) on dialysis following snake bite, when compared with the group not needing fasciotomy.Conclusion: In snake bite patients presenting with compartment syndrome, fasciotomy should be considered in view of favourable renal outcome.

Mapping changes in the utilization of childhood immunization over 5 years in a south Indian tertiary care hospital

Background: Altered vaccine demands and uneven utilization patterns in childhood immunization are evident nationwide. These variabilities may stem from a range of internal and external factors influencing parental preferences. Regular checks and balances are necessary to ensure equal accessibility for all sections of society. Aim: To assess the usage trends of childhood vaccines for 5 years (2018–2022) and to monitor instances of delayed/incomplete immunization status within the community. Methodology: This study recorded the utilization trends of all recommended childhood vaccines over a 5-year period using an ambispective design. The immunization details from 3 years (2018, 2019 and 2020) were retrieved retrospectively, while those from 2 years (2021–2022) were collected prospectively through the immunization registry. Trends in childhood vaccine utilization were recorded across different years, and delays and incomplete vaccine utilization among children, along with factors resulting in deviated immunization timelines, were analysed and compared. The association of factors with deviated immunization utilization was determined using the chi-square test, and a two-way ANOVA analysed utilization variabilities over 5 years. Result: Overall, the study profiled 32,085 children’s (who utilized 87,782 vaccine doses) vaccine utilization pattern for 5 years. Optional vaccines were less utilized (18.12% doses by 25.14% children) compared to mandatory vaccines (81.88% doses utilized by 74.86%). The most utilized mandatory vaccine was oral polio (17.48%) and for optional vaccines, it was measles mumps rubella (MMR; 28.31%). Boys had the highest utilization (55.97%) with a significant male preponderance in optional vaccine utilization ( p value <0.05). Overall, there was a 26.12% decline (percent change) in vaccine utilization in 2022 compared to 2018. Among children with delayed immunization timelines (6.02%), 3.38% were on catch-up, and 2.45% were not. The most commonly delayed vaccines were diphtheria + tetanus + pertussis boosters (30.90%), Tdap (26.19%) and MMR vaccines (20.65%). Influenza vaccines (28.08%) were the most partially utilized optional vaccine, followed by varicella vaccines (20.92%). Factors such as gender (female), age over 1 year, rural residence and low- to middle-income families were significant predictors of deviated immunization status in children. Conclusion: The study mapped the utilization trends of immunizations at a tertiary care hospital in south India over the past 5 years, including the COVID-19 years. Gender inequality in the utilization of optional vaccines is a concern that warrants further research and redressal. Timely administration of childhood vaccinations is crucial for reducing susceptibility to vaccine-preventable diseases and promoting overall well-being.

Prevalence and Predictors of Adverse Events Associated With Dipeptidyl Peptidase-4 (DPP-4) Inhibitors in Type 2 Diabetic Patients: A Cross-sectional Study.

Dipeptidyl peptidase-4 (DPP-4) inhibitors are oral hypoglycemic agents widely prescribed in India despite safety concerns. However, studies focused on their safety profile are scarce, especially in South India. To evaluate the prevalence and predictors of adverse events (AEs) with DPP-4 inhibitors in patients with type 2 diabetes mellitus (T2DM). This retrospective cross-sectional study analyzed data from medical records of T2DM patients prescribed DPP-4 inhibitors admitted to the medicine department from 2019 to 2021 at a South Indian tertiary care hospital. The causality of AEs was assessed using the WHO-Uppsala Monitoring Centre (WHO-UMC) criteria and the Naranjo scale, and severity using the Modified Hartwig and Seigel scale. We applied a Generalized model with a binary response and logit-link function to understand the factors that best explain the AE. The best-fit models were chosen based on least Akaike's information criterion and highest PseudoR 2 and presented the odds ratio (OR) with a 95% confidence interval. The analyses were performed in R software version 4.2.1. Among the 796 patients included in the study, 26% experienced AEs. A total of 212 AEs were observed, and Saxagliptin-associated AEs were the most prevalent (66.6%). Hepatic AEs were predominant (37.7%), followed by gastrointestinal events (16.5%) and electrolyte imbalances (12.3%). Most AEs were possible based on WHO-UMC criteria (78.7%) and the Naranjo scale (86.7%), with 58% being of moderate severity and 42% mild. In the multivariate analysis, aspartate transaminase [OR: 1.013 (0.006-1.020)], alkaline phosphatase [OR: 1.004 (1.001-1.007)] and patients already on DPP-4 inhibitors [OR 1.191(1.012-1.366)] were significant predictors for AEs with DPP-4 inhibitors. The study highlighted a high prevalence of AEs with DPP-4 inhibitors and identified significant predictors of these AEs. These findings underscore the necessity of vigilant monitoring and risk assessment while prescribing DPP-4 inhibitors to the Indian population.

A Retrospective Study on Clinical Outcomes of Pregnancy-Related Acute Kidney Injury Patients at a South Indian Tertiary Care Hospital.

Introduction Acute kidney injury (AKI) significantly contributes to maternal morbidity and mortality in developing nations. In a retrospective study conducted at our tertiary care center in collaboration between the Department of Nephrology and the Department of Obstetrics and Gynecology, we investigated patients admitted with pregnancy-related acute kidney injury (PR-AKI) under the following parameters: incidence, etiology, and maternal outcomes. Methods We evaluated 70 patients admitted with PR-AKI from May 2016 to August 2020. A thorough evaluation was carried out for these patients. The results were analyzed for the association of mortality with the etiology of PR-AKI and the dialysis requirement. Results The mean age among the PR-AKI patients was 24.56 ± 4.2 years. During the study period, there were 33,403 deliveries, consisting of 20,126 vaginal deliveries, and 13,277 were performed via a lower segment cesarean section (LSCS). Seventy patients developed AKI, with an incidence of 2.9 per 1,000 deliveries. The various etiologies included sepsis in 54 cases (74.3%), preeclampsia/eclampsia in 44 (62.85%), LSCS in 27 (38.6%), abruptio placentae in 11 (15.7%), postpartum hemorrhage (PPH) in 11 (15.7%), post-abortion in eight (11.4%), and hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome in seven (10.46%). The number of patients in various stages of AKI was noted as one in Stage I, 22 in Stage II, and 47 in Stage III. The odds ratio of death in the abruptio placentae was 0.73 (95% CI: 0.08-6.72), whereasamong those with PPH, it was 1.96 (95% CI: 0.34-11.29). The odds ratio of death among patients with LSCS was 0.50 (95% CI: 0.09-2.64). Out of the total, 34 patients (48.6%) required renal replacement therapy (RRT) provided as intermittent hemodialysis. In total, there were eight deaths (11.3%). The odds ratio of death in dialysis patients was 1.89 (95% CI: 0.42-8.54). Perinatal mortality was 32.9%, whereas total perinatal mortality among all patients was 3.5%. The odds ratio of perinatal mortality among those with AKI was 13.29 (95% CI: 8.05-21.96) with p < 0.0001. Conclusion Our study demonstrates that sepsis was the most common cause of PR-AKI, which can be attributed to a lack of antenatal and postnatal care. Other causes included preeclampsia, LSCS, and hemorrhage. The present study also shows that a significant association exists between PR-AKI and perinatal mortality. The requirement of RRT in AKI predicts a less favorable prognosis.

A retrospective investigation of Candida spp. and its antifungal susceptibility profile in cancer patients at a South Indian tertiary care hospital

Among the most frequently recognized pathogenic fungi, . from Clinical samples plays a vital role. In recent decades, poor antifungal therapy usage critically in immunocompromised patients has led to antifungal drug resistance among . Hence, expeditious and dependable species identification is crucial for the effective implantation of treatment strategies and the management of diseases. The purpose of the study was to look at the presence of in various Clinical samples taken from cancer patients who are being treated at a tertiary care hospital in South India. The primary objective of this investigation is to ascertain the susceptibility patterns shown by antifungal drugs. This retrospective investigation was undertaken between January 2022 to April 2023. The isolates were subjected to antifungal susceptibility (AFST) by both Conventional (disc diffusion assay) and Automated methods (VITEK-2 compact - AST YSO1). The susceptibility pattern was recorded against antifungal agents like Fluconazole (FLU), Voriconazole (VOR), Amphotericin B (AMB), and Caspofungin. . was identified by conventional method (Chrome ID) as per standard laboratory protocols and by an automated method using MALDI – TOF. Among 215 samples received from cancer patients suggestive of Candidiasis, albicans (64.6%) was the predominant isolate, and the lowest one was (2.25%). Male patients had a higher prevalence of (55.8%). Similarly, the prevalence was higher in patients over 60, with male patients having an incidence of 38.3% and female patients having 23%. By disk diffusion assay and showed 100% sensitivity to all antifungals used in this study. We conclude that the disc diffusion assay is a more cost-effective, user-friendly, and effective screening test than the VITEK 2, and it has the potential to be used as a workable method for Antifungal susceptibility test. The use of Chrome ID for identification of . is cost-effective and reliable. However, MALDI TOF has the advantage of rapidity, providing correct findings promptly. The timely delivery of diagnostic reports facilitates early diagnosis of patients. Therefore, it is recommended in this research to use MALDI TOF for the identification of . and the disc diffusion technique for antifungal susceptibility testing (AFST).

Utilization of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 scale for evaluation of quality of life among cancer patients treated with chemotherapy: A hospital-based observational study.

In this new era of cancer management, the quality of life (QOL) is given more importance than the quantity of life. QOL evaluation studies are widely used in oncology to assess the patient's performance in different cancer types and treatment modalities. To evaluate cancer patients' QOL after various chemotherapy cycles. An observational study was performed on cancer patients receiving chemotherapy in the daycare setting of a South Indian Tertiary Care Hospital for 6 months. European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) questionnaire was employed to study the QOL. Precisely, 102 patients participated in the study, out of which the majority were in the 51 to 60 age group (24%). Female participants (65%) were more. Functional scale domains especially physical ability (P = 0.004), role (P = 0.033), and emotional functioning (P = 0.01) were significantly decreased in patients treated with 4 to 6 chemotherapy cycles. Cognitive ability (P = 0.043) significantly improved in patients treated with more than 6 chemotherapy cycles. Dyspnea (P = 0.036) was significantly increased in patients treated with 4 to 6 chemotherapy cycles and decreased significantly with the further addition of chemotherapy cycles. Dyspnea is a commonly observed symptom among cancer patients and is often neglected by physicians. Chronic dyspnea can negatively impact a patient's functional ability. Cancer symptoms such as dyspnea should also be given priority and need appropriate treatment. Based on the findings, further interventions can be made to improve the functional ability of cancer patients. Also, studies can be conducted to correlate with cancer rehabilitation programs to improve functional ability and complete the entire chemotherapy cycle.

Clinical pharmacist-initiated assessment and amelioration of appropriate antibiotic use in surgical units at a South Indian tertiary care hospital - A handshake approach

Studies on the appropriateness of antibiotic use among surgical patients are limited in developing countries, notably in India. Therefore, we aimed to evaluate the inappropriateness of antibiotic use, demonstrate the impact of clinical pharmacist interventions and determine the predictors of inappropriate use of antibiotics in the surgical units of a South Indian tertiary care hospital. This was a 1-year prospective interventional study on in-patients of the surgical wards to determine the appropriateness of the prescribed antibiotics by reviewing medical records using available antimicrobial susceptibility test reports and medical evidence. When inappropriateness in antibiotic prescriptions was identified, the clinical pharmacist discussed and conveyed apt suggestions to the Surgeon. Bivariate logistic regression analysis was applied to evaluate its predictors. Among the 660 antibiotic prescriptions of 614 patients that were followed and reviewed, about 64% were inappropriate. Most inappropriate prescriptions were witnessed in the cases that involved the gastrointestinal system (28.03%). Among the inappropriate cases, 35.29% were attributed to an excessive regimen of antibiotic use which marked the highest. Based on the category of use, most of the antibiotics were used inappropriately as prophylaxis (76.7%) followed by empirical (71.31%). The increase in the percentage of the appropriate use of antibiotics resulting from pharmacist intervention was 95.06%. There was a significant link between inappropriate antibiotic use and the presence of two or three comorbid conditions, the use of two antibiotics, and length of hospital stay of 6-10 days and 16-20 days (p < 0.05). An antibiotic stewardship program in which the Clinical pharmacist is an integral part along with well-framed institutional antibiotic guidelines must be implemented to assure appropriate antibiotic use.

Knowledge, attitude, and practices toward pharmacovigilance among undergraduate medical students in a South Indian tertiary care hospital

Background: The adequate knowledge, attitude, and practice (KAP) of pharmacovigilance and adverse drug reactions (ADRs) reporting is essential for undergraduate medical students. Aims and Objectives: The study aimed to analyze KAPs toward pharmacovigilance among undergraduate medical students in a South Indian Tertiary Care Hospital. Materials and Methods: This cross-sectional, KAP questionnaire-based study was conducted among Phase II onward undergraduate medical students. Phase I students were excluded because pharmacovigilance is included in the Phase II curriculum and clinical postings are not part of the Phase I curriculum. The KAP questionnaire was designed to assess participants’ knowledge of pharmacovigilance, attitudes toward pharmacovigilance, and ADR reporting practices. Responses were analyzed question-by-question, and percentages were calculated using Microsoft Excel software. Results: This study found that undergraduate medical students had an average knowledge score of 66.64% on pharmacovigilance. In addition, 91.18% of students agreed that reporting ADRs is necessary, 86.76% believe that reporting ADRs should be compulsory for all health-care professionals, and 92.65% of students are willing to implement ADR reporting in their practice. However, only 15.44% of students have reported an ADR during their clinical postings, and only 33.82% of students have been trained on ADR reporting. Conclusion: This study found that undergraduate medical students have a good knowledge and a positive attitude towards pharmacovigilance but lack practice in reporting ADRs. Pharmacovigilance aims to ensure patient safety and the rational use of medicines.

Autologous stem cell transplant in pediatric oncology: Insights from a South Indian tertiary care hospital

Autologous stem cell transplant in pediatric oncology: Insights from a South Indian tertiary care hospital

Correlation of mineral status with levels of blood pressure in essential hypertension among patients attending a tertiary care hospital in South-India

Correlation of mineral status with levels of blood pressure in essential hypertension among patients attending a tertiary care hospital in South-India

Investigating the Quality of Life of Retinoblastoma Survivors: An Initial Exploration

Background: The purpose of this study was to assess the viability of using the quality-of-life questionnaire and structured interview in South Indian tertiary eye care hospital survivors, age-matched controls, and their parents.

Clinicopathological and Microbiological Profile of Patients with Chronic Diarrhoea and Malabsorption with Special Emphasis on Duodenal Biopsies: A Study from Tertiarycare Hospital in South India

Background: Chronic diarrhoea and malabsorption continue to be a major health problem worldwide. Due to conflicting reports regarding the clinicohistological spectrum of malabsorption, this study was conducted to study the spectrum of malabsorption.&#x0D; Objective: To study the morphologic spectrum of duodenal biopsies and stool microbiological profile in patients with chronic diarrhoea and malabsorption.&#x0D; Materials and Methods: The study included 106 patients aged above 18 years, presenting with chronic diarrhoea or malabsorption. Duodenal mucosal biopsy obtained was evaluated for villous atrophy, crypt architecture and Intraepithelial lymphocyte count (IEL) by H&amp;E and immunohistochemistry for CD3. Stool samples collected were subjected to wet mount and culture examination. Serological testing for antibodies to coeliac sprue were also performed.&#x0D; Results: This descriptive study included 57 males and 49 females. Duodenal biopsy spectrum consisted of chronic duodenitis (48), duodenitis associated with autoimmune conditions (20), histomorphology of coeliac sprue (5), duodenitis with villous atrophy (14), only increased IEL (11) and miscellaneous (8). CD3 stained sections (n=90) offer a slightly better advantage over H &amp; E-stained sections in detecting IEL. Stool microscopy and culture were positive in 6 cases. Coeliac sprue antibodies were positive in 1 case with Marsh type 1 lesion.&#x0D; Conclusion: Duodenal biopsy is a useful parameter in the study of malabsorption which must be adjuncted by microbiological and serological tests. Coeliac sprue is a rare entity in our population as per this study.&#x0D; Key words: Chronic diarrhoea, Malabsorption, Duodenal biopsy, Serological testing

Group B Streptococcal Colonization among Pregnant Women and Neonates in a Tertiary Care Hospital in South India.

ObjectivesTo assess the prevalence of maternal and neonatal group B Streptococcal colonization, incidence of neonatal systemic illness, and antibiotic sensitivity of isolates.MethodsThis prospective cohort study was conducted in a South Indian tertiary care hospital. Rectovaginal swabs from pregnant mothers at 360/7–376/7 wk gestation and throat and rectal swabs from their neonates at 48 h of age were collected. Presence of group B Streptococcus (GBS) was identified by broth enrichment step, and traditional microbiologic methods and antibiotic sensitivity of isolates was noted. All mothers received intrapartum antibiotic prophylaxis (IAP). Culture-positive sepsis, clinical sepsis, pneumonia, meningitis, and urinary tract infection were defined as neonatal systemic illness. Neonates of colonized mothers were followed at 3 mo for late-onset sepsis.ResultsOf the 310 mothers, 40 were GBS colonized (prevalence: 12.9%; 95% CI 9.2%, 17.6%). None of the neonates were colonized. Maternal GBS colonization was significantly associated with premature rupture of membrane (RR - 2.93, 95% CI - 1.66–5.16) and neonatal systemic illness (RR - 2.78, 95% CI - 1.39–5.54). Positive correlation was noted between duration of IAP ≤ 4 h and neonatal illness and between maternal GBS colonization and Apgar at 1 min ≤ 4. Clindamycin resistance was noted in 20%. All neonates remained well at 3 mo follow-up.ConclusionHigh maternal colonization alerts the need for GBS screening in India. Clindamycin resistance among GBS isolates questions its effectiveness as alternative therapy in penicillin allergy.

Do Indian physicians heal themselves? An online cross-sectional survey of health access behaviour of doctors at a tertiary-care hospital in South India

BackgroundThe conflict of a doctor presenting as a patient is very much perceived in healthcare profession. Often overlooked, the well-being of physicians is an essential prerequisite to the health services they provide to their patients. Hence we aimed to assess the healthcare access behaviours of doctors of Saveetha Medical College and Hospital, Chennai, India and analyse barriers experienced by them in accessing healthcare. MethodsAfter obtaining Institutional ethical clearance, all consenting doctors were administered a structured, validated questionnaire via WhatsApp and SMS. Means and proportions were calculated and Pearson's Chi-square test of significance was used to identify association among variables. ResultsPoor health-access behaviour was observed among majority of the 111 doctors who participated in the study. Familial involvement in healthcare was reported with 65% allowing their family to intervene in their health matters and 78.5% seeking consultation from their medically-qualified relatives. Younger (p = 0.026) and less experienced doctors (p = 0.18) were significantly more satisfied with self-treatment with no need felt for a primary care physician. Majority (75.7%) of doctors were inclined to informally consult for their personal medical conditions before seeking formal care. The respondents who weren't taking prescription medicines had significantly (p = 0.01) positive attitudes towards healthcare access. The major barriers in healthcare access were preference for informal consultations; worry about imposition on other busy doctors, pressure to stay healthy and long duty hours. ConclusionIndian doctors identified significant barriers in healthcare access. Strategies directed at enhancing doctors’ healthcare access should focus on tackling their professional culture of self-reliance.

Toxicity profile, adverse drug reactions and drug-drug interactions among geriatric cancer patients under metronomic chemotherapy in a South Indian tertiary care hospital.

The study aims to examine the toxicity profile, pattern of adverse drug reactions (ADRs) and drug-drug interactions (DDIs) in geriatric cancer patients receiving metronomic chemotherapy. Patients were followed after each cycle till 12 weeks. Haematological parameters such as complete blood count, liver function test and renal function test were recorded from the baseline to the final visit. The Common Terminology Criteria for Adverse Events (CTCAE) scale was used to characterise the toxicity profile. ADRs that the patients had were documented and assessed for its causality, severity and preventability. The Lexicomp drug interaction checker was used to grade DDIs. Of 129 patients, according to CTCAE grading, haemoglobin indicated grade 1 toxicity, while other haematological parameters revealed no toxicity. Although there was a statistically significant difference in ALT, alkaline phosphate, serum creatinine and potassium (p < 0.05), it was not clinically significant. A total of 226 ADRs were documented. Anaemia was the most frequently occurred ADR (14%) and Capecitabine caused the highest number of ADRs. Assessments of causality showed that the majority of cases are "possible" (63%). In evaluating the severity of ADRs, 99% ADRs were "mild" and 61% of ADRs were "probably" preventable. Upon assessing the DDIs, 82% of the prescriptions had "no known interaction". Metronomic chemotherapy in geriatric cancer patients exhibited grade 1 toxicity for haemoglobin. Anemia was the most common ADRs. The majority of cases were "possible" in causality, "mild" in severity, and "probably" preventable. The majority of the prescriptions have no known DDIs.

A Cross-sectional Study on the Development of Diabetic Cardiovascular Complications in Type 2 Diabetes Mellitus in a South Indian Tertiary Care Hospital

Background: Diabetic cardiovascular complication is a familiar macrovascular complication of Type 2 Diabetes mellitus (T2DM). Cardiovascular disease (CVD) is the major cause of morbidity and mortality for people with diabetes.&#x0D; Objective: The aim of this study was to evaluate the parameters related to diabetic cardiovascular complication in patients with T2DM.&#x0D; Methodology: This study was conducted on 530 subjects (171 with or 359 without diabetic cardiovascular complication). Prevalence of diabetic cardiovascular complication was measured, risk factors for diabetic cardiovascular complications, and drug utilization pattern was assessed.&#x0D; Results: Cardiovascular complication was significantly higher in the subjects who are poorly educated, nature of work (house wives) and risk factors were pre-existing conditions (Hypertension, Cardiac, endocrine and other diseases), habit of smoking (past smoker), tea/coffee (twice without sugar), poor glycemic control, elevated triglyceride levels, elevated creatinine levels, duration of diabetes (5-10 years; &gt;10 years).&#x0D; Conclusion: Combination of Glimepiride and Metformin (35.10%), Metformin (34.04%), combination of insulin isophane and insulin regular (23.40%), Insulin Regular (11.70%) were the anti-diabetic drugs widely prescribed to the T2DM patients with cardiovascular complications. Significant risk factors for development of diabetic cardiovascular complication were multiple.